Published 9 October 2008, doi:10.1136/bmj.a1872
Cite this as: BMJ 2008;337:a1872

Analysis

Moving forward on rationing: an economic view

¹ Institute of Health and Society, Newcastle University, Newcastle upon Tyne NE2 4AA , ² University of Calgary, Calgary, Canada, ³ North Yorkshire and York Primary Care Trust, Harrogate HG2 8RE, ⁴ Vancouver Island Health Authority, Victoria, British Columbia, Canada , ⁵ Faculty of Medicine, University of British Columbia, Canada

Twelve years ago (BMJ 1996;312:1553-4) the BMJ argued that health systems needed to be explicit about rationing and published articles describing different ways of rationing fairly. Here a clinician (doi:10.1136/bmj.a1846), two ethicists (doi:10.1136/bmj.a1850), and four health economists discuss how their ideas have developed—and been put into practice—since then

The first 150 words of the full text of this article appear below.

Economists normally propose markets for rationing of goods. However, we know markets do not work well for health care.^{1 2} But the creation of publicly funded healthcare systems, in recognition of such market failure, does not get rid of scarcity. To sustain publicly funded health care and prevent moves back towards more market based systems, societies need to wake up and tackle rationing through explicit recognition and management of scarcity.

Management of scarcity requires two things. The first is to eliminate waste (where opportunities exist to meet a need at less cost, or meet more need at no extra cost, we should take them). Beyond this, we need to consider relative value (disinvesting from interventions providing little benefit to fund those providing greater benefit). Box 1 outlines a framework for doing this.³ It can be applied wherever scarcity of resources is a problem. This framework tends to be known as programme . . . [Full text of this article]

Context
Decision making
Context
Making decisions

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Priority setting needs strong leadership

Jonathan V Howell
BMJ 2008 337: a2386. [Extract] [Full Text]

It’s the evidence, stupid

Fiona Godlee
BMJ 2008 337: a2119. [Extract] [Full Text]

Why Oregon went wrong

Vidhya Alakeson
BMJ 2008 337: a2044. [Extract] [Full Text]

Where are we in the rationing debate?

Susan Dorr Goold and Nancy M Baum
BMJ 2008 337: a2047. [Extract] [Full Text]

Clinical priority setting

Ole Frithjof Norheim
BMJ 2008 337: a1846. [Extract] [Full Text]

Accountability for reasonableness: an update

Norman Daniels and James E Sabin
BMJ 2008 337: a1850. [Extract] [Full Text]

Using economics to set pragmatic and ethical priorities

Stuart Peacock, Danny Ruta, Craig Mitton, Cam Donaldson, Angela Bate, and Madeleine Murtagh
BMJ 2006 332: 482-485. [Full Text] [PDF]

Programme budgeting and marginal analysis: bridging the divide between doctors and managers

Danny Ruta, Craig Mitton, Angela Bate, and Cam Donaldson
BMJ 2005 330: 1501-1503. [Extract] [Full Text] [PDF]

National Institute for Clinical Excellence and its value judgments

Michael D Rawlins and Anthony J Culyer
BMJ 2004 329: 224-227. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Hansen, P. (2009). Commentary on 'What is a priority?' by Paul Spicker. J Health Serv Res Policy 14: 117-118 [Full text]  
• Howell, J. V (2008). Priority setting needs strong leadership. BMJ 337: a2386-a2386 [Full text]  
• Goold, S. D., Baum, N. M (2008). Where are we in the rationing debate?. BMJ 337: a2047-a2047 [Full text]  

Rapid Responses:

Read all Rapid Responses

A less complex contribution.

Steven Ford
bmj.com, 23 Oct 2008 [Full text]

PBMA or HTA is no choice at all

Christopher J. McCabe, et al.
bmj.com, 13 Nov 2008 [Full text]

Online poll

Find out more >>