Managed mental health care: A history of the federal policy initiative.

Abstract

The true beginning of the modern concept of managed health care is somewhat obscure. There are events in the early 1900s that could lead one to agree to a date like 1904 or 1906. With the Ross-Loos Clinic becoming operational in 1929, that year has a good claim. The Depression-era efforts of Kaiser Permanente became fully recognized in 1945, so that date stands out. The passage of the federal Health Maintenance Organization Act in 1973 can be viewed as a central date as well.The lumbering and mining industries operating in the Pacific Northwest in the early 1900s provided the site of a n early prepayment plan-that is, the provision of a set package of health care services by a n identified provider for a preestablished fee. The Western Clinic, a fee-for-service partnership in Tacoma, Washington, is reported to be one of the first prepaid group practices. In 1906, two physicians contracted to provide medical care for lumber employees for 5 0 ~ per individual per month. Physicians in private practice in Tacoma, in opposition to the prepaid concept, organized the Pierce County Medical Service Bureau and attempted to limit competition and became a predecessor of county medical societies (Bennett, 1988;Flinn, McMahon, & Collins, 1987).The combination of prepayment schemes with group practice arrangements began in the 1920s. In the rnid-l920s, a prepaid system for farmers in cooperatives in rural Oklahoma was initiated. In 1929, the Ross-Loos Medical Group contracted with the employees of the Los Angeles County Department of Water and Power and their families for a consumer-controlled comprehensive health care program.The Kaiser Permanente Health Plan is another forerunner to the modern health maintenance organization (HMO). The Kaiser Permanente version of managed health care was born in the Mojave Desert of California during the

The psychotherapy dose-response effect and its implications for treatment delivery services.

“…In this day of accountability and managed health care, the need for clinical research to reach and affect policy makers becomes especially important. For example, concerns have been raised by DeLeon, Vandenbos, and Bulatao (1991) about the current practices of managed health care organizations. These concerns included (1) services are limited as a result of a physician gate-keeping process; (2) unrealistic limits are enforced on the number of sessions provided and/or the amount of money available for service; (3) the quality and appropriateness of provided mental health service may be inadequate; (4) consumers of mental health services are not provided full information about the services available and, in fact, are usually given positive information while negative aspects of services are withheld; and (5) utilization review is often carried out by unlicensed individuals with little training in mental health issues.…”

Practicing psychology in the era of managed care: Implications for practice and training.

“…Rep. No. 95-837, 1978) encouraged the growth of HMOs through a series of financial and administrative incentives (DeLeon et al, 1991). Managed care systems increased in numbers as a result.…”

1998-1999 award winners.

“…In the past decade, four forces started to affect mental health practice. First, the most obvious influence was the emergence of managed health care (DeLeon, VandenBos, & Bulatao, 1991;Government Accounting Office, 1993). A major effect of managed care was the direct attack on the clinicians' autonomy or ability to decide what care a client should receive.…”