Editorials

Rationing health care

BMJ 1996; 313 doi: http://dx.doi.org/10.1136/bmj.313.7071.1499 (Published 14 December 1996) Cite this as: BMJ 1996;313:1499
  1. Alan Maynard
  1. Professor Department of Health Sciences and Clinical Evaluation, The University of York, York YO1 5DD

    What use citizens' juries and priority committees if principles of rationing remain implicit and confused?

    After a “spring offensive” on healthcare rationing,1 2 3 4 new work is falling on the NHS like autumn leaves. Three recent books examine the hard choices of resource allocation.5 6 7 They offer insights into the processes of rationing and how these processes might be developed, for example, by greater citizen involvement and national mechanisms of priority setting. But does all this academic effort help or hinder policy making?

    There seems to be a consensus that rationing is ubiquitous in all healthcare systems, yet in no country is there a clear and publicly accepted set of principles that can determine who gets what health care and when. The NHS has a limited budget of over £40bn, and clinicians, purchasers, general practitioners, and providers are given discretion to “do their own thing,” rationing care by rules that differ and are incoherent and implicit.

    This leads to both inefficiency and inequity. The discussion of the handling of the case of Child B8 raises questions about the …

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