Managed Care and Psychotherapy - Essay Example

Managed care and Psychotherapy Managed care is a concept in U.S. health care which was introduced during presidency of Mr. Ronald Reagan. Itgained much popularity and importance during his period. Managed Care is a method of health care Coverage provided by health maintenance organization. It streamlines health services and creates a health care system that provides financial assistance and delivery of services to the consumer. (Utilization of Psychiatry and Psychiatric Specialists in Managed Care Systems, 1997). This system was a mean to control Medicare payments. 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 psychotherapist requires a specific referral from PCP to the specialist. consumer is free to choose his/her own physician, but greater benefits returns are more if consumer utilizes given 'network' caregivers. "Network" care givers and facilities are independent of insurance company. Preferred PPO's is a better service than HMO in psychotherapies as it gives more privacy to the consumer. Point of service: POS managed care plans allow members the choice of using providers outside or within approved network. The flaws of managed care in psychotherapy can be explained in every step of treatment. The American Heritage Dictionary of the English Language (2000) defines psychotherapy as, "the treatment of mental and emotional disorders through the use of psychological techniques designed to encourage communication of conflicts and insight into problems, with the goal being relief of symptoms, changes in behavior leading to improved social and vocational functioning, and personality growth." It is also known as an understanding of the behaviors and feelings of an individual people who undertake psychotherapy and it also a treatment in which a client engage in interactional relationship that promotes positive behavioral changes, enhances insight, and utilizes optimal functioning. Mental health problems have psychological, social, emotional and somatic problems accompanied. These problems make it impossible for people to manage their lives in which additional burden get in the family and the stigmata of the community. The term counseling is often used interchangeably with psychotherapy. The American Heritage Dictionary of the English Language (2000) defines counseling as "the act of exchanging opinions and ideas; consultation Counseling occasionally needs long sessions and managed care provided by insurance companies try to make the sessions cost effective and responsible for improper shorter therapy. They increase corporate profits by strictly rationing therapy. Insurers usually decide how long therapy will continue by controlling therapists working for insurance, or managed care company. In a managed care plan cost effective mental health care decides the treatment of a client with psychiatric symptoms, they are evaluated by psychiatrists to group them in different categories and to prevent feigning in general. Common categories based upon the cause of psychiatric symptoms are reported by Kuhl, V. (1994): 1. Symptoms that appear to be caused by psychiatric disorder could in reality a result of underlying illness. E.g: Hyperthyroidism causes anxiety attacks. 2. Serious symptoms can be caused by drugs prescribed for treatment of medical condition, over the counter medications, illicit drugs, drug toxicity. In a managed care plan a consumer with symptoms of psychiatric origin will be liable to enter into: 1. Integrated Health care plan(in this plan evaluation is done by Primary care physician, internist, nurses or any other specialist) 2. Carve-Out psychiatric plan (evaluation done by psychologist, psychiatric social workers, marriage and family counselors) The problem with managed care plan is the consumer is referred to a specialist psychiatrist only after complications arise and sometimes it is worst. It may increase the illness as well as vulnerability to disease and at the same timeit has implications on consumer and his family to go into therapy and it makes a highly additional cost for the family. Psychotherapy is a treatment approach based on listening skills which draw out the subject from clients rather than confronting or provoking them. Insurance companies pressurize therapists working for them to decrease number of sessions which indefinitely affects the treatment through psychotherapy. This leads to therapists relying more on pharmacological pills. Therapists care would also reflect in the client's ability to promote his/her personality and ease the level of anxiety thus it shorten some factors that hinder the capability of a person to prone in any illnesses. The use of pharmacological pills may begin to use by the therapists and yet some therapy will be delayed and sometimes it leads to some reactions that the patient begin to suffer into some stress and systemic reactions. That's why any psychiatric pills required prescription rather than over-the-counter and should be prescribed by the licensed psychiatric physicians. Managed care fails to inform consumers of treatment alternatives outside the plan. This failure to inform serves the purposes of the managed care company because patients who do not know other treatment is possible, are more likely to report satisfaction with the managed care treatment. Unfortunately, this failure to inform also undermines the consumer's control, because the patient loses the choice to self-pay for the preferred treatment. Medication is frequently presented as complete treatment. In fact, psychotherapy, (either, instead of, or in combination with medication), is a better treatment than medications alone. The complete treatment provides faster relief to the patient from suffering illnesses and prevent from relapsing. Patients who are sent to psychotherapy are usually told that ultra brief therapy is the treatment of choice, and if they don't improve, they are told that there are no realistic alternatives. The reality is that longer-term psychotherapy can be a more effective treatment for many presenting problems. Many people find it so helpful that they opt to self-pay for longer-term, depth psychotherapy. Therapists are expected and usually legally bound to respect client privacy and client confidentiality. The scenario completely changes as insurance corporations need the whole data and the 'gatekeeper' (Primary care physician) also is compelled to get the whole information about client which can be sensitive and confidential. There are mainly six main systems of psychotherapy: Psychodynamic Psychotherapy, Cognitive Psychotherapy, Humanistic/Supportive Psychotherapy, Behavioral Psychotherapy, Brief Psychotherapy, and Systemic Therapy (Family therapy and marriage counseling. (Bohart, A.; O'Hara, M.; Leitner, L. et al., 1997.) In all the above therapies cognitive behavioral therapy is particularly common mode of Psychotherapy. Here treatment id dictated by insurance companies who want financially limited commitment. The importance of this psychotherapy will be enabling to help the client to lessen the financial burden as well as the way to achieve the optimum level of functioning of the patient. It will lead also in a good interpersonal relationship between the therapist and the patient. The symptoms of anxiety will be lessening as this therapy makes it possible. This therapy includes changing a person's distorted thinking and short structured therapy. Short structured therapy may not be fruitful in treating the underlying psychosis. This is preferred method of treatment for depression, substance abuse, anxiety disorders, eating disorders, insomnia and phobias. The used of short structured therapy may need limit setting but, need more close supervision to the method of treatment such as depression and eating disorders in a way that this disorder may lead to fatal if this patient will be ignored. Kuhl, V. (1994) reports "Within a managed care plan a consumer with symptoms that may be of psychiatric origin will enter integrated health care plan or carved out psychiatric plan. In carved out psychiatric plan consumers are treated by psychologists, psychiatric social workers, marriage and family counselors etc. They necessarily need not be qualified psychiatric practitioners. This again is a flaw in managed care plan." The above mentioned will be identified the risk of a person prone to any psychological disturbances that's why it is required to all individual to undergone any psychological test as well as the importance of counseling that may need more options to the clients. Some people might think that it is not important to get any counseling to a psychiatric as they feel that they are well comfortable and physically fit but, mentally are not. The problem which they will be getting was being irresponsible parenthood, battered wife syndrome, child abuse, and neglect the capability of a child to grow up. The primary care providers necessarily are to refer the consumer to a specialist if any complication arises but, due to dictatorship by insurance companies they fail to do so.. The standard of knowledge and skill of primary care provider are doubtful.A failure to fulfill the needs of consumer can be considered as NEGLIGENCE. Many patients require concomitant psychotherapy and psychotropic treatment. Due to short sessions, psychotherapy may be sidelined and psychotropic treatment becomes the mainstream treatment. "Health care ethics require that professionals publicly report potential harm from a treatment, attempt to evaluate possible harm, and consider possible risks along with potential benefits when making treatment decisions. Managed care, on the other hand, usually reports only those statistics that show the benefits of managed care and does not adequately examine the potential harm to patients," as reported by Kuhl, V. (1994). Other management have the policies to conduct in taking treatment to a patient some may required consent prior to any procedure for the evident of legal document but, the psychotherapy is not an invasive procedure but, ethically side it may need privacy and confidentiality. Kuhl, V. (1994) states, "When managed care considers cost effectiveness, it often does so only on the basis of cost to insurance, not the costs to the patients or their families. For example, when ultra brief therapy is used for the treatment of depression, fewer patients will recover. The many patients who don't recover will suffer damages through missing work, losing a job, a divorce, inadequate parenting of their children, or suicide. Their families also may need to take time from work and be less productive. Both the patient and their family will suffer emotionally. However, when reports about managed care cost-effectiveness decisions are revealed, these reports do not consider these important costs to the patients and their families." Psychotropic treatment has its own adverse effects compared to psychotherapy. Pills are prescribed even when psychotherapy can cure the illness. The fallouts of managed care plan are few but are of grevious nature. Many reasonable people are justifiably concerned about revealing personal information in therapy. This becomes a part of their permanent medical insurance and employment data. Effective psychotherapy cannot be functional without privacy of an individual. The therapist is forced to submit frequent progress reports and share case sheets about clients. This is a breach in therapist / client relationship. If the treatment is completed the evaluation of the patient will be reported to the relatives of the patient if have improvement or not and it must be secure by the property of the institution provided that it is legal documents and true testament. Managed care plan should include and make provision for out patient individual psychotherapy. By doing so in short term treatment, will avoid costly emergencies in long term, unnecessary medical visits and hypochondriacs and superfluous hospitalization. Majority of people, who want privacy assured and controlled, pay their own expenses in receiving psychotherapy. Legislation should be made in managed care plan psychotherapy, where in the consumers total privacy is reserved. All the clients seeking psychotherapy shouldbe treated according to integrated health care plan. Each consumer should b e given optimum time and insurance sector should stop interfering with therapist/client relation. Understanding between therapist/client can be improved by decreasing demands of insurance companies. Unconditional regard, genuineness, and empathic understanding should be encouraged among therapists. This can be done by cutting the restrictions imparted by insurance sector. In some managed care settings, psychotherapy has been taken away as a reimbursable treatment performed by psychiatrists. In others, reduced reimbursement for psychotherapy and increased demand for paperwork has created powerful disincentives for psychiatrists to provide psychotherapy services. To the extent that psychotherapy is recognized as medically necessary by managed care, it has been drastically reduced in length and depth. An additional problem created by this managed care climate is that psychiatric residents are finding it increasingly difficult to receive adequate training in psychotherapy. This has long range implications for the quality of psychotherapy treatment and supervision of other mental health care providers by psychiatrists. If these trends continue, psychiatric practice can become primarily triage, consultation, medication management, and team management. Individual and group therapy will no longer be within the psychiatrist's job description or expertise. References Bohart, A.; O'Hara, M.; Leitner, L. et al. (1997). Task Force for the Development of Guidelines for the Provision of Humanistic Psychosocial Services. Guidelines for the provision of humanistic psychosocial services. The Humanistic Psychologist 25(1) 64-107 California Psychiatric Association Documents: Utilization of Psychiatry and Psychiatric Specialists in Managed Care Systems (1997). CPA Managed Care Task Force. Retrieved June 7, 2006, from http://www.calpsych.org/publications/handbooks/caresystemsapp3.html Haber, S.; Rodino, E.; and Lipner, I. (2001). Saying Goodbye to Managed Care: Building an Independent Psychotherapy Practice. New York: Springer Publishing Company. Kuhl, V. (1994). Managed Care Revolution: Implication for Humanistic Psychology. Journal of Humanistic Psychology. Sage Publications Limited. 34(2), 62-81.1994. Henneberger, M. (1994). Managed Care: Changing Practice of Psychotherapy. The New York Times. Retrieved June 26, 2006, from http://query.nytimes.com/gst. O'Hara, M. (1997). Emancipatory therapeutic practice in a turbulant transmodern era: a work of retrieval. Journal of Humanistic Psychology, 37(3), 7-23. Psychotherapy and Managed Care: Position Statement (May, 1999). Retrieved June 26, 2006, from http://www.psych..org/edu. Rogers, C.R. (1990). Counseling and Psychotherapy. New York: Houghton Mifflin Co. The American Heritage Dictionary of the English Language, Fourth Edition. (2000). New York: Houghton Mifflin Co. Retrieved June 26, 2006, from http://dictionary.reference.com/searchq=psychotherapy. Read More