Thursday, October 20, 2011

The Birth of Managed Care

I recall a meeting of the private practice committee of the Manhattan District Branch of the American Psychiatric Association at the Payne-Whitney Clinic more than 25 years ago. I guess nobody was worried about the future of private practice back then. Only about three of us attended. We talked about psychiatrist Jay Reibel, MD at Four Winds psychiatric hospital and his attempts to cut costs for the State of New York by reviewing cases in what may have been the first "behavioral carve out."

We love to hate managed care in psychiatry as much as anywhere in medicine, but to help keep it all in perspective think back to the months long hospital stays and years of four sessions a week psychotherapy. Ask yourself whether we could ever be wealthy enough as a society to sustain such benefits for more than a privileged few. You can read more in this 1985 article from the New York Times:


  1. I remember the excesses very well. Inpatients waiting for antidepressants to kick in when they could be doing that at home for much cheaper. The "OT" and "RT" deserved the derisive appelation of "basket weaving." Psychotherapy could go on forever with no specific goals other than "personal growth."

    Mangled care did indeed cut the fat. Unfortunately, they then went on to cut the muscle and bone. I was there in California where and when it all got started. If you couldn't cure a severe personality disorder in five sessions, they would say further sessions were not "medically necessary." (Now they don't do that any more; they just ratchet down our fees) Actively suicidal patients would have hospital days denied.

  2. Managed care is hurting so many people! I work as a one-on-one for children and teenagers with disabilities and I now have a person who works for an insurance company telling me what a 7 year old non-verbal girl with severe autism needs.