Skip to main content
SpringerLink
Log in
Book cover

Regulatory and Economic Aspects in Oncology pp 189–205Cite as

Prioritization not Rationing in Cancer Care

  • Chapter
  • First Online:

Part of the book series: Recent Results in Cancer Research ((RECENTCANCER,volume 213))

Abstract

Conditions of scarcity impact healthcare services for cancer patients. This is the unpleasant reality for nations, local governments, hospitals, and even individual doctors. This means that medical services judged by objective standards as potentially effective by medical professionals are limited because of financial or access scarcity. With this situation of scarcity as premise, one must raise the ethical question of how to deal with scarcity while respecting fundamental principles of human dignity and human rights. This chapter focuses on the German healthcare context where dignity and rights form the basis and framework for medical ethics. Accordingly, in Germany, rationing medical services for life-threatening diseases has been traditionally and appropriately criticized and prohibited. Granting a situation of scarcity, however, some prioritization becomes increasingly necessary. Thus, there is present need for careful ethical analysis of non-emergency regulatory prioritization principles and protocols. Above all, analysis and conclusions must preserve and foster society’s deepest moral commitments.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Notes

  1. 1.

    The article covers with much greater elaboration the same ground as Knoepffler (2015), Knoepffler and Daumann 2017: 105–113.

References

  • Aggarwal A, Ginsburg O, Fojo T (2014) Cancer economics, policy and politics: what informs the debate? Perspectives from the EU, Canada and US. J Cancer Policy 2:1–11

    Article  CAS  Google Scholar 

  • Anassi E, Ndefo UA (2011) Sipuleucel-T (provenge) injection: the first immunotherapy agent (vaccine) for hormone-refractory prostate cancer. Pharm Ther 36:197–202

    Google Scholar 

  • Bundesärztekammer (German Medical Association) (2010) Pressemitteilung der Bundesärztekammer: Hoppe: “Wir brauchen einen Sozialpakt für die Zukunft”. Dresden

    Google Scholar 

  • Chapman PB, Hauschild A, Robert C et al (2011) Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med 364:2507–2516

    Article  CAS  Google Scholar 

  • Cutler DM (2011) Where are the health care entrepreneurs? The failure of organizational innovation in health care. Innov Policy Econ 11:1–28

    Article  Google Scholar 

  • Dartmouth Atlas Project (2007) Supply-sensitive care: topic brief. Dartmouth Institute for Health Policy and Clinical Practice Lebanon, New Hamshire

    Google Scholar 

  • Deutscher Ethikrat (2011) Medical benefits and costs in healthcare: the normative role of their evaluation—opinion. Berlin

    Google Scholar 

  • Diederich A, Du Bois G, Dörr D (2015) Eine qualitative Studie zur Priorisierung medizinischer Leistungen in der Onkologie: Präferenzen und Kriterien unterschiedlicher Stakeholdergruppen. In: Priorisierung in der Medizin FOR 655 Nr. 40/2015

    Google Scholar 

  • Dietz A (2011) Gerechte Gesundheitsreform? Ressourcenvergabe in der Medizin aus ethischer Perspektive. Campus, Frankfurt

    Google Scholar 

  • Ellis R, Fernandez J (2013) Risk selection, risk adjustment and choice: concepts and lessons from the Americas. Int J Environ Res Public Health 10:5299–5332

    Article  Google Scholar 

  • Enthoven AC (1993) The history and principles of managed competition. Health Aff 12:24–48

    Article  Google Scholar 

  • German Medicines Commission (Juni 2012) zitiert nach. http://www.akdae.de/Arzneimitteltherapie/NA/Archiv/2012034-Zelboraf.pdf (zuletzt eingesehen 26 Feb 2015)

  • Gigerenzer G (2013) Risiko: Wie man die richtigen Entscheidungen trifft. C. Bertelsmann Verlag, München

    Google Scholar 

  • Greiner W, Knittel M (2011) Economic potentials of indvidualized medicine. PharmacoEconomics Ger Res Art 9:45–54

    Article  Google Scholar 

  • Guttmacher AE, Collins FS, Drazen JM (2004) Genomic medicine. Johns Hopknis University Press, Baltimore

    Google Scholar 

  • Hatz MHM, Schremser K, Rogowski WH (2014) Is individualized medicine more cost-effective? A systematic review. PharmacoEconomics 32:443–455

    Article  Google Scholar 

  • Kim H, Rajagopalan MS, Beriwal S et al (2015) Cost-effectiveness analysis of single fraction of stereotactic body radiation therapy compared with single fraction of external beam radiation therapy for palliation of vertebral bone metastases. Int J Radiat Oncol Biol Phys 91:556–563

    Article  Google Scholar 

  • Knoepffler N (2008) Justice for cancer therapy. In: O’Malley M, Klemm A (eds) Cancer research is a social endeavor. Utz Verlag, Munich, pp 67–80

    Google Scholar 

  • Knoepffler N (2004) Menschenwürde in der Bioethik. Springer, Heidelberg

    Book  Google Scholar 

  • Knoepffler N (2015) Priorisierung oder Rationierung in der Onkologie. Der Onkologe 2015(8):717–723

    Article  Google Scholar 

  • Knoepffler N, Daumann F (2017) Gerechtigkeit im Gesundheitswesen. Alber Verlag, Freiburg

    Google Scholar 

  • Larkin J, Ascierto PA, Dréno B et al (2014) Combined vemurafenib and cobimetinib in BRAF-mutated melanoma. N Engl J Med 371:1867–1876

    Article  Google Scholar 

  • Oberender P, Zerth J (2014) Selektivverträge als „ökonomischer Kern“ der Solidarischen Wettbewerbsordnung, in: Cassel/Jacobs/Vauth/Zerth (Hrsg.): Solidarische Wettbew-erbsordnung. Genese, Umsetzung und Perspektiven einer Konzeption zur wettbewerblichen Gestaltung der Gesetzlichen Krankenversicherung, Heidelberg, S. 173–198. In: Cassel D, Buchner F, Jacobs K (eds) Solidarische Wettbewerbsordnung: Genese, Umsetzung und Perspektiven einer Konzeption zur wettbewerblichen Gestaltung der gesetzlichen Krankenversicherung. Medhochzwei, Heidelberg, pp 173–198

    Google Scholar 

  • Oberender P, Zerth J, Engelmann A (2016) Wachstumsmarkt Gesundheit. UVK, Munich

    Google Scholar 

  • Olsen JA (2011) Concepts of equity and fairness in health and health care. In: Glied S, Smith PC (eds) Oxford handbook of health economics. Oxford University Press, Oxford, pp 814–836

    Google Scholar 

  • O’Malley MJ (2013) Value ethics: a meta-ethical framework for emerging sciences in pluralistic contexts. In: Baumbach-Knopf C, Achatz J, Knoepffler N (eds) Facettn der Ethik. Königshausen Neumann, Würzburg, pp 71–90

    Google Scholar 

  • Perry PA, Hotze T (2011) Oregon’s experiment with prioritizing public health care services. AMA J Ethics 13:241–247

    Google Scholar 

  • Schüller A (2002) Sozialansprüche, individuelle Eigentumsbildung und Marktsystem. ORDO 53:59–110

    Article  Google Scholar 

  • SOU (1995) Priorities in health care. Ethics, economy, implementation: final report by the Swedish parliamentary priorities commission (Vårdens svåra val). In: Socialdepartementet (ed), Stockholm

    Google Scholar 

  • Temel JS, Greer JA, Muzikansky A et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:733–742

    Article  CAS  Google Scholar 

  • Weissberger D (2008) Rationierung in der Gesetzlichen Krankenversicherung Deutschlands. Verlag P.C.O, Bayreuth

    Google Scholar 

  • Zentrale Ethikkommission (ZEKO) bei der Bundesärztekammer (2007) Priorisierung medizinischer Leistungen im System der Gesetzlichen Krankenkassen (GKV): Beratungsergebnis (Stand 19 Aug 2017). Berlin

    Google Scholar 

  • Zerth J (2015) Ökonomische Rahmenbedingungen und medizinische Indikation (Hrsg.):, Kohlhammer, Stuttgart, S. 125–140. In: Dörries A, Lipp V (eds) Medizinische Indikation: Ärztliche, ethische und rechtlicher Perspektiven. Kohlhammer, Stuttgart, pp 125–140

    Google Scholar 

Download references

Acknowledgements

Jan Schildmann, Wilhelm Löhe Hochschule, Fürth, Germany, Eefje Barber, Fockbek, Germany

Author information

Authors and Affiliations

  1. Friedrich Schiller University, Jena, Germany

    Nikolaus Knoepffler & Martin O’Malley

  2. Wilhelm Löhe Hochschule, Fürth, Germany

    Jürgen Zerth

Authors
  1. Nikolaus Knoepffler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jürgen Zerth
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin O’Malley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nikolaus Knoepffler .

Editor information

Editors and Affiliations

  1. Institute for Pharmaeconomic Research, Vienna, Austria

    Evelyn Walter

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Knoepffler, N., Zerth, J., O’Malley, M. (2019). Prioritization not Rationing in Cancer Care. In: Walter, E. (eds) Regulatory and Economic Aspects in Oncology. Recent Results in Cancer Research, vol 213. Springer, Cham. https://doi.org/10.1007/978-3-030-01207-6_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-01207-6_12

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-01206-9

  • Online ISBN: 978-3-030-01207-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation