ABSTRACT
As public sector managed care (PSMC) spreads more widely, there is growing anxiety among public sector clinicians and managers about the perceived incompatibility of “managed care” with community mental health (CMH) ideology, and with their own deeplyheld principles and ideals regarding public sector service. (See Table 1). This anxiety results, in turn, in substantial opposition to the implementation of managed-care initiatives and programs, and this may interfere significantly with the ability of their programs to respond creatively and proactively to the changes in mental health system organization and financing that managed care represents. Paradoxically, the more committed that clinicians, managers or programs become to resisting “managed care” because of the belief that it compromises their ideals of patient care in the public sector, the more likely that patient care will be adversely affected by reductions in reimbursement or loss of contracts. Successful response to managed care, therefore, requires clinicians and managers to address their ideological discomfort directly, and to explore carefully whether the perceived ideological incompatibility of “managed care”
TABLE 1: Areas of Perceived Ideological Incompatibility
1. Managed care is concerned with cost-cutting, not with quality service provision.
