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Distributing medical resources

An application of cooperative bargaining theory to an allocation problem in medicine


Antje Köckeritz

Allocating scarce medical resources has become an important topic in public discussion. In the German statutory health system we are facing a situation of lacking adequate funds for all needs. The financial restrictions force us to use resources wisely. This emphasizes the need of general allocation rules and criteria applied in medical allocation situations. The purpose of this work is to implement and interpret properties of cooperative bargaining theory to special allocation situations in medicine. The author shows how the concepts of Nash and Kalai/Smorodinsky can be applied to a medical allocation problem and discusses implications of their properties and solutions for the German health system.


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1 Motivation


In the German statutory health system (GKV) allocating medical resources and keeping finances for medical goods and services in balance has become a strenuous task. Over the past years the increasing number of examination methods and medications as well as the aging of population intensified the trade- off in allocating financial resources to different medical areas. Tragic choices, when medical therapies suffice to treat only a fraction of patients are indeed very common, for example, in intensive care, dialysis treatment, and organ allocation. In following years, as technological progress and demographic change proceed, the competition over medical resources is expected to become even more intense. Therefore, it is important to find fair distribution mechanisms that may eloquently solve the medical allocation problems about scarce resources. Ways to deal with restricted resources for medical goods are manifold: to cut or to withhold services such as nursing time or waiting time for a doctor’s appointment, to increase contribution fees or co-payments, to give incentive to private insurance. So far, the German statutory health system has experienced different changes in selected medical areas. For example, in dental care we have defined minimal services and a system of co-payments and an incentive to private insurance. In a health system with restricted financial resources, several alternatives of keeping the system in balance may be introduced. Yet it is important to understand the consequences of underlying allocation rules their solutions and properties in order to apply in specific medical allocation situations. The question is, which rule...

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