Ten Dimensions of Public-Sector Managed Care

Abstract

Managed care in the public sector remains a poorly defined concept. It is currently understood largely through case examples, an approach of limited usefulness because each managed care initiative is shaped by local forces and is constantly changing. The authors describe ten key dimensions on which such initiatives vary and suggest that they can be used to examine essential characteristics of the initiatives and core differences between them. The dimensions are objectives, scope, organizational structures and authority, enrollment, benefit package, strategies for managing utilization, best practices, financing, quality management and outcomes measurement, and the impact of the initiative on the public mental health system. Using these dimensions to assess existing initiatives, the authors conclude that most focus on one principal dimension to the exclusion of other critical dimensions. The authors argue for a comprehensive approach to planning and implementing managed care projects that should ultimately lead to better care for public-sector populations.

The Last Half-Century of Psychiatric Services as Reflected in Psychiatric Services

“…In 1990 Dorwart (332) discussed myths about managed mental health care, including that managed care caused, and that managed care would cure, the current problems of mental health care. Throughout the 1990s managed mental health care rolled itself out, first on the private side and then on the public (333)(334)(335)(336)(337)(338)(339)(340)(341)(342)(343)(344)(345)(346)(347)(348)(349)(350).…”

Putting Social Work Values into Action

“…In truth, managed care takes on so many forms that, similar to the term case management, it has become difficult to define. Hoge, Jacobs, Thakur, and Griffith (1999) perhaps summed up this issue best when they noted that "if you've seen one managed care program, you've seen one managed care program" (p. 51). The inability or unwillingness to define managed care adds to the emotionality of the debate and results in the substitution of personal experience for objective analysis in evaluating the merits of this health care delivery model (Bachrach, 1995).…”