Schomerus Georg, Matschinger Herbert, Angermeyer Matthias C
Klinik und Pdiklinik für Psychiatrie, Universität Leipzig, Johannisallee 20, Leipzig, 04317, Germany.
Soc Psychiatry Psychiatr Epidemiol. 2006 May;41(5):369-77. doi: 10.1007/s00127-005-0029-8. Epub 2006 Jan 19.
Increasing costs for patient care may necessitate financial cuts in the health-care budget. Our aim is to examine whether the public prefers cuts for psychiatric rather than medical conditions and how resource allocation preferences are related to illness beliefs and attitudes.
A telephone survey involving German adult population was conducted in 2004 (n = 1012). Participants were presented with a list of nine medical and mental diseases including alcoholism, depression, schizophrenia, Alzheimer's disease, cancer, diabetes, rheumatism and AIDS, and were asked to name three conditions where they would prefer to see health-care resources cut. For all conditions we asked about personal attitudes and illness beliefs.
People were more willing to have financial resources cut for psychiatric than for medical conditions, with resources for alcoholism having the least public backing. Alzheimer's disease was rated more favourably compared to other mental disorders. Generally, the perception of the severity of a disease was associated with resource allocation decisions, favouring those conditions that were considered to be severe. Mental diseases evoked a far greater desire for social distance than most medical diseases which had considerable influence on resource allocation preferences. The perception of personal responsibility had, in contrast, only limited effect on resource allocation decisions. It varied considerably in the case of psychiatric conditions but was not fundamentally different among medical and mental diseases. Personal susceptibility, treatment effectiveness and the perceived life-threat posed by a disease also had limited effects.
According to public resource allocation preferences psychiatric patients are at risk of being structurally discriminated within the health-care system.
患者护理成本的不断增加可能使医疗保健预算不得不进行削减。我们的目的是研究公众是否更倾向于削减精神疾病而非躯体疾病的医疗资源，以及资源分配偏好与疾病认知和态度之间的关系。
2004年对德国成年人群进行了一项电话调查（n = 1012）。向参与者展示了包括酒精中毒、抑郁症、精神分裂症、阿尔茨海默病、癌症、糖尿病、风湿病和艾滋病在内的9种躯体和精神疾病清单，并要求他们说出3种他们希望看到削减医疗资源的疾病。对于所有疾病，我们询问了个人态度和疾病认知。
人们更愿意削减精神疾病而非躯体疾病的医疗资源，其中酒精中毒方面的资源获得的公众支持最少。与其他精神障碍相比，阿尔茨海默病的评价更为有利。一般来说，对疾病严重程度的认知与资源分配决策相关，倾向于那些被认为严重的疾病。与大多数对资源分配偏好有相当大影响的躯体疾病相比，精神疾病引发了更大的社交距离需求。相比之下，个人责任认知对资源分配决策的影响有限。在精神疾病方面差异很大，但在躯体疾病和精神疾病之间没有根本区别。个人易感性、治疗效果以及疾病所带来的感知生命威胁也影响有限。
根据公众资源分配偏好，精神科患者在医疗保健系统中存在受到结构性歧视的风险。
