DETRE AND McDonald1 provide a clear and incisive explanation for the current effect of managed care on psychiatry. We are under siege. Either by design or default, market forces are being used to ration medical care and reduce costs in the United States. Market forces, embodied by forprofit managed care imperatives, give primary care clinicians a competitive edge over higher-cost specialists. Nonmedical mental health professionals compete aggressively for patients in an unbridled marketplace. In the absence of good outcome or cost-effectiveness data, those clinicians or systems that can promise good enough care at the lowest cost thrive—highly specialized systems or practitioners who focus exclusively on quality suffer. This is different in various parts of the country, with the marketplace being most ferocious in California, Minnesota, Massachusetts, Maryland, and more recently in New York.
See also pages 201 and 206
Detre and McDonald propose a solution to this crisis