Rethinking professional prerogative: managed mental health care providers

Managed care represents a response to the wider institutional demand for technical rationality and efficiency. In the US, managed care exemplifies the commodification of health and is governed by a technocratic-rationality that often conflicts with the professionally governed value rationality of providers. Providers must negotiate between contradictory institutional demands for cost containment and quality care in their everyday work practices, and consequently experience a series of ethical dilemmas. This paper examines the effect the commodification of health care has had upon the work of mental health care providers, their loss of professional prerogative, their concrete experience of the ethical dilemmas which result from the commodification of care, and evidence of countervailing power.