Raspe H
Institut für Sozialmedizin, Universität und Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2010 Sep;53(9):874-81. doi: 10.1007/s00103-010-1112-1.
While setting priorities in healthcare has been discussed internationally for about 25 years, attempts to even start a discussion in Germany have failed for more than a decade. On the contrary, the topic was and still is actively suppressed. In this respect, one helpful mechanism is to deliberately or carelessly confuse prioritization with rationing, a German taboo-word. The national healthcare debate again and again neglects the question on what to spend Germany's still very considerable resources. This helps our health politicians to continue to live the postulate that everybody should have immediate, unrestricted access to all medically indicated healthcare. Attempts to distinguish between priority setting and rationing as two entirely distinct programs based on prioritization models from Sweden, England, and Oregon/USA are presented. While discussing possible objects, levels, criteria, ethics, and normative implications of priority setting in healthcare, recent recommendations of a permanent vaccination committee (STIKO) are used as an example.
虽然在国际上，医疗保健中的优先事项设定已被讨论了约25年，但在德国，甚至连开启相关讨论的尝试在十多年里都以失败告终。相反，这个话题过去被、现在仍然被积极压制。在这方面，一个有用的机制是有意或无意地将优先排序与配给（德语中的禁忌词）混为一谈。德国全国性医疗保健辩论一次又一次地忽略了关于如何使用德国仍然相当可观的资源这一问题。这有助于我们的卫生政策制定者继续秉持这样的假设，即每个人都应该能够立即、不受限制地获得所有医学上建议的医疗保健服务。本文介绍了基于瑞典、英国以及美国俄勒冈州的优先排序模型，将优先事项设定和配给区分为两个完全不同的项目的尝试。在讨论医疗保健中优先事项设定的可能对象、层面、标准、伦理以及规范影响时，以常设疫苗接种委员会（STIKO）最近的建议为例。
