[Priorization in healthcare. An important duty, an unnecessary luxury, or playing with fire? A sociomedical point of view].
While setting priorities in healthcare has been discussed internationally for about 25 years, attempts to even start a discussion in Germany have failed for more than a decade. On the contrary, the topic was and still is actively suppressed. In this respect, one helpful mechanism is to deliberately or carelessly confuse prioritization with rationing, a German taboo-word. The national healthcare debate again and again neglects the question on what to spend Germany's still very considerable resources. This helps our health politicians to continue to live the postulate that everybody should have immediate, unrestricted access to all medically indicated healthcare. Attempts to distinguish between priority setting and rationing as two entirely distinct programs based on prioritization models from Sweden, England, and Oregon/USA are presented. While discussing possible objects, levels, criteria, ethics, and normative implications of priority setting in healthcare, recent recommendations of a permanent vaccination committee (STIKO) are used as an example.
Raspe
H
H
Institut für Sozialmedizin, Universität und Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck. heiner.raspe@uk-sh.de
D001675:Bioethics / Q000639:trends; D003363:Cost Control / Q000191:economics / Q000639:trends; D003431:Cross-Cultural Comparison; D003695:Delivery of Health Care / Q000191:economics / Q000639:trends; D005544:Forecasting; D005858:Germany; D015276:Health Care Rationing / Q000191:economics / Q000639:trends*; D006292:Health Priorities / Q000191:economics / Q000639:trends*; D006297:Health Services Accessibility / Q000191:economics / Q000639:trends; D006801:Humans; D009313:National Health Programs / Q000191:economics / Q000639:trends*