Dialogue. Carve-out or HMO: which will serve public sector beneficiaries better?

We are pleased to have three distinguished and thoughtful participants take part in this issue's Dialogue section. As the healthcare industry changes dramatically, new ideas and different approaches are being aired and debated. The three panelists in this discussion attempt to meet head on some of the problems that presently beset managed care and give us their expertise about the pros and cons of privatization, integrated systems, carve-outs, and carve-ins. They provide examples of steps that are being taken right now and suggest alternative means to achieving a more responsive and equitable system. Dr. Patterson provides an overview of the history of this question. Dr. Stelovich argues for systems that integrate mental health and medical services in a managed care setting and suggests that they provide the mental health patient with better healthcare delivery. Deborah Happ makes the case for the carve-out approach in which behavioral health and physical health services are separated and put under the direction of managed behavioral healthcare organizations (MBHOs). She cites Tennessee's TennCare Partners Program as an example of a successful endeavor and carve-out alternative.