BMJ 1995;311:811 (23 September)

Letters

Rationing: the case for "muddling through elegantly"

EDITOR,--Chris Ham's editorial on health care rationing1 misrepresents my position on the issue. He suggests that I subscribe to an approach to rationing by muddling through. My actual position is rather more subtle, hence the description "muddling through elegantly." I emphasise "elegantly" because I do not seek to defend the previous closed system, in which resource allocation decisions were often dressed up as clinical ones and hidden from public scrutiny.

I, too, support greater transparency in decision making, but I don't believe discussions about rationing can be tackled effectively or sensibly in a national debate. Muddling through elegantly starts from the premise that rationing will always be a messy affair. The choice confronting policy makers is as follows: does the inevitability of micro level rationing mean a continuation of the kind of diffuse, largely invisible, kind of rationing that has characterised the NHS, or is there a need to find . . . [Full text of this article]


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Relevant Article

Health care rationing
Chris Ham
BMJ 1995 310: 1483-1484. [Extract] [Full Text]

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