Rationing

In general parlance is meant by rationing the allocation of limited existing goods or services.

Rationing is a state-ordered subpoena (issue of food stamps, etc.) ( etc. war, economic crisis, famine, disaster, epidemic ) is usually only in times of need apply. Rationing measures shall be within the limits of the fundamental right.

Economics

In economics, rationing may occur if the price mechanism or other reasons not lead to a balancing of supply and demand. If demand is greater than supply ( excess demand ), the demanders are rationed ( correspondingly reversed when excess supply ). A rationing mechanism ensures an appropriate division. An example is the allocation of scarce food in times of need through food stamps or the allotment of shares as a result of over-subscription in the issue of securities or in the trading of securities on the exchange. Here is the price notation "r" rationiert / scaling down used on the course overview.

Health service

Rationing in health care is a downstream decision of the prioritization of medical services. By prioritizing created a ranking by which identify useful medical services and less meaningful benefits may be rationed.

The reasons for rationing in health care are often financial restrictions, or limited resources called.

As part of the discussion about the rationing of medical services different types of rationing are presented below:

Primary / Secondary: Due to financial shortage, the state is forced to set a reasonable share of total spending on health care. Thus an intention accepted shortage of medical services, as the available budget is limited. This decision - taken by the state and health care - is called the primary rationing and involves determining the quantity available. To some extent, this also spoken by indirect rationing, since no person, but a resource-related rationing is meant.

The secondary is then rationing within the health system. This is about the financial allocation to specific medical areas as well as on the allocation of resources to the patients themselves in this context is often spoken of the direct form of rationing; the physician decides on a case on the ground that the respective patient receives a specific benefit.

Hard / Soft: Another differentiation is the word pair hard and soft. In the hard rationing purchase of medical services is not possible. It is forbidden by law to purchase additional services in personal responsibility and with its own financial resources. Thus, a full supply of equality of all stakeholders be ensured.

In contrast, there is at the soft rationing a legal market for the procurement of medical supplies that are not funded by the state. In Germany, this allows private insurance, or self-financing of medical services. Critics in the soft rationing that not wealthy members of society are disadvantaged.

Explicit / Implicit: From the explicit rationing is not the result the establishment of policy shall be published by means of which, what services may offer doctors and what. Patients are given specific information about the criteria or rules that contribute to the decision of the rationalization question. Therefore, this form of rationing is also referred to as open.

In contrast, the patient is experiencing and the implicit, or hidden, rationing not know whether resources are withheld from him because of rationing. The decision is delegated without prior public debate to the doctors who are required to implement this decision.

Another temporal form of rationing are queues. This is not about monetary cost, but time costs - which are required to take a medical service in claim can - to save.

In view of the growing conflict between medical progress on the one hand and the limited financial resources on the other hand, rationing has become increasingly a topic of scientific and public debate. For example, said in 2011, the outgoing president of the German Medical Association, Jörg- Dietrich Hoppe: "We will use in the German Medical Association a working group to continue to the topic prioritization in medicine The working group will develop proposals as a prioritization can be implemented We doctors. . will take the issue of prioritization in the hand, because politics has thus far refused to address this issue. "

This is particularly discussed

• Ethical and legal aspects of rationing,
• Socially acceptable eligibility criteria and
• Method for prioritization of indications, procedures or patient groups

The rationing debate in other countries - particularly in the UK, the Netherlands, Sweden and Denmark - more advanced. There rationing or prioritization of certain medical services is practiced.

The Federal Joint Committee G -BA is debated to no longer offer services where the cost-benefit ratio systems (COS ) is too bad. The determination of the KNV a medical service for individual patients, for groups of cases and / or for society ( economic benefit ) is difficult and often controversial.

A famous example of rationing in health care policy offered in 1987 in the U.S. state of Oregon. It should there be introduced the entire population of health insurance that covers without increasing the total cost of Medicaid. This was only possible with a reduction of the power scale. Instead, for example, Organ transplantation in children were therefore financed in future screening tests in low-income pregnant women and children - with the risk that some children were severely affected due to failure to carry out transplants. The holistic approach was adopted in the priority list for all medical measures.

For the needs of an aging population with an increasing burden of disease limited financial and human resources are available. In Germany, the public health insurance financed with six per cent of gross domestic product ( as of 2010) to supply approximately 70 million people. Medical practitioners have capped budgets; when many practices end of the quarter include ( "Holiday" ), this is also a form of rationing.

Trade

After sugar hoarding due to the large difference in price, the sale was rationed in April 2011 at the German - Polish border area with several grocers.

Demarcation

Rationing is not to be confused with rationalization.