title: [Impact of rationing on health care during the last years of life].
abstract: Old-age-based rationing of health care takes places both implicitly and explicitly. Its effects show on an emotional level and it affects medical practice. A distinction is made between explicit and implicit health care rationing. For example, performing fewer human organ transplants can be regarded as explicit rationing. Implicit or soft rationing may arise through either an undersupply of medical and nursing staff or through an oversupply of medical care as a consequence of the DRG bonus system. In this way an underlying and misleading incentive for an oversupply of diagnoses and treatments is created while at the same time the pressure is increased to reduce the length of hospital stay. Consequently, patients especially miss out on what they need most at this late stage of life: care and time to care. There are no clear rules for old-age-based health care rationing, which undermines the credibility of the health care system.
authors.affiliation: jonitz@aerztekammer-berlin.de
authors.forename: Günther
authors.initials: G
authors.lastname: Jonitz
mesh_terms: D000368:Aged; D005858:Germany; D015276:Health Care Rationing / Q000639:trends*; D006299:Health Services for the Aged / Q000592:standards* / Q000639:trends*; D006801:Humans; D007902:Length of Stay; D013727:Terminal Care / Q000592:standards* / Q000639:trends*