[Rationalisation, prioritisation and rationing: approaches to future health care delivery]

Complex developments are increasing the gap between the financial feasibility of the German health care system and new possibilities in diagnosis and therapy. Influencing factors, inter alia, include rapid medical progress, demographic and epidemiological trends and changing perceptions of health and illness. This raises the question of how a just allocation of scarce resources can be developed and implemented. Concepts such as rationalisation, rationing and prioritisation are being intensively discussed. In this paper definitions of and differentiations between these terms will be presented, which are often missing from the current debate. Furthermore, the need for action implying ethical and structural-political challenges will be outlined. In this regard, a sustainable process should focus on transparency, responsibility and public involvement.