Where are we in the rationing debate?

doi:10.1136/bmj.a2047

Published 10 October 2008, doi:10.1136/bmj.a2047
Cite this as: BMJ 2008;337:a2047

Editorials

Where are we in the rationing debate?

Improved tools and public participation can inform fair systems

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

Three linked articles (doi:10.1136/bmj.a1850; doi:10.1136/bmj.a1872;doi:10.1136/bmj.a1846) take different perspectives on the needto allocate limited resources for human health fairly.¹ ² ³Norheim examines clinical priority setting, which occurs implicitlyor explicitly in clinicians’ daily practice. He courageouslyproposes that clinicians should integrate concern for cost effectivenessand health inequalities into decisions about clinical prioritysetting, and describes an elegant way of measuring inequalities.Donaldson and colleagues argue convincingly that explicit attentionto comparative costs and relative values, using methods likeprogramme budgeting and marginal analysis, can allow "genuine"reallocations. Finally, Daniels and Sabin draw on experienceusing their framework, "accountability for reasonableness,"as a guide for priority setting in three different locations.

The articles present valuable arguments, although a few typesof methods of resource allocation are missing. While Donaldsonand colleagues dismiss incentives as "smokescreens" used toavoid hard decisions, market-like approaches to allocation . . . [Full text of this article]

Susan Dorr Goold, director, bioethics programme¹, Nancy M Baum, doctoral candidate²

¹ University of Michigan Medical School, Ann Arbor, MI 48109-0429, USA, ² University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA

sgoold@umich.edu

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