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Ethics or economy?

 

Over recent years there has been a marked growth in the number of psychologists and psychiatrists leaving public health services in favor of the private sector. This seems to be driven more by professional concerns than financial ones.



Norway has traditionally had a strong public health service with little supplementation from the private sector. In recent years this has changed, ushering in a debate on whether private health is supplanting rather than supplementing public health and the consequences this entails for the population, especially those with economic challenges.


The debate has centered around recruitment of health personnel, seeing this as a finite resource. Increased recruitment in the private sector therefore means decreased recruitment in the public sector. This development has prompted our associations to collaborate on a member survey, asking members of our two professions about their experience with the public health sector.


The results reveal that some of our members have grave concerns about the quality of care they have resources to provide. This regards both duration of treatment, frequency of treatment and possibility of tailoring treatment to the patients needs.


One can argue that providing health services includes an element of prioritizing and the acceptance that not all patients can be given the treatment they themselves desire nor will all patients have the desired outcomes of treatment. However, the number of members reporting concerns and the nature of the concerns gives reason to assert that this is not a question of unrealistic expectations, rather an experience of not being afforded the possibility of giving health services in accordance with their training and current research recommendations.


It would be disingenuous to claim that our members are not motivated by financial remuneration. However, the primary concern for our members seems to be the opportunity to help their patients to the best of their ability. Image by Unsplash.
It would be disingenuous to claim that our members are not motivated by financial remuneration. However, the primary concern for our members seems to be the opportunity to help their patients to the best of their ability. Image by Unsplash.

We lack the equivalent data from our members in the private sector, however we do have some data on the financial renumerations they receive. Comparatively, they do not receive significantly more than their colleagues in the public sector. When combining this with qualitative feedback from our members in both sectors, it appears that the opportunity to give services of adequate professional and ethical standards is the main reason compelling our members to abandon public health in favour of the private sector.


This has led our associations to raise these concerns with relevant authorities. Mental health problems have a higher prevalence in the segments of the population with lower income, so the observed development begs the question of whether our professions are helping the people with most needs. From our perspective, there is a pressing need to review and change the regulation and financing of the public health sector if this development is to be halted or reversed.


It would be disingenuous to claim that our members are not motivated by financial remuneration. However, as stated above the primary concern for our members seems to be the opportunity to help their patients to the best of their ability. This reflects well on our members, but less well on the will of our society to provide adequate mental health care. □

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