The introduction of the concept of managed care into mental and physical
health care appears to be a juggernaut of unparalleled impact. The two
extremes of thought about this impact are (I) that managed care is a
villainous foe to be resisted in order to bring back the earlier halcyon
years of independence in practice decisions with greater reimbursement
for psychologists' services or (2) that managed care is a laudatory
attempt to restrain health care costs that are out of control and
spiraling upward by rooting out mismanagement and reversing financial
incentives to provide unnecessary care. The former view calls managed
health care such names as "mangled care" and distributes bumper stickers
stating "Just Say No to HMOs. " The latter view points to the slowdown
of increases in health care expenditures and the enhancement of health
care affordability and appropriateness for greater numbers of persons
resulting from managed care cost-containment strategies and service
review procedures. Mental or behavioral health care has been as strongly
impacted as medical care under managed care. Where managed care has
forced practitioners' attention to validated procedures and to examining
previous wasteful practices, we ap- plaud the movement. Where managed
care has had adverse impact, we think there needs to be greater public,
legal, and regulatory attention to its excesses and abuses.