The impact of managed care systems on relapse prevention and quality of life for patients with schizophrenia

In general clinical practice, relapse rates for patients with schizophrenia are worse than well-controlled studies suggest are achievable. This paper discusses the reasons for this shortfall and suggests that properly delivered ''managed care'' could reduce the gap between theory and practice. Shortsighted attempts to limit expenditure can lead to overall increases in expenditure on the care of patients with severe mental illness, as has happened in New Hampshire, where reducing expenditure on psychiatric drugs led to an increase in other costs that exceeded the savings on drugs by seventeen-fold. Other studies have shown that patients with schizophrenia can be managed in the community, and that the provision of proper community-based support services reduces the overall costs of caring for these patients. An analysis of the overall costs of medial care before and after the introduction of risperidone has also revealed that total health care expenditure fell, even though expenditure on medication increased. Proper managed care should ensure that services are integrated and that the appropriate level is provided for patients with severe mental disorders, such as schizophrenia. Drugs, such as risperidone, which have wider therapeutic spectrums than the older conventional neuroleptics, are likely to enable these co-ordinated services to provide better and more comprehensive care of patients with schizophrenia.