The Influence of Managed Care Policy on Clinical Decisions of Mental Health Clinicians

Many studies have been done that attempted to define “managed care” and identify the challenges it presents to the clinician. Several of these studies deal with the identification of ways that managed care may interfere with the ability of clinicians to hold onto the values and ethics held dear to their profession. A study by Thompson et al. (1992) found savings attributed to managed care were largely due to decreases in inpatient hospitalizations. Managed care reviewers tended to rate functioning higher than other clinicians did. This research investigates the effect of managed care policy on clinical decisions made in regard to mental health clients. It investigates the relationship between level of care decisions for mental health clients and the employer for whom a clinician works. It also looks at differences between managed care clinicians and those working in the public/private sector in how they prioritize clinical factors when making decisions for level of care. A survey was distributed to mental health clinicians representing a variety of clinical backgrounds and settings. The respondents were practicing in a mid-south metropolitan area. A group of undergraduate psychology students at Tennessee State University were asked to complete the survey and were used as a control group. The survey responses remained anonymous. The respondents were asked to sign a consent form for participation which was handed in separately. They were given assurance there would be no attempt to connect names with data. Subject numbers were used to track the data. Respondents were asked to give their decision for GAF rating, Level of Care recommendation and Potential Risk assessment for four client scenarios. The scenarios were based on actual case histories of clients who presented for assessment and treatment. The research found a significant relationship between the clinician\u27s employer and the recommendation for level of care made by the clinician. There was no significant difference found in how clinicians prioritized clinical factors in making decisions for level of care