Private inpatient psychiatric care.

A recent leading article on Private In-patient Psychi atric Care by Isaac Marks & Graham Thornicroft ( 1990)generated a flurry of indignant responses from colleagues working in the private sector (White et al, 1990). So far as I could tell, the leader contained neither factual errors nor rash statements yet such discussions always generate an emotive response. I am committed to the concept of a health care system, available to all regardless of ability to pay and providing comprehensive continuous, effective, humane and continuous care to all of those in need. At the same time I am convinced that no society has the resources to provide care on demand without some form of rationing, of which ability to pay is one. Another approach to rationing is demand limi tation. In Britain an effective mechanism for achiev ing this has been the general practitioner or primary care service which provides the filters so elegantly described by Goldberg & Huxley (1980). In the general population about 250 per 1,000 have some detectable psychiatric morbidity, some 230 attend the general practitioner of whom 140 are recognised as having conspicuous psychiatric morbidity. Only 17 reach the psychiatric services and six become in-patients. The correlations between 'seriousness' or 'severity'