Managed care may be viewed as the most recent attempt to control the rate of increase of health and mental health care costs in the United States. The majority of people who receive insured mental health services do so through some form of managed care program. Now increasing concerns are being raised about whether managed care really reduces costs, whether it adversely affects the quality of care, and whether it restricts access to care. The author discusses the origins, actors, and major issues involved in managed health care in terms of prevailing myths and future realities. He calls for more and better research to answer important clinical and policy questions about managed care and for improved communication between mental health professionals and managed care organizations.