Ethical issues of cost effectiveness analysis and guideline setting in mental health care.
This article discusses ethical issues which are raised as a result of the introduction of economic evidence in mental health care in order to rationalise clinical practice. Cost effectiveness studies and guidelines based on such studies are often seen as impartial, neutral instruments which try to reduce the influence of non-scientific factors. However, such rationalising instruments often hide normative assumptions about the goals of treatment, the selection of treatments, the role of the patient, and the just distribution of scarce resources. These issues are dealt with in the context of increased control over clinical practice by third parties. In particular, health insurers have a great interest in economic evidence in clinical care settings in order to control access to and quality of (mental) health care. The authors conclude that guideline setting and cost effectiveness analysis may be seen as important instruments for making choices in health care, including mental health care, but that such an approach should always go hand in hand with a social and political debate about the goals of medicine and (mental) health care. This article is partly based on the results of a research project on the normative aspects of guideline setting in psychiatry and cardiology which was conducted under the guidance of the Royal Dutch Medical Association.
Berghmans
R
R
Institute for Bioethics, Health Ethics and Philosophy, Department of Caring Sciences, University of Maastricht, Maastricht, the Netherlands. r.berghmans@ige.unimaas.nl
Berg
M
M
van den Burg
M
M
ter Meulen
R
R
D000787:Angina Pectoris / Q000191:economics / Q000628:therapy; D001689:Biological Psychiatry / Q000191:economics / Q000941:ethics; D003362:Cost-Benefit Analysis / Q000941:ethics; D003863:Depression / Q000191:economics / Q000628:therapy; D006040:Goals; D015276:Health Care Rationing / Q000191:economics / Q000941:ethics; D006297:Health Services Accessibility / Q000191:economics / Q000941:ethics; D006801:Humans; D007358:Insurance, Psychiatric / Q000191:economics / Q000941:ethics; D008605:Mental Health Services / Q000191:economics / Q000941:ethics*; D010358:Patient Participation; D017060:Patient Satisfaction; D011057:Politics; D017410:Practice Guidelines as Topic; D017009:Professional Autonomy; D011613:Psychotherapy / Q000191:economics / Q000941:ethics; D011787:Quality of Health Care / Q000191:economics / Q000941:ethics; D012935:Social Justice / Q000191:economics / Q000941:ethics