The present volume is the result of a conference devoted to the topic of Rationing in Medicine, which was organized by the Europäische Akademie zur Erforschung von Folgen wissenschaftlich-technischer Entwicklungen Bad Neuenahr-Ahrweiler GmbH. One of the purposes of this volume is to contribute to a clarification of the concept of rationing and its possible implementations and thereby to help the participants in the debate to avoid further unnecessary confusion. Authors from the disciplines of medicine, philosophy, economics and law as well as practitioners of health care itself and from the field of health-care financing have contributed to this volume.

This paper represents the collaborative work of a game theorist and a policy analyst in an attempt to examine severa! questions that go to the hearl of the way individuala achieve social order. The capacity of any individual to undertake long-term, productive activities that affect and are affected by the actiona of other individuala dependa upon gaining a minimallevel of predictability among those involved. No one could successfully drive to work if the behavior of other drivera were noi relatively predictable. No one could operate a stare, if potential consumers did not purcha. se, rather than stea!, the commodities offered to the public. No one would ma. ke a. ny investments other than those tha. t would be made by a solitary individual in an isolated setting (the cla. ssic Robinson Crusoe situation). One of the ways that individuals achieve predictability in social arrangements is to a. gree to follow a set of normative prescriptions a. bout what they must, must not, or may do. Agreeing to a set of prescriptions is relatively easy. Actually following those prescriptions over time when temptations arise offering potentially high payoffs, is not at all easy. In natural settings, individUala follow agreed upon prescriptions to a greater or lesser extent depending on enforcement levels. A frequent assumption made by policy ana. lysts a. nd game theorists is tha. t enforcement is externa! to the situa. tion under analysis. That a.

This paper represents the collaborative work of a game theorist and a policy analyst in an attempt to examine severa! questions that go to the hearl of the way individuala achieve social order. The capacity of any individual to undertake long-term, productive activities that affect and are affected by the actiona of other individuala dependa upon gaining a minimallevel of predictability among those involved. No one could successfully drive to work if the behavior of other drivera were noi relatively predictable. No one could operate a stare, if potential consumers did not purcha. se, rather than stea!, the commodities offered to the public. No one would ma. ke a. ny investments other than those tha. t would be made by a solitary individual in an isolated setting (the cla. ssic Robinson Crusoe situation). One of the ways that individuals achieve predictability in social arrangements is to a. gree to follow a set of normative prescriptions a. bout what they must, must not, or may do. Agreeing to a set of prescriptions is relatively easy. Actually following those prescriptions over time when temptations arise offering potentially high payoffs, is not at all easy. In natural settings, individUala follow agreed upon prescriptions to a greater or lesser extent depending on enforcement levels. A frequent assumption made by policy ana. lysts a. nd game theorists is tha. t enforcement is externa! to the situa. tion under analysis. That a.

The book series on the ethics of science and technology assessment edited by the Europ?ische Akademie is devoted to the publication of the work-reports of its project groups, works on the foundations of ethics, the philosophy science, and other issues related to the work of the Europ?ische Akademie. In addition, the series comprises the proceedings of conferences organized by the academy. The 13th volume documents the proceeding of the academy's spring symposium in 2000 on Rationing in Medicine which was held in Bad Neuenahr-Ahrweiler on March 23-25, 2000. An intense discussion on the future of health care in Europe has been stimulated by increasing difficulties of securing adequate and needs orientated medical care in the face of scarce resources and medical progress. Un fortunately, quite of ten a rational discussion of rationing is drowned out by the politic al talk of the day. But only an open and well-informed debate, if anything at ali, can lead to transparent and just rationing procedures which eventually might be acceptable to the public at large. For this debate much can be learnt from observing the experiences other countries have made with their health care arrangements. What kinds of mistakes should be avoided and what might be useful in the different states and perhaps also in the supra-national context of an emerging Europe are interesting and important issues."