Strech Daniel
Institut für Geschichte, Ethik und Philosophie der Medizin, Zentrum Öffentliche Gesundheitspflege, Medizinische Hochschule Hannover (MHH), Hannover, Germany.
Onkologie. 2011;34 Suppl 1:16-9. doi: 10.1159/000323066. Epub 2010 Dec 27.
In addition to empirical forecasts on the extent of the current and future limitations on health care resources, empirical data on the status quo of bedside rationing play a significant role in developing suitable alternatives in dealing with limited financial resources.
This article presents and discusses selected results of the international and German survey research on bedside rationing.
Survey studies among physicians could prove world-wide that rationing decisions are made already today by individual physicians in the in- and out-patient services. In German hospitals, rationing is also a wide-spread though non-transparent and not (yet) very common phenomenon for an individual physician. Varying criteria for bedside rationing contribute to the fact that the current approach to bedside rationing leads to dissatisfaction on the part of physicians and to a potential disadvantage of certain patient groups.
Explicit, i.e. transparent and systematic, ways of rationing could remedy these deficiencies and are therefore clearly preferable in this context. However, further specification of the methods of explicit rationing and a critical evaluation of their application in practice are needed. Moreover, it is mainly the quality of the underlying evidence that determines whether or not the actual decisions become more reasonable and fair by means of more explicit rationing approaches.
除了对当前及未来医疗保健资源限制程度的实证预测外，关于床边配给现状的实证数据在制定应对有限财政资源的合适替代方案中发挥着重要作用。
本文展示并讨论了关于床边配给的国际及德国调查研究的部分结果。
针对医生的调查研究能够在全球范围内证明，如今门诊和住院服务中的个别医生已经在做出配给决策。在德国医院，配给也是一种普遍存在但不透明且（目前）对个别医生来说不太常见的现象。床边配给的标准各不相同，这导致当前的床边配给方式引起医生不满，并使某些患者群体可能处于不利地位。
明确的，即透明且系统的配给方式可以弥补这些不足，因此在这种情况下显然更可取。然而，需要进一步明确明确配给方法，并对其在实践中的应用进行批判性评估。此外，主要是基础证据的质量决定了通过更明确的配给方法实际决策是否会变得更合理和公平。
