Rationalisierung, Rationierung, Priorisierung: Terminologie und ethische Begründungsansätze zur Allokation bei begrenzten Ressourcen in der Hämatologie/Onkologie

Rationalization, Rationing, Prioritization: Terminology and Ethical
Approaches to the Allocation of Limited Resources in
Hematology/Oncology The field of oncology with its numerous
high-priced innovations contributes considerably to the fact that
medical progress is expensive. Additionally, due to the demographic
changes and the increasing life expectancy, a growing number of
cancer patients want to profit from this progress. Since resources
are limited also in the health system, the fair distribution of the
available resources urgently needs to be addressed. Dealing with
scarcity is a typical problem in the domain of justice theory;
therefore, this article first discusses different strategies to
manage limited resources: rationalization, rationing, and
prioritization. It then presents substantive as well as procedural
criteria that assist in the just distribution of effective health
benefits. There are various strategies to reduce the utilization of
limited resources: Rationalization means that efficiency reserves
are being exhausted; by means of rationing, effective health
benefits are withheld due to cost considerations. Rationing can
occur implicitly and thus covertly, e. g. through budgeting or the
implementation of waiting periods, or explicitly, through
transparent rules or policies about healthcare coverage. Ranking
medical treatments according to their importance (prioritization)
is often a prerequisite for rationing decisions. In terms of
requirements of justice, both procedural and substantive criteria
(e. g. equality, urgency, benefit) are relevant for the acceptance
and quality of a decision to limit access to effective health
benefits.