Genuine managed care in psychiatry

The rise of managed care and concurrent utilization review has had a profound impact on the practice of inpatient psychiatry. Little has been written, however, on the clinical impact of the review process itself. The actions of insurance reviewers often result in their being incorporated into the psychopathology of individual patients and into the dynamics of families and institutional settings. The authors apply psychodynamic understanding to a series of case examples to illustrate how concurrent review may promote splitting, impede the patient's ability to separate from the hospital, and paradoxically reinforce the patient's illness. They also explore a number of typical responses of treatment staff and families to the review process. A case vignette demonstrating a sincere effort at mutual collaboration between payers and providers is also presented. This spirit of compromise is proposed as the solution that best serves patient care.

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Genuine managed care in psychiatry

Cited by 6 publications

References 13 publications

Social and Legal Implications of Managed Care in Psychiatry

Social and Legal Implications of Managed Care in Psychiatry

Rethinking patient placement: The human service matrix model for matching services to needs

A psychodynamic perspective on the clinical impact of insurance review

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