Abstract

Definition of the problem: Rationing medical health care has been debated in the industrialized Western hemisphere for at least two decades. Many factors have contributed to the fact that medical care can no longer be provided free of charge, which used to be an explicit political goal in all countries with a well-established welfare system. Considerable shortage of public financial resources is now generally accepted to pertain also to the health care system. Arguments: So far, efforts have been made to rationalize various medical procedures both with regard to specific medical treatment strategies and to administrative support processes. However, these means are limited in their effects to curb medical costs at a significant level. Thus, rationing medical health care is necessary to further enable the reimbursement system to cover expensive diagnostics and treatment that would exceed the individual’s capability to pay. Rationing can occur explicitly or implicitly. Implicit rationing has to be regarded as an unfair procedure and should be rejected on ethical grounds. Conclusion: Distributive justice in medical care can only be accomplished if the reimbursement system is based on a new theoretical foundation. This entails a stronger emphasis on individual responsibility for one’s own life and health and the insight that health is an individual rather than a collective good. Nevertheless, a mutual insurance-based collective health care system should not be abolished as long as it is thoroughly reformed. As a minimum requirement, it must provide incentives to spend money on preventive health measures