Abstract
This chapter discusses the effectiveness and cost in managed care as discussed by Shaffer. Managed care encompasses a continuum of organizational structures for the financing and delivery of health care services. The various structures are most appropriately operationalized according to the distribution of financial risk among the payers, providers, and facilitators that are involved in the health care delivery system. Managed care has greatly promoted the principles of evidence-based medicine in the area of mental or behavioral health. The managed-care-driven emphasis on outcomes has changed that. Providers have to justify their recommended treatment vis-a-vis those who pay for it, and if the treatment does not work, they must expect to change it. The concept of value that is long appreciated in other areas of the consumer market has finally been brought to behavioral health care. In the long run it seems illusory to attach hopes for realizing true market efficiencies to a product that by necessity can never meet economists' specification for a commodity in a market operating under the conditions of perfect competition.
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