Question

What is the current and future trends of clinical psychology?

Answer 1

In the Beginning
A number of national issues will significantly impact future trends in clinical research. Just as clinical psychology and research got their first big push from the Veterans Administration just after World War II, so too will the future be guided primarily by major economic and social issues. We tend to go where the money is (traineeships, fellowships, research grants) and to work on the socially relevant/important problems of our time. The VA impetus was but the first example of how clinical research trends start.
Health Care Reform
Two of the most common types of managed care are Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Mash and Hunsley defined HMOs as organizations that typically provide “services through a health care company, a group practice formed by several health care practitioners, or an employer’s own staff of practitioners.” Whereas, PPOs are defined as being “represented by service providers who have contracted with organizations to provide their services at a reduced rate in return for a high volume of referrals
Although we have used different terms in the past, “managed care” has been kicked around for over 30 years. Why is it becoming more of a reality now? Because health care reform is now linked to the “economy!” Whether you are for or against managed care, most people agree that something has to be done with the current health care system. In a recent issue of the Health Psychologist, Kaplan noted three major problems with the health care system in the United states.
Expensive, Inaccessible, and Unproven Health Care
First, it’s unaffordable. The 1992 expenditure for health care was $800 billion. We spent more than $3,000 per person, per year. Second, it’s inaccessible. Overall, 40 million people have no health insurance at all. Finally, there is no accountability.

“Despite the fact that we spend more money on health care than any other country, we are unable to document that these expenditures result in increased life expectancy, better quality of life, or improvements on any other health indicator” (Kaplan, 1992).
Research and Practice
Kaplan notes that two components in the Clinton plan are of particular interest to health psychologists. First, the plan calls for core benefits that will include prevention care. This implies a potential major increase in the amount of preventive care delivered which in turn suggests more school-based clinics, community health centers, and training programs. The second component, an intensified health-education system, is reinforced by Clinton’s public statements that health behavior is a major contributor to ill health and high health care costs. He has proposed programs to reduce unhealthy behavior and encourage personal responsibility for health.


Managed competition, says Kaplan, is another important concept in the Clinton proposal…. Managed competition forces competition — between insurance companies — under a set of structured rules. For example, employers would be required to provide employees a choice between competing alternatives. Employees would choose plans that best meet their needs, and since at least a portion of the insurance premium would come from the employee’s paycheck, there would be an incentive to choose the plan that provides the most value.

Perhaps the most important concept in the plan, according to Kaplan, is global budgeting which attempts to limit the systematic increases in health care expenditures as a proportion of the gross national product. Global budgets would set limits on how much could be spent for treating individuals.

Efficacy Research

However, the global budgets will force competition. The competition is likely to increase the need for clinical research.

“Under global budgets, it makes the most sense to pay for services that are most effective in making people well. Currently, it is difficult to decide which services should be supported because we have insufficient evidence about the efficacy of the alternatives. This ignorance has spawned a whole new industry of ‘outcomes research’ designed to evaluate the costs, risks, and benefits of competing treatments” (Kaplan, 1992).
Societal Issues and Research
In January 1991, the Steering Committee of that summit reported its progress at the next Behavioral Science Summit in Houston. Through these meetings, the Human Capital Initiative (HCI) was proposed. The HCI is “a sustained, national research effort, to enhance the understanding of human development and behavior. The [HCI] is intended to support research relevant to a set of…six critical problems that are facing our nation, communities and families today, and that can helped by psychological science.” They include:

Worker Productivity,Schooling and Literacy,The Aging Society ,,Drug and Alcohol Abuse ,Mental and physical health.