Managing Managed Care

by Michael C. Roberts, and Linda K. Hurley. New York, Plenum, 1997, 191 pp., $37.50; $21.50 (paper).

Am J Psychiatry 156:148, January 1999

Cambridge, Mass.

The authors of this useful volume state on page viii that their purposes are to

  1. Inform the clinician (especially the clinical child/pediatric psychologist) about the managed care system: what types of managed care systems exist, how they work, and what the advantages and pitfalls of working within these systems are.
  2. Assist the clinician in providing quality and effective services to children and their families within the managed care system.
  3. Help the clinician understand how to work within the managed care system without being significantly harmed financially, legally, or professionally.
  4. Help the clinician identify other ways of practicing without entering the managed care system or of restricting the percentage of their practice that is based on managed care.
  5. Provide information for trainers and students about the managed care environment with special applications to the issues of children, adolescents, and families.

In seven chapters, they generally accomplish their goals. The first chapter, "Basics of Managed Care in Psychological Services for Children and Families," is a useful introduction for clinicians. The second chapter, "Problems Posed by Managed Care for Services to Children and Families," defines the substantial control that managed care exercises over the quality of care experienced by patients. Chapter 3, "Legal and Ethical Issues for the Clinician in Managed Care," is only partially successful. The section on conflicts of interest is far too brief, but perhaps this topic might be a separate book in itself. Dealing with the need for clinicians to know themselves or to have training in organizational countertransference might also require another work.

Chapter 4, "Adapting to the Managed Care Environment," is an introduction to the authors' clinical practice methods. It could have been far more informative if these clinicians had explored the limitations of their practice. This is to some extent what chapter 5, "Limiting Negative Impact of Managed Care on a Clinical Child/Pediatric Psychology Practice," attempts to do. "Practicing Outside Managed Care," chapter 6, is an excellent how-to chapter—itself well worth the time it takes to read the book as a whole. Chapter 7, "Scientific Bases for Clinical Practice in Managed Care," can best be understood by keeping in mind that outcome studies in medicine and mental health are still in their measurement infancy. For example, how to measure "autonomy" or "authenticity" and what "consumer satisfaction" means are among the questions that need to be addressed by outcome measurement.

Despite the above questions, I recommend this book as an important introduction to managing mental health managed care. The authors ought to be commended for their pioneering effort. I look forward to the next edition as well.