Rationalization (healthcare)
Under rationalization measures for efficiency and productivity growth meant that the exploitation of efficiency reserves allow. In economics, rationalization aims to increase the level of care with the same financial outlay or to maintain the level of care with less financial outlay. Measures should be chosen in such a way that they are appropriate to the target (effective) and at the same time lead to the target being achieved with the lowest possible resource consumption (efficient).
The medical concept of rationalization refers to organizational and administrative processes as well as therapeutic and diagnostic procedures. Profitability reserves can be exhausted by identifying and no longer carrying out processes and procedures that are ineffective, less effective than alternative measures with the same costs, or not more effective than cheaper means.
In addition to the continuous improvement process , it can also be about the cancellation of services, but only those that can be identified as strictly superfluous. The exact boundary between services that are strictly superfluous and those that are marginally effective or useful is difficult to determine and empirically and practically controversial. In addition, medical rationalization measures must not impair the quality of care or affect the interests of patients. You must not withhold anything that is necessary or useful, but merely prevent the waste of resources .
Limits to Medical Rationalization
Rationalization is one of the options to respond to the increasing scarcity of resources and increasing funding bottlenecks in the health system in Germany . It is assumed that there is still potential for rationalization in the health system, both in terms of structure and processes, but also in terms of the health services offered.
A critical view, however, sees rationalization efforts only as having a one-time effect on health expenditure , which is why the scarcity of resources cannot be remedied, but only reduced or mitigated. One difficulty with rationalization is that it is often methodologically complex, requires a structural change in the use of resources and has control deficits, which means that the economic reserves cannot all be used up immediately. Rationalization measures often lead to one-time, limited and time-shifted savings . Resource management often does not mean that the necessary changes to processes and structures are sought. It is therefore doubtful that the pure exhaustion of rationalization reserves can ensure that in the future all patients will have access to medical services to the extent that they are used to. As a result, one is forced to deal with the basic resources of the institutions against the background of rationing and prioritization of medical services .
Limits of ergonomics
Ergonomics wants to make a contribution to rationalization , with one goal of ergonomics being ergonomic work design , where it is important to ensure efficient and error-free work. In practice, however, there is a risk that the workload, both mentally and physically, will continuously increase due to rationalized and ergonomically optimized work processes and lead to overload.
Rationalization and rationing
In view of the solidarity-based financing system of the German health care system, one often finds the principle in health policy: Rationalization before rationing . This means, as long as there is potential for rationalization and efficiency reserves, rationalization must be carried out before political and social decisions about performance limitations have to be made. The Central Ethics Commission (ZEKO) at the German Medical Association warns against starting rationing, although rationalization reserves have not yet been exhausted, which can lead to certain patients being refused medical measures, while at the same time money is being spent that can be saved without disadvantaging the patient .
criticism
Apart from rationalization and rationing, there are approaches that see a solution to the seemingly natural scarcity of resources. They pursue the goal of further expanding the solidarity-based financing system and achieving redistributive effects. They consider the scarce resources available in the health sector to be "artificially" created, as the amount of the resource depends on the respective tax legislation. Based on Baumolschen's cost disease , these approaches assume that there are limits to rationalization in the health system and that these have already been largely reached. Rationalization in this area must therefore lead to a deterioration in the quality of care. In this approach, the solution to the problem of scarce resources lies neither in rationalization nor in rationing. The redistribution of resources from the productive to the so-called unproductive sector then appears to be the solution to the artificial scarcity of resources.
Individual evidence
- ↑ Rationalization, rationing and prioritization, what is meant Ch. Fuchs, E. Nagel, H. Raspe, Dtsch. Doctor bl. 2009; 106 (12): A-554 / B-474 / C-458.
- ↑ Ergonomic evaluation of work processes (PDF; 294 kB).
- ^ Statement by the Central Ethics Committee at the German Medical Association (PDF; 170 kB).
- ^ A b Karen Horn: No cure for the cost disease. Retrieved June 14, 2020 .
literature
- Walter A. Wohlgemuth, Michael H. Freitag (ed.): Prioritization in medicine . Medical Scientific Publishing Company, Berlin 2009, ISBN 978-3-939069-85-0 .
- Behnam Fozouni, Bernhard Güntert (Hrsg.): Conference volume " Setting priorities in the German health system" . Logos Verlag, Berlin 2002, ISBN 3-89722-870-X .
- Heinz Lohmann, Uwe Preusker (eds.): Prioritization instead of rationing: Securing the future of the health system . Economica, 2010, ISBN 978-3-87081-589-9 .
- Andreas Bäcker: Rationing and prioritization in health care . GRIN Verlag, 2010, ISBN 978-3-640-66624-9 .
- Hermes Andreas Kick, Jochen Taupitz (Ed.): Health care between economy and humanity . LIT Verlag, Münster 2005, ISBN 3-8258-8901-7 .