Preferences of the public regarding cutbacks in expenditure for patient care: are there indications of discrimination against those with mental disorders?

Background: 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.

Method: 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.

Results: 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.

Conclusion: According to public resource allocation preferences psychiatric patients are at risk of being structurally discriminated within the health-care system.