Manage or Perish?

The greater emphasis on quality of life and heightened public expectations about health care have resulted in increased demands for services. Expensive improvements in diagnosis and treatment have led governments, desperate to limit their expenditure, to propose the rationalization of health care. An intermediate solution - managed care - emerged in the US and soon after elsewhere. Examining the practical and ethical implications of managed care and its effect on the patient-doctor relationship, this text analyzes the after-effects of the US-born managed care revolution, and addresses the question of a European perspective: What is the European reality? How can psychiatrists adapt to the new cost-containment strategies which imperil patients' most basic needs while avoiding the ethical quagmires that would compromise their own principles?