Are competing psychotherapists manageable?

Behavioral health care faces major overhauling. The twin objectives of improved access and greater efficiency require reorganization of the delivery system from a disjointed array of competitors to an integrated continuum of collaborators. Ironically, the motif for achieving such a change is that of competition. This article questions reform through market forces alone and suggests a guided five-step process: guaranteeing the right to necessary care, regionalizing resources under capped budgets, replacing fee-for-service reimbursement with prospective payment, aligning continuing education requirements with performance-defined gaps in knowledge, and funding professional retraining. Shared accountability is proposed as an alternative to the problematic ethic of competition.