title: [Physicians caught between ethics and cost pressure].
abstract: In the second half of the 20th century rapid progress in medicine has led to qualitative improvement and quantitative expansion of the range of healthcare services. Premature death can be avoided in many cases--but the price to be paid often is the need for permanent care. This fact has been neglected in both the cost debate and in the efforts to reform the system. Rather, statutory health insurance serves as a second taxation system. As a result of the politically imposed limitation of resources a restriction of services is inevitable. However, this poses an ethical dilemma for the individual physician, as does the call for more economic competition which frequently results in quantity and speed becoming more important than safety. Patients are turned into work-pieces in the value chain of the healthcare industry. The dominance of economics jeopardises patient autonomy and the physician's freedom of decision leading to conflicts between medical liability law and social insurance law. Scarce resources must be geared to patients' healthcare needs. This calls for abandoning the politically driven provision of all-encompassing healthcare through the state, with a national insurance plan and regulated structures for funding healthcare provision that cripple personal initiative and self-responsibility.
authors.affiliation: Kaiserin-Friedrich-Stiftung. Karsten.vilmar@t-online.de
authors.forename: Karsten
authors.initials: K
authors.lastname: Vilmar
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000941:ethics; D004992:Ethics, Medical; D005858:Germany; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D016365:Liability, Legal / Q000191:economics; D010820:Physicians / Q000191:economics* / Q000941:ethics*; D013660:Taxes