Rationing health care has until recently been a taboo subject in German politics. Hardly anyone was prepared to discuss openly the necessity and permissibility of an allocation of medical services. Very recently, this picture has changed dramatically. Today, to discuss the inevitability of rationing health care means to participate in an intense discussion and no longer breaks any taboos. The necessity and permissibility, but also the limits of rationing health care have become focal points for debate in both scientific and political circles. The article discusses constitutional limits of rationing health care in Germany. The article differentiates between two kinds of rationing. It firstly focuses on forms of indirect rationing, which may be the consequence and manifestation of political decisions regarding the total capacity of a public health care system. The article delineates the constitutional limitations German authorities have to consider when making capacity allocation within a given health care system. The article then looks at forms of direct rationing which occur when services in a situation of medical necessity or need are denied as a result of shortages in service capacity. Direct rationing occurs through the regulation of demand whereby condition treatment pairs indicate in which cases a medically indicated service will not be delivered due to scarcity. The article again determines the constitutional framework which authorities have to consider when rationing health care directly.