The ethical issue behind health care rationing with special concern for mental health

Abstract

Human being has a tendency to use more resources than are available. More and more countries spend almost all their economic growth on health services and education. Yet the public do not feel that the huge increasing of funding allocated to health has produced a significant change. In fact, it comes out in surveys that people are more concern about whether or not they will be able to access health services when they or their family members need it than the quality of those services.

AIM. This paper offers an ethical interpretation of health care rationing. How can we justify the choices of prioritizing a patient before another one? How far can we go? Should we only take into consideration the stage of the sickness? Why not age, capacity to benefit from the treatment, and merit-consideration? In addition another issue is rising: how can we apply these criteria in mental health care?

METHODOLOGY AND RESULTS. This paper is focused on psychiatrically health services for children. I tried to capture the opinion of decision-makers and to understand the process of evaluation of referrals to children psychiatric clinic. I interviewed three decisions makers and I followed the process of evaluated the referrals from family doctors. I decided to present five patient cases that, in my opinion are most representative for children psychiatry and to projects. One aims to find out how different decision makers from different clinics evaluate same referral and the other one measures how good are the referrals from family doctors. Although the results are not representative for the general population, there are significant differences, which should at least raise some ethical questions.

LIMITATIONS. A social perspective upon an economical aspect struggles always to capture rational attitudes. The truth is we are more likely to be rational about sexual desire than spending money.

CONCLUSION. The topic is on debate since Euripides' time and I do not pretend that I can solve it hic et nunc. When it comes to our responsibility towards other people, personal sense of justice seems to be a “good enough” way to deal with it.