"How Healthy is Managed Care," the Chapter’s preliminary report on health and mental health managed care in New York City is about to be released to the media, public officials and consumers. The report documents the results of NASW’s Managed Care Critical Incident Project which was undertaken by the Chapter last year.

The report describes the painful personal experiences of consumers and providers in attempting to access and use managed care. In addition, the preliminary report adds the human element to the statistics of the social and financial impact of problems with the system.

The report cites major problems within managed care in six critical areas: Health care decisions are not made by patients and their providers; Appeals related to inappropriate health care decisions are delayed or restricted; Home care services are refused; Emergency access is being denied; Barriers to care are rising; and Continuity of care is disrupted.

Among the more horrific examples of these problems:

The patient with advanced head and neck cancer who could not swallow as a result of radical neck surgery to remove the cancerous growth. The managed care organization (MCO) refused to approve coverage for nutritional supplements for the patient, despite continuous calls by the physician over a two week period to obtain approval. The patient was starving to death.

An MCO decided to reduce the size of their provider panel and dropped several mental health providers without explanation. Current patients were transferred to other providers. Among the patients who were affected by this change was a nine-year-old boy who had attempted to commit suicide by hanging himself in school. The mental health provider who was dropped from the panel had been working with this child for 1 ½ years. The MCO refused to allow the therapist to continue treatment.

The data detailed in "How Healthy is Managed Care?" comes from hundreds of consumers and providers who filled out a widely distributed form (written in English and Spanish). Chapter President Dr. Elaine Congress commented: "NASW, with its 10,000 members, collectively reaches hundreds of thousands of health and mental health consumers each year. Our members have the unique advantage of being able to collect data and monitor the problems that are experienced with managed care organizations."