The demand for healthcare services is basically unlimited, for all life terminates with death, which is usually preceded by ill health. It is in addition unlimited because in the context of the general shift in values the general and scientific understanding of what is an illness in need of treatment and what is simply a variation of the state of health and wellbeing is changing. It is further unlimited because medical progress is always discovering new methods of treatment (propagated by medical need and also scientific curiosity). In the end it is unlimited because, thanks to general welfare and medical progress, the prevalence of chronic, i.e. long-term treatable illnesses, is on the increase. Parallel to principally unlimited demand is the "medical market", a supply dominated market, in which the patient, as a supplicant without competence, and naturally affected by vital interests, cannot be a fully autonomous customer (even if he is medically qualified). Therefore supply must determine demand. It is natural that the basically unlimited demand cannot be satisfied by unlimited resources, insofar as the latter are to be jointly and severally financed. The principles of budgeting are first outlined below, followed by the mechanics of healthcare budgeting. This is then followed by a critical review of the mechanics for guaranteeing maintenance of the budget. Finally, the necessity of prioritizing health and care aims with necessarily limited means is described, and an algorithm suggested.

Reprinted with Permission from Springer's Open Choice