[Dealing with bottlenecks in ambulatory patient care: experiences of an office-based statutory health insurance physician].

The present paper deals with the ambulatory care setting where regulation based on economic reasoning has led to rationing. Today medical practice can best be characterised by terms like health budget, medication budget, financial volume of total remuneration for medical services, medical fee complexes, and budgeting of diagnostic and therapeutic areas. Economic reasoning has thus found a foothold in ambulatory medicine. Separate services are absorbed by medical fee complexes: the financial volume of total remuneration for health care services leads to a limitation in the medical services provided to patients, and the medication budget helps curtailing therapeutic freedom. A two-class medicine seems to be emerging as shown by special service offerings (i.e., health care services not covered by statutory health insurance); conflicts will arise between doctor and patient.