Schildmann Jan, Tan Jacinta, Vollmann Jochen
Institut für Medizinische Ethik und Geschichte der Medizin, Ruhr-Universität Bochum, Bochum, Germany.
Onkologie. 2011;34 Suppl 1:20-4. doi: 10.1159/000323069. Epub 2011 Jan 17.
Costs for medical care and strategies to handle limited resources in health care are discussed in many European countries. Few empirical studies explore the oncologists' perceptions and views regarding economical aspects in clinical practice.
Semi-structured interviews with physicians working in oncology in Germany and England. For this paper, parts of the transcripts in which interviewees discuss economical aspects of clinical practice were analysed exploratively and according to principles of content analysis.
17 (Germany) and 12 (England) research interviews were analysed. German physicians described different forms of implicit rationing. The effects of economic considerations are judged as predominantly negative. Physicians working in England named concrete situations in which interventions are not performed because of cost considerations. The rationing of medical care was viewed as necessary in light of limited resources. The assignment of allocation decisions on the macro-level was favoured because of the resulting relief for the physician-patient relationship.
The narratives of interviewees in both countries differ regarding the perceptions and views on economical aspects in clinical practice. The specific approaches of each health care system towards the allocation of limited resources offer one basis for explanations of these differences.
