Dr. Sharfstein's introduction: Managed care has had a profound impact on clinical practice. Clinicians find fourth and fifth parties are looking over thier shoulders to review their treatment plans for cost-efficiency. The biopsychosocial model of diagnosis and treatment is called into question as more stringent measures of medical necessity and appropriateness become the basis for reimbursement. In this column, Dr. Robert Schreter identifies ten trends in managed care and examines their impact on the biopsychosocial model.
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