Daniel Strech1. 1. Institut für Geschichte, Ethik und Philosophie der Medizin, Zentrum Öffentliche Gesundheitspflege, Medizinische Hochschule Hannover (MHH), Hannover, Germany. strech.daniel@mh-hannover.de
Abstract
BACKGROUND: In addition to empirical forecasts on the extent of the current and future limitations on health care resources, empirical data on the status quo of bedside rationing play a significant role in developing suitable alternatives in dealing with limited financial resources. MATERIALS AND METHODS: This article presents and discusses selected results of the international and German survey research on bedside rationing. RESULTS: Survey studies among physicians could prove world-wide that rationing decisions are made already today by individual physicians in the in- and out-patient services. In German hospitals, rationing is also a wide-spread though non-transparent and not (yet) very common phenomenon for an individual physician. Varying criteria for bedside rationing contribute to the fact that the current approach to bedside rationing leads to dissatisfaction on the part of physicians and to a potential disadvantage of certain patient groups. CONCLUSIONS: Explicit, i.e. transparent and systematic, ways of rationing could remedy these deficiencies and are therefore clearly preferable in this context. However, further specification of the methods of explicit rationing and a critical evaluation of their application in practice are needed. Moreover, it is mainly the quality of the underlying evidence that determines whether or not the actual decisions become more reasonable and fair by means of more explicit rationing approaches.
BACKGROUND: In addition to empirical forecasts on the extent of the current and future limitations on health care resources, empirical data on the status quo of bedside rationing play a significant role in developing suitable alternatives in dealing with limited financial resources. MATERIALS AND METHODS: This article presents and discusses selected results of the international and German survey research on bedside rationing. RESULTS: Survey studies among physicians could prove world-wide that rationing decisions are made already today by individual physicians in the in- and out-patient services. In German hospitals, rationing is also a wide-spread though non-transparent and not (yet) very common phenomenon for an individual physician. Varying criteria for bedside rationing contribute to the fact that the current approach to bedside rationing leads to dissatisfaction on the part of physicians and to a potential disadvantage of certain patient groups. CONCLUSIONS: Explicit, i.e. transparent and systematic, ways of rationing could remedy these deficiencies and are therefore clearly preferable in this context. However, further specification of the methods of explicit rationing and a critical evaluation of their application in practice are needed. Moreover, it is mainly the quality of the underlying evidence that determines whether or not the actual decisions become more reasonable and fair by means of more explicit rationing approaches.