How Managed Care Is Changing Mental Health

Gin Lane Hogarth

Those with an interest in the history of American medicine will recall how the delivery infrastructure has evolved through the years, from careless care to poorly managed care to mismanaged care to the paradigm currently in vogue, managed care.

Seems simple enough, and yet, there are as many definitions for managed care as there are for quincunx, so let’s cut through the clutter and have a look at what it actually means, especially in a mental illness/mental health context.

Historically, care could only be denied on a case-by-case basis, which was very time consuming for care providers. Insurance companies struggled with tremendous overhead because it was necessary for them to maintain large departments staffed by professionals skilled at denying claims one at a time.

Then, in the 1980’s, computer technology changed all that when the first integrated health networks were formed. These sophisticated health delivery systems linked hospitals, physician practices, labs, rehab facilities and other participants with insurance providers creating a vertically integrated continuum of care! For the first time, all members of the healthcare delivery infrastructure were able to communicate on-line real-time, sharing vital patient information and updating the data pool on an ongoing basis.

Suddenly the healthcare denial process was brought into the digital age, and with it, a whole new level of care inaccessibility. For the first time in many years, health insurance companies were able to offer a truly inspiring panoply of mental health care options since they could be certain there was no chance they would be delivering them.

Muckrakers, malcontents, and professional whiners complained about this, calling managed care a “devious, disingenuous, deleterious, dastardly dupe designed to fatten the pockets of capitalist bloodsuckers by draining the life from unsuspecting hod carriers.” Managed Care industry spokesman Reginald Entwhistle responded thusly.

“The human body is an astonishing mechanism. Chief among its virtues is the ability to heal itself. Indeed, as that government which governs least governs best, so that healthcare delivery system that heals least heals best. Now, specifically how does this work? Let’s start with a real life example.

“You are overcome with an attack of Munchausen By Proxy. Panic stricken you hop a cab to Holy Guacamole Hospital where you are denied admission because, thanks to access to your Online Medical Record, it is revealed that your plan, Criss-Cross of America, only covers regular Munchausen’s – without Proxy.

“They refer you to Whassamatta U., (a teaching hospital), which sometimes takes on psychiatric cases pro bono as long as patients don’t mind participating in studies.

“On the long cab ride across town you have plenty of time for your body’s natural healing process to take place and you arrive at Whassamatta U fit as a fiddle, sound as a dollar, strong as an ox, and healthy as a horse. With luck, your insurance company picks up 85% of the cab ride, after you have met your deductible.

“Elegant in its simplicity and made possible by the magic of computers!”

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Alistair McHarg

Alistair McHarg was born in Cambridge, Massachusetts, moved immediately to Edinburgh, and three years later moved to Amsterdam. At 6 he settled in Philadelphia and for 16 years was confused by Quaker education; Germanton Friends School and Haverford College. A Master of Arts in Creative Writing from the University of Louisville nudged him even closer to unemployability. Convinced at an early age that fate had chosen writing as his calling, Alistair followed a characteristically slow and circuitous path. He has found work as deck hand on a Norwegian tramp freighter touring South America, Bureau of Land Management Emergency Fire Fighter in Alaska, guide at a Canadian wilderness survival camp, truck driver crisscrossing Colorado's continental divide, and inner city cabbie. Alistair has been arranging words on paper for a living since 1983.