Mental health management environments: Managed mental health care-from cottage industry to system of care

Economically speaking, there is perhaps no greater testament of the value of the healing arts to American society than that they be gradually redefined as the "health care industry" and come under the same economic scrutiny as any other business. This transition has not been easily achieved. In the manner of a cottage industry, the patient traditionally entered into a direct contract with the doctor or therapist. To varying degrees, the patient delegated responsibility for the management of care to the health care provider. However, this basic contractual arrangement belies the reality of how health care is financed today.