The rationing of medical care is inevitable. The economic term "rationing" describes in a value-neutral manner that goods and services have to he withhold if financial means are limited. A changing demographic structure of society, rising expectations of patients as well as relatives and medical-technological progress are the main reasons for the rising rationing pressure and these developments can, if at all, be influenced only to a minor degree. Rationalization, i.e. to increase efficiency is a prerequisite before any rationing should be initiated and it often combines cost-savings with improved patient care. Rationalisation, however, cannot render rationing unnecessary. Rational should take place in an explicit manner, with open discussions and comprehensible modes of discussion. One has to ask. a) which ideas about justice prevail in a society, b) which philosophical theory could provide a widely accepted and coherent basis for a rationing calculus and c) how a theoretical model can be transformed into application social politics and decision modes.
