Document Type

Peer-Reviewed Article

Publication Date



The transformation of the American health care environment from retrospective fee-for-service to managed care has been both rapid and chaotic. This period of change has been infected by value conflict, evoking unconscious processes in system participants as they have attempted to cope with personally threatening situations. This article attempts to elucidate this process by presenting an account of events and accompanying value conflict as it occurred over time. It also includes a systems analysis of the rapidly changing mosaic of unconscious processes that resulted from the divergent values held by the public and health care professionals, using various organization behavior theories. Examples of the types of theory used are Jungian archetypes, scapegoating and mutual negative stereotyping, the Karpman Drama Triangle, and Wells' 'group-as-mother' analogue.