A rational bureaucracy in a civilised societyBMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7150.48 (Published 04 July 1998) Cite this as: BMJ 1998;317:48
- Christian M Koeck, president. ([email protected])
- Koeck, Ebner, and Partners, Parkring 12A/4, A-1010 Vienna, Austria
Psychoanalysis is among the most important contributions to civilisation made by Austria. Sigmund Freud's theories about the structure of the human psyche and the unconscious have changed the way we look at ourselves and society. Among the most central concepts of his theory is the notion of ambivalence. This is probably the best word to use to describe how the NHS is viewed in Austria; the spectrum of opinion on the NHS ranges from praise to harsh rejection depending on whom you ask.
On one end of the spectrum are the average doctor, health policy maker, and professor in a medical faculty. Ask them about the NHS and you will most likely hear critical remarks—ranging from stories about poor care, long waiting lists, a lack of access to care, and a shortage of advanced technology to outright rejection of the NHS model, based on claims of inhumane rationing and the exclusion of the elderly and the very sick from the benefits of modern health care. The factual basis of these judgments is not entirely clear. It is most likely that stories such as those about child B (an 11 year old girl with myeloid leukaemia who was denied a second transplant operation by the local health authority) and about age limits for treatment options such as transplant operations and dialysis have left (independent of the actual facts and circumstances) a lasting impression among doctors and health policy makers. They have come to view the NHS as a system which is in desperate need …
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