title: Some early lessons from the rise of managed behavioral health care in the United States.
abstract: In the 1990s the United States has, because of an unacceptable surge in health care costs, made a revolutionary shift of the reimbursement process from fee-for-service to managed care's restricted, discounted and capitated payment approaches. Mental health care has for 150 years largely been subsidized by tax supported hospitals and clinics. Federal and state governments have recently instead begun to direct much of their monies to for-profit national managed mental health care companies. While efficiency has improved and the steep rise in costs has been eased, the major drawback of this change is a too enthusiastic focus on corporate profits. Since on the whole managed care organizations do not reinvest profits into medical education or research and may pull out of the health care business once the business is no longer so profitable, clinicians and academicians must become more successful in urging politicians and the citizenry to better manage managed care.
authors.affiliation: Yale Child Study Center, New Haven, Connecticut 06520-7900, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Schowalter
mesh_terms: D003362:Cost-Benefit Analysis; D049673:History, 20th Century; D006801:Humans; D007557:Israel; D008329:Managed Care Programs / Q000266:history / Q000592:standards* / Q000639:trends; D008605:Mental Health Services / Q000191:economics* / Q000266:history / Q000592:standards; D011787:Quality of Health Care / Q000191:economics*; D014481:United States