Dialogue. Quality and the bottom line. How can shareholder interests be prevented from interfering with quality care?

Market-driven, for-profit behavioral health systems put patients and investors in the same financial equation. Do shareholder profits depend on preventing patients from receiving appropriate care? Does investor greed directly increase consumer pain and suffering? Or, does the marketplace work the way one hopes: providing profits to investors in proportion to improvements in healthcare quality and affordability? Well-intentioned providers find themselves walking right through the middle of this high-stakes minefield. Should the government and the marketplace allow clinicians--and their standards of ethics and social values--to be swept away in the name of efficiency? Or does the marketplace for behavioral healthcare require government intervention through legislation and regulation to protect the interests of both patients and providers? This debate is far from over. Every reader of this journal has a vital stake in the outcome. In the following dialogue, leaders representing employers, clinicians, and managed care plans argue different positions in this debate and propose compelling solutions.