SOME EARLY LESSONS FROM THE RISE OF MANAGED BEHAVIORAL HEALTH-CARE INTHE UNITED-STATES

In the 1990s the United States has, because of an unacceptable surge i n health care costs, made a revolutionary shift of the reimbursement p rocess from fee-for-service to managed care's restricted, discounted a nd capitated payment approaches. Mental health care has for 150 years largely been subsidized by tax supported hospitals and clinics. Federa l and state governments have recently instead begun to direct much of their monies to for-profit national managed mental health care compani es. 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 prof itable, clinicians and academicians must become more successful in urg ing politicians and the citizenry to better manage managed care.