It rapidly spread to health insurance industry in private sector. It relies upon and effort to control ever increasing health care costs by health insurance industry, which fixes a reasonable fee. Health care provides charge for their services. Thanks to managed care facilities provided by health insurance industry, medical inflation rate decreased drastically in 1990's in U.S. But right now the effect looks like it has ended abruptly and U.S. medical inflation is beginning to rise steeply. Psychotherapy in its traditional form is being challenged due to managed care pressures.
Managed care is not needful for psychiatric patients as it creates many hindrances to the consumer in the early steps of treatment. Managed care makes the psychotherapy sessions completely transparent, when it is supposed to be undisclosed.
There are pros and cons. Managed care in psychotherapy is significantly a bane to the consumers. Psychotherapy always requires long number of sessions but due to pressure from insurance companies, psychotherapists reduce the number of sessions. It is the indirect supervision of the financial management of a consumer's medical care performed by the ultimate reimbursement entity, commonly known as the payer.' Payers use utilization review'-a medical professional oversees the treating physician's decisions to determine if the most financially efficient method is being used. In the optimistic view, managed care offers coordinated, integrated systems of care that emphasize prevention and cost restraints. But actually managed care leads to limited access, lack of choice and, sometimes, limitation of care. O'Hara, M. (1997) reports:
Nowhere are the concrete consequences of the rising levels of cultural incoherence more visible than within the community of psychotherapists. Therapeutic psychology and its spin-offs, clinical social work, marriage and family therapy, psychiatric nursing, and organizational behavior, are disintegrating as academic disciplines and as fields of professional practice. The field of psychology and the individuals who inhabit it are in the midst of theoretical, epistemological, methodological, and ethical meltdown. Pluralism in graduate school training, discussions about licensing and credentialing, variations in clinical theory and practice, debates about the status of psychological knowledge as science and as evidence in courts of law, shifting definitions of ethical and unethical behavior, and proliferation of antitherapist consumer protection laws are just some of the ways the postmodern crisis is already affecting the field. And it will get worse.
Psychotherapists get into prescription business and provide pills. They are likely to have very less interaction with consumer and hinder the normal process of psychotherapy. Managed care minimizes the professional secrecy. As primary care physician refers the consumer to a specialist psychotherapist.
Managed care programs that are commonly used are, as listed by Kuhl, V. (1994):
Health Maintenance organization (HMO): In this a federally qualified HMO in exchange for a subscriber fee (Premium) allows members to access to a panel of employed physicians and facilities, including hospitals. In return HMO receives mandated market access and receives federal development funds. In HMO plan, a member is assigned a "Gatekeeper", a primary care physician (PCP) who takes care of members assigned to him. To avail specialty services like a specialist