No abstract

No abstract

The Benefits and Drawbacks of Managed CareThe threatofmanaged care to traditionalmedical practice blinds many clinicians to larger economic and historic forces. Big dollars flowing out of government and insurance companies for health care services have hit critical mass, exploding into managed care.Triggered by both employer and employee needs for affordable health care, managed care meets priority needs. For national corpora tions, it offers service from national suppliers. For employers, it allows control ofmental health and chemical dependency costs, which are es calating at twice the high medical inflation rate. For employees, it means care at good prices via contracts that spread risk, obtain discount hospi tal beds and medicines, and manage clinician behavior. Furthermore, with its vast data base and competitive pressure, man aged care contributes strongly to outcome research. Some procedures, forced by economic necessity, turn out to be better medicine. Multidis ciplinary teams in staff-model health maintenance organizations provide community-mental-health-type services with high staff and patient satis faction.On the other hand, there are dangers in assembling mega-systems run by business. Components of care are being divided up for business rca sons. The result is fragmentation of care due to communication barriers between clinicians and instability in relationships due to yearly renego tiation of contracts. The managed care bureaucracy must maintain a corn plex of utilization review, quality assurance, and productivity monitor ing systems that add up to a lot ofoverhead for each service dollar.U.S. industry has a poor record ofprotecting data bases containing personal information. A story was told recently about an HMO that refused to release confidential information to an employer looking for â€oe¿ losers and boozers.―The employer pulled the contract and sought a more pliable provider.There is a quality lesson from public mental health. While psychia trists were prominent in its early development, cost pressure forced higher-paid practitioners out of clinical and administrative positions. That's occurring already in â€oe¿ big-business― psychiatry, with predictable deterioration in clinical sophistication. Reducing clinicians to bureaucratic service workers degrades the system. Some predictions: Salaried clinicians in managed care settings will unionize to maintain a balance ofpower. Managed care is here to stay and will grow. Some recommendations: The growing managed care sec tor is a utility; regulatory boards must be more clinically effective. Clini cal training needs to teach business and administrative survival so that clinicians can wield appropriate power in systems. Professional societies should help members deal with managed care through educational pro grams and advocacy.â€"SANFO1w R. WEIMER, M.D., M.P.H., health plan medical director, MCC ofCal:fornia, Los Angeles Hospital and Community Psychiatry, established in 1950 by Daniel Blain, M.D., is published monthly by the American Psychiatric...

"Witchcraft illness" is a widespread belief among many people, even after acculturation to technological concepts of illness etiology. Two cases are presented to show that such beliefs can complicate physical or psychological dysfunctions, or themselves can be the primary origin of physical or psychological dysfunctions. In both instances, witchcraft beliefs take on a dynamic of their own and must be resolved both in terms of the patient's culture as well as the clinician's treatment plan. Considering such phenomena from the vantage point of family systems provides useful insights into etiology as well as amelioration. The latter requires engaging all parties in the health care system-clinician, patient, family, and indigenous health caretakers.