[Rationalization versus rationing in surgery].

In the discussion on cost savings in public health, one can differentiate between rationalisation and rationing. In this context rationalisation means increase in productivity with reduced resources, or more efficient rationing of the available means in order to obtain sufficient room for manoeuvre in the public health system. By efficient use of the existing resources and adaptation to medically appropriate and necessary options one is able to define medical standards for treatment. These treatment standards enable the preservation of medical freedom of action as well as participation in scientific-technological progress with the help of consequent evaluation of treatment patterns. This process could result in the development of a so-called priorisation, i.e. active preference of certain indications or therapies, which correspond extensively to the expectations and priorities of all concerned persons. From the medical point of view explicit rationing of health performances has to be strictly rejected.