[Socioeconomic aspects as the limiting factor]. / Sozioökonomische Aspekte als limitierender Faktor.

Even a health system is no exception to the rule that resources are scarce, i.e. only limited financial means are at the disposal of the health sector and thus of medicine. Medically sensible possibilities and needs are constantly growing due to technological progress, i.e. a deficit occurs between possibilities and needs on one hand and financial resources on the other. This leads to a shift in the paradigms of medicine, with functional healthcare being the only feasible alternative to maximum care due to financial shortage. The scarceness of resources thus makes a sparing use of financial means paramount (rationalization) and necessitates the insight that not everything that is medically sensible can also be realized (rationing). All participants must be prompted by means of individual incentives to save costs. It is important that a provision of hardship is established for those who are economically weak. Rationing, i.e. the refusal of effective measures, should take place by waiting lists without any special arrangements for emergencies. Humanitarian reasons do not permit rationing by income or age. "Tight" rationing should occur if the chances of third persons within the system will thereby be diminished, whereas "loose" rationing would be the obvious thing to do, if the system will be relieved because of that.