Ethical Dilemmas of Psychologists in Managed Care Settings: a Critical Incidents Study

Managed care has dramatically changed the landscape of mental health care in this country. Psychologists have had to significantly alter their practice to accommodate clients covered by managed care organizations. In this new health care environment, the profession is faced with unprecedented challenges in adhering to ethical standards of practice. The first step in resolving these conflicts is to examine the specific dilemmas that psychologists face. Four hundred members were randomly selected from a subgroup of the American Psychological Association to participate in this study. They were selected from the 1997 APA Directory Survey by the APA Research Offices and asked to identify up to three critical incidents in which they faced ethical dilemmas working with managed care clients. Forty-nine members responded identifying a total of eighty-three complaints, consisting of both specific incidents and general critical issues. These complaints were then sorted into categories which were subsequently verified by independent raters. Twelve categories were identified: limited number of sessions, authorizations only for certain diagnoses and conditions, cumbersome administration, limited confidentiality, provider/panel issues, limitations on therapeutic methods, low fees and reimbursement rates, deceptive coverage practices, lack of coverage for testing, only medication favored by the managed care organization, breach of trust or contract, and other. Ethical dilemmas presented by these complaints were discussed and solutions considered