Managed care cost effectiveness: fantasy or reality?

This article reviews some of the health care issues raised by K. Roy MacKenzie. The author identifies additional contributors to spiralling costs and offers a slightly different perspective on the issue of the efficacy of short-term time-limited psychotherapy. In particular, the author raises questions regarding the cost-driven aspect of today's health care delivery system versus quality of care. He also challenges some of the research findings used in support of MacKenzie's argument that short-term time-limited group therapy is as cost-effective as long-term individual psychotherapy. More specifically, he considers how resistance and the sense of hopefulness might influence the favorable outcomes of the studies cited in MacKenzie's article. In addition, the relationship between short-term psychotherapy and managed care abuse is addressed and a partial solution to preventing such abuse by legislating public accountability is offered.