Managed care: a means of rationing psychiatric treatment.

Some form of patient care review has become an integral component of most health insurance plans. The author describes the numerous ways in which such review negatively affects the therapeutic relationship between the doctor and the patient. Pressured to cut costs, reviewers are unlikely to be objective in their evaluation of the need for treatment. Many are not qualified to review particular types of treatment. Avenues for appeal of reviewers' decisions are weak. The intensity and frequency of review are often disruptive both to the treatment and to the psychiatrist's practice. Some patients discontinue treatment after learning that their care is being reviewed because of fears about loss of confidentiality or other reasons. Informed consent procedures relating to release and protection of confidential information are inadequate. The author emphasizes the need for setting standards for review organizations that will help overcome these and other problems.