For the past several years, the health care and insurance industries in America have been undergoing significant reform in order to rein in the high cost of delivering health care services. Managed care has become a cornerstone of this process (Strickland, 1995). The case management industry (with its focus on cost containment, managed competition, and quality care) is playing an increasingly important role in the managed care environment (Owens, 1996). According to Mullahy (1995a), the number of case managers has risen astronomically in recent years. These individuals come from diverse professional backgrounds and practice settings that include nursing, rehabilitation counseling, and social work. Case management, however, is not a new concept. Many human service, rehabilitation, and health care professions have a history of using case management models in the execution of their responsibilities. For example, in many psychiatric rehabilitation work settings social workers are frequently hired as case managers to coordinate the provision of community-based services to their clientele (Sledge, Astrachan, Thompson, Rakfeldt, & Leaf, 1995). Case management is also an extremely important function of rehabilitation counselors in both public and private sectors (Leahy, Chan, Taylor, Wood & Downey, 1997; Leahy, Szymanski & Linkowski, 1993; Matkin, 1995). Similarly, medical case management is increasingly being viewed as an essential aspect of professional nursing practice (Lamb, 1995). The Development of Private Sector Case Management
The impetus for case management practice in health care settings can be traced to the skyrocketing cost of workers compensation in the 1970s. Private sector rehabilitation grew in response to the demand for vocational rehabilitation services by workers' compensation insurance carriers (Matkin, 1995). Federal legislation also promoted the growth of private sector case management services. albeit inadvertently. The Rehabilitation Act of 1973...
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