No Free Lunch: Limitationson Psychiatric Care in HMOs

Dr. Sharfstein's introduction: In our zeal to replace psychiatric hospitalization with cost-effective alternatives, we must take care to ensure that appropriate resources remain available for the most severely symptomatic patients with life-threatening psychiatric pathology. This month's column provides appropriate warnings about the pitfalls of capitation arrangements for psychiatric hospitals and for beneficiaries who develop severemental illness. Providers and consumers alike must be aware of limitations on care resulting from scarce resources when choosing models of health care delivery.