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Allies and Adversaries: The Impact of Managed Care on Mental Health Services

James H. Kocsis, MD
JAMA. 1994;272(22):1797. doi:10.1001/jama.1994.03520220093041.
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This is an intelligently written and even sometimes entertaining primer on the title subject. The evils, tensions, potentials, and promises of interactions between the managed care industry and the mental health care delivery system in America are covered in a pithy fashion enriched by clinical anecdote. The authors represent a range of divergent interests, from psychiatrists in private practice to hospital administrators, CEOs of managed care companies, and family members of patients with severe mental illness. The observations are often refreshingly frank and outspoken.

In his chapter, Daniel Y. Patterson, MD, a psychiatrist in private practice, opines, "To remove the emperor's clothes, no utilization review program has workable criteria for reviewing outpatient care." Steven S. Sharfstein, MD, a hospital administrator, says, "Unfortunately, much of the denial of hospitalization has been a form of deinstitutionalization of the insured or middle class." Laurie M. Flynn, executive director of the National Alliance for


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