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Three quarters of German intensive care doctors and cardiologists admit to rationing treatment

BMJ 2009; 338 doi: (Published 22 June 2009) Cite this as: BMJ 2009;338:b2542
  1. Annette Tuffs
  1. 1Heidelberg

A survey that found that 77% of German doctors who work in intensive care or cardiology have withheld treatment from a non-private patient at least once in the previous six months has reignited the debate about healthcare rationing in Germany.

The study, by ethicists from the Universities of Tübingen, Hannover, and Berlin, was published in a recent issue of the Deutsche Medizinische Wochenschrift (2009;134:1261-6, doi:10.1055/s-0029-1225273).

In May the call by Jörg-Dietrich Hoppe, president of the German Medical Association, for a list of diseases to be established for which patients should pay for diagnostic procedures and treatment was heavily attacked by politicians and health insurance companies (BMJ 2009;338:b2045, 20 May, doi:10.1136/bmj.b2045).

In the new national survey, which was funded by a government grant, 1137 randomly selected doctors working in cardiology or critical care medicine were asked to complete a questionnaire, of whom 507 (45%) responded. Of these, 77% said that at least once in the previous six months they had withheld a potentially beneficial treatment from a patient and substituted a cheaper but less effective treatment. However, only a minority, 13%, said that this happens often. Slightly more cardiologists admitted to rationing than intensive care doctors (79% versus 76%).

Most of the respondents said that cost pressures had a negative effect on their work satisfaction and their relations with patients. They did not see a way to reduce treatment costs without sacrificing quality of health care. More than half said that the healthcare system should receive additional funding, either through higher contributions to statutory health insurance schemes or higher spending by patients out of their own pockets.

The study’s senior author, Georg Marckmann, assistant professor in the Institute for Ethics and History of Medicine at the University of Tübingen, Baden-Württemberg, concluded that physicians needed support in making inevitable rationing decisions at the bedside. “Doctors should not have to decide every individual case,” he said.

Three quarters of the doctors would welcome such guidelines, the survey found. Guidelines could be developed on an ethical basis, said Professor Marckmann, but because rationing has become such a dirty word among the public, a constructive discussion was impossible.

In response to the study the German health ministry said that the health system had adequate funds and that budgets had been raised recently.


Cite this as: BMJ 2009;338:b2542

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