[Extent and impact of bedside rationing in German hospitals: results of a representative survey among physicians].
BACKGROUND
Healthcare rationing is increasingly discussed among German physicians. However, in contrast to the relatively intense debates on how to prioritize and ration on the macro level of the health system, there is hardly any discussion on how doctors can make the unavoidable rationing decisions on the micro level in a medically and ethically appropriate manner. The development of both accountable and feasible guidance requires empirical evidence about the prevalence of bedside rationing and a more in-depth understanding of the practical challenges.


METHODS
Based on the official German hospital registry a national survey was performed nationwide among 1,137 randomly selected physicians working in cardiology or critical care medicine.


RESULTS
68% of the respondents stated that they had already withheld from patients medical services with a potential benefit for the patient because of cost considerations. However, only few of them indicated that this happens often. The frequency of bedside rationing differed, in some cases significantly, in relation to specialty, professional status and hospital funding. The majority of clinicians describes a negative impact of cost pressure on their work satisfaction and on the patient-doctor relationship. German clinicians have become aware of only a few opportunities that would allow them to increase their efficiency with a view to avoiding healthcare rationing. Instead, more then 50 % of the doctors considered additional funding for the health care system, through higher contributions to the statutory health insurance or higher out-of-pocket spending by patients, to be an acceptable approach to dealing with scarce resources.


CONCLUSIONS
There is a need to develop explicit methods that support physicians in making inevitable rationing decisions at the bedside. Such methods must be accompanied by consultation procedures so that a rational and fair use of scarce health care resources is achieved.
Strech
D
D
Institut für Geschichte, Ethik und Philosophie der Medizin, Medizinische Hochschule Hannover, Hannover. strech.daniel@mh-hannover.de
Danis
M
M
Löb
M
M
Marckmann
G
G
D002309:Cardiology / Q000706:statistics & numerical data; D003422:Critical Care / Q000706:statistics & numerical data; D003625:Data Collection; D005858:Germany; D015276:Health Care Rationing / Q000191:economics / Q000941:ethics / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D007588:Job Satisfaction; D010817:Physician-Patient Relations / Q000941:ethics; D010820:Physicians / Q000941:ethics; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*