Managed Competition and Access to Emergency Psychiatric Care

Abstract

preauthorizing treatment before it is actually delivered. While gatekeeping may be an effective cost management method, it affects physicians and patients in several ways. First, it may deter patients from seeking care and discourage physicians from offering it (3). Second, gatekeeping may be perceived as a barrier to treatment, resulting in high levels of patient dissatisfaction over time (4). Third, and most worrisome, the requirement that all treatment be preauthorized may have detrimental consequences in an emergency (5). Rapoport and colleagues (6) recently examined the relationship between managed care and intensive care. They found that even when treatment was provided in an intensive care unit(ICU), patients enrolled in managed care plans had shorter 1W and hospital stays, lower costs, and less use of mechanical ventilation compared with patients who had traditional insurance. There was no apparent difference in mortality or rate of ICU readmission between the groups. Nevertheless, managed care clearly influenced the utilization of resources in a setting where lifethreatening conditions are common and significant discretion in making decisions about treatment would not be expected.