There are extrinsic as well as intrinsic limits to the resources avail
able for health care. Therefore, economic factors have become an essen
tial part of medical activity, leading to a disruption of the traditio
nal doctor-patient relationships. A new economic approach of health ca
re (ie, through managed care) and ethical attitude (to overcome the li
mits of managed care) are essential, especially in psychiatric practic
e.