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February 23, 1994

Managed Care, Mental Health, and the Marketplace

Author Affiliations

CMG Health Owings Mills, Md

JAMA. 1994;271(8):587. doi:10.1001/jama.1994.03510320027021

To the Editor.  —In response to the Commentary by Drs Jellinek and Nurcombe,1I would point out that there are other more realistic views as to what is occurring in US psychiatry.To focus on the profit motive as the explanation of the changes is similar to dismissing the Industrial Revolution as simply an attempt by the capitalists to exploit the proletariat. Psychiatrists may mourn the passing of their golden age of innocence and independence, but the traditional covenant between physician and patient has undergone many modifications over the centuries growing out of an interplay between societal needs and the individual interests of both parties.The health care provision system is beginning to focus on managing the health of whole populations in the context of limited resources, rather than doing everything possible for the individual patient. Clinicians must be part of a larger system providing greater access to care

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