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Health economics issues primarily concern the efficient and equitable use of resources in the healthcare system. They become particularly urgent in times of scarcity and in situations of considerable economic pressure. In Germany, the focus of health economics is on ensuring fair access to medical services under the conditions of a solidarity-based healthcare system. The claim that everyone should have access to all medically necessary services is becoming increasingly difficult to realise, even in this country. This is not only due to rising costs incurred, for example, by expensive diagnostic and therapeutic procedures, but also due to factors such as the shortage of specialised medical personnel and demographic change.
Debates about prioritising or rationing medical services raise fundamental questions about economic allocation criteria and their ethical justification. Such questions came up with unusual urgency during the COVID-19 pandemic, for example regarding the fair distribution of intensive care resources (“triage”) or the prioritisation of vaccination. The fact that preventive measures provided for in pandemic plans had not been sufficiently realised emphasises the general importance of allocating adequate resources to prepare for medical disasters and emergencies.
Other normatively challenging health economics issues concern the desirable proportion of the overall budget of a public health system to be set aside for funding research and development of medical innovations. For example, does an allocation of funds which is strictly aiming at maximising overall medical benefits inevitably lead to unfair disadvantages for those affected by rare diseases? Given that approaches of personalised or individualised medicine hold great therapeutic promise, how should their development and introduction be assessed? The promises have to be weighed against the considerable economic and normative risks of these approaches, because the demand for more and more individualised medicine could lead to a cost explosion and, gradually, to the introduction of a two-tier healthcare system.
