Panoptic Care
Using this brief introduction to Foucault's ideas, one readily can
conceptualize managed care as a disciplinary apparatus for surveillance and
normalization par excellence. In many respects, through the modern
convenience of the telephone coupled with the data base capability of
today's computer, it realizes the ideal of Bentham's Panopticon institution.
In both cases, it is the experience of constant visibility (even when one is
not actually being observed) that reflects a permanent exercise of power and
control.
To expand upon this analysis, managed care makes use of two important
processes in establishing its panoptical network, credentialing and
utilization review. The credentialing process opens a case on each
provider. It individualizes for the sake of compartmentalization. Degree
and field of study are only part of the data collected along with
theoretical orientation, therapy techniques used, various types of patient
populations served, as well as continuing education credits; all are used to
locate the provider in a ideal table of therapist specifications. The
stated goal of managed care is to contain the cost of mental health
services, but its means for achieving this end are to organize the field
into ever larger units of production. Providers are taken up into the
provision of a service product, which is sold to the managed care company's
customers, such as insurance companies, self-insured businesses, or
government agencies. The conceptualization of this service product
determines the apparatus of production, as it were, and individual providers
are fitted to this apparatus. Further training is expected, if not
specified, in order to maintain homogeneity within the various preconceived
service delivery components.
Through a process of on-going utilization review, the clinician's work with
his or her patients is kept under surveillance. Information is gathered on
treatment planning, techniques to be used, progress toward goals, and number
of sessions; these questions bear as much on the character of the provider
as they do on the nature of the patient's case. There are strong forces of
normalization at work insofar as there are preconceived standards of care.
These standards determine, for example, what is an adequate history, what is
an adequate diagnosis, and what is an adequate treatment plan. A uniformity
of treatment is to be assured in this manner. The essential feature of
these standards is that they be observable. The conformity that managed
care seeks and requires rests upon the power to make everything about the
treatment process objective. Managed care's panoptical goal is to make the
provision of psychotherapy completely transparent and visible before its
gaze. In this way, one practitioner's work can be compared to that of
another, and deviations from the norm can be highlighted and corrected
(i.e., further training specified). The subjection of providers to the
mental health service delivery industry is accomplished through an
objectification of them and their activities.
Using this brief introduction to Foucault's ideas, one readily can
conceptualize managed care as a disciplinary apparatus for surveillance and
normalization par excellence. In many respects, through the modern
convenience of the telephone coupled with the data base capability of
today's computer, it realizes the ideal of Bentham's Panopticon institution.
In both cases, it is the experience of constant visibility (even when one is
not actually being observed) that reflects a permanent exercise of power and
control.
To expand upon this analysis, managed care makes use of two important
processes in establishing its panoptical network, credentialing and
utilization review. The credentialing process opens a case on each
provider. It individualizes for the sake of compartmentalization. Degree
and field of study are only part of the data collected along with
theoretical orientation, therapy techniques used, various types of patient
populations served, as well as continuing education credits; all are used to
locate the provider in a ideal table of therapist specifications. The
stated goal of managed care is to contain the cost of mental health
services, but its means for achieving this end are to organize the field
into ever larger units of production. Providers are taken up into the
provision of a service product, which is sold to the managed care company's
customers, such as insurance companies, self-insured businesses, or
government agencies. The conceptualization of this service product
determines the apparatus of production, as it were, and individual providers
are fitted to this apparatus. Further training is expected, if not
specified, in order to maintain homogeneity within the various preconceived
service delivery components.
Through a process of on-going utilization review, the clinician's work with
his or her patients is kept under surveillance. Information is gathered on
treatment planning, techniques to be used, progress toward goals, and number
of sessions; these questions bear as much on the character of the provider
as they do on the nature of the patient's case. There are strong forces of
normalization at work insofar as there are preconceived standards of care.
These standards determine, for example, what is an adequate history, what is
an adequate diagnosis, and what is an adequate treatment plan. A uniformity
of treatment is to be assured in this manner. The essential feature of
these standards is that they be observable. The conformity that managed
care seeks and requires rests upon the power to make everything about the
treatment process objective. Managed care's panoptical goal is to make the
provision of psychotherapy completely transparent and visible before its
gaze. In this way, one practitioner's work can be compared to that of
another, and deviations from the norm can be highlighted and corrected
(i.e., further training specified). The subjection of providers to the
mental health service delivery industry is accomplished through an
objectification of them and their activities.