Some distinctive features of the impact of managed care on psychiatry

Past research suggests that the spread of managed care is affecting the tre atment of mental and physical illnesses differently. This article develops six hypotheses that could explain the differential effects of managed behav ioral health care, based on characteristics of mental disorders, profession al norms of treatment, and the broader societal consequences of untreated m ental illness. Using data from the 1998 Socioeconomic Monitoring System fie lded by the American Medical Association, we tested these hypotheses by com paring the experiences of psychiatrists under managed care with those of pr imary care providers and medical specialists. We found the following: (1) p sychiatrists face substantially more aggressive external review than do pri mary care providers and are less successful in overturning denials; (2) psy chiatrists feel significantly more at risk for disaffiliation from health p lans; (3) psychiatrists report facing review protocols that are more confus ing than those for primary care physicians, but psychiatrists' staff spend less time on external review; (4) psychiatrists are more likely than other physicians to report that their patients have difficulty making informed ch oices about managed care; and (5) psychiatrists evidence greater time commi tment to advocacy on behalf of their patients with respect to managed care.