[Distributive justice in healthcare during times of change: a medical ethics perspective].

Abstract

This paper examines existing funding structures and options for cost savings in the healthcare sector from the perspective of fairness. Funding via wage-related contributions with an income ceiling is criticised since other forms of income are not taken into account and the wealthy are relatively spared. The separation of statutory and private health insurance creates inequalities. Three options for savings are examined: avoiding unnecessary measures, increasing the efficiency of effective services, and prioritisation based on need, benefit, and cost. The advantages of the first two options over prioritisation are outlined, as are the respective responsibilities.