[Is there health care rationing in German hospitals? How exactly do we know and why should it not be the most important question?].

A questionnaire study, conducted by the authors among a representative sample of hospital doctors in Germany, showed that health care rationing in German hospitals is already a fact. But since the results were published in 2009 the validity of its findings has been questioned. This article provides empirical data to demonstrate that the findings are not biased to any significant extent by misunderstandings or political motivation of the responding doctors. There is thus an urgent need for action in support of medical professionals to make it possible for them to deal with implicit rationing and with the potential disadvantages to which vulnerable groups of patients may be exposed. Taking into account health opportunity costs, increased funding in the health sector should not be the primary demand. The availability and critical appraisal of scientific evidence on the risk/benefit ratio of medical interventions must first be improved in order to optimize the administration of scarce health care resources in a medically rational way so that it is ethically and legally acceptable as well as economically reasonable. Georg Thieme Verlag KG Stuttgart, New York.