Health Insurance Managed Care Mental Illness

The problem with managed care is…

Managed care, as the names suggests, aims to manage health care.  The goal is to identify high quality, low cost treatments in order to insure that patients get the best care while keeping premiums low.  While good in theory, managed care critics often contend that some of the stricter managed care policies reduce patient access to high-quality medicines.  Health care providers complain that managed care may save insurers money, but imposes a significant paperwork burden on them.

Consider the excerpt from an the excellent book Far from the Tree: Parents, Children, and the Search for Identity where author Andrew Solomon discusses how managed care affects the treatment of patients with schizophrenia.

When I asked Jeanne Frazier whether it had been emotionally draining to work with schizophrenic patients, she said, “The thing that makes me emotionally drained is managed care.  When I have to fill out yet one more form just to increase the dose of an antipsychotic that’s already approved, it really impacts the quality of service I can provide.”

This is a fundamental tension with managed care. Allow physicians to practice medicine as they like, they typically provide high quality care but are less concerned with cost. Allow insurers to dictate care from on high, costs decrease but care becomes bureaucratic and quality can suffer. How to find the perfect medium between centralized managed care and decentralized physician lead decision-making is continual challenge to achieve both lower costs and higher quality of care.


  • Solomon, Andrew. Far from the tree: Parents, children and the search for identity. Simon and Schuster, 2012.

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