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Managed Behavioral Health Care: An Industry Perspective
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Sharon A. Shueman, Warwick G. Troy, and Samuel L. Mayhugh; eds. Springfield, Illinois: Charles C. Thomas; 1994. $55.75.
Professional societies, academic physicians, and psychologists have lost control of managed mental health care. Managed Behavioral Health Care traces the history of attempts by government, industry, and the leadership of our professional guilds to work cooperatively in developing specific guidelines for mental health care. It is a history of intraprofessional organizational conflicts between membership and leadership and of the ultimate impotence of the profession to design managed behavioral health care.
As a physician who must deal with the consequences of our professional organizations' failure to control the agenda, I found myself alternately angered and fascinated by the lucid and factual discussions of the earliest federal and state government initiatives in managed health care and of the ultimate ceding of control to industry. Physicians insisted on complete freedom to treat without specific attention to defining and documenting criteria for objective improvement in patient function in the workplace and at home. This blind insistence on control contributed greatly to industry takeover and to the growth of case management by business-oriented and, frequently, undertrained persons. For anyone who is interested in the history of managed care or who must interact with case managers, this book is worthwhile reading. The very absence of clinician input into any of the book's chapters underscores how far control of clinical care has wandered from the traditional "physician-patient" relationship.
The authors are up front about opposing slavish adherence to practice guidelines by inadequately trained and overloaded case managers. Criticism of "for profit" organizations' excessive focus on the "bottom line" will help to soften antagonistic feelings of readers who directly care for patients. Informative chapters cover learning objectives for practitioners who work within the managed care environment; these chapters have companion tables outlining specific learning objectives and can be useful for those responsible for directing clinical training programs.
The chapters on the development of electronic databases for case management and clinical care are excellent. The authors are enthusiastic about the need for further research on process and outcome measures.
If we are changing the medical paradigm and moving toward restructuring health care, then education of current and future practitioners is crucial. Managed Behavioral Health Care is a contribution to this effort. Those from industry and government and consumers and providers of health care will benefit from this book. We all have a responsibility to dedicate ourselves to building a health care enterprise with the most humanistic intent and with documented high-quality process and outcome measures.
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