Effect of Managed Care Constraints on Psychiatrists and their patients

Mark Schlesinger, Ph.D., Robert A.Dorwart, MD, MPH, Sherrie S. Epstein, BA.

The increasing involvement of insurers and hospitals in monitoring patient
care is encroaching on the psychiatristis autonomy in making clinical
decisions. This study examined the prevalence of constraints on psychiatric
inpatient practices, as well as how characteristics of psychiatrists affect
the type and the degree of these external pressures.

Results of the study showed that more than three quarters of those surveyed
reported pressure from insurers for early discharge; nearly two-thirds said
hospitals limited length of stay; and about half had been discouraged from
admitting severely ill patients, the uninsured, or Medicaid recipients.
Characteristics of psychiatrists, such as length of time in practice,
income, sex, and medical school education outside the United States, were
associated with the prevalence of external pressures.

The study concluded that constraints on psychiatristsi practices are
widespread. Their ability to resist pressures depends on their bargaining
power, which seems to be lower for those who have relatively little
experience, who are female, or who have gone to medical school outside the
United States. Psychiatrists appear to be willing to trade off more
constraints for higher incomes. Severely ill patients and those with little
or no insurance are more likely than others to be affected by these limits on
psychiatrists autonomy.

Excerpted from Am J of Psychiatry, 2/96; 153:256-260

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