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RESEARCH PRODUCT

Germany: Where Are We Going?

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Germany’s health policy, in the past, has tried to limit health expenditures by defining an overall health budget, by installing a DRG-system and by forcing patients to participate directly at health costs by demanding copayments. These measurements were somehow effective in keeping premiums stable but have led to resource allocation at the bedside and therefore on an implicit level. Yet, implicit-level decisions create ethical dilemmas for physicians as they not only have to deliver best medical care but shall also have cost in mind, are unjust because rationing criteria differ from one case to another, and create a general fear of legal uncertainty, in turn leading to defensive medicine with the overuse of inappropriate medical acts. Furthermore, they have no democratic legitimation.