Rationing health careBMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7098.1901 (Published 28 June 1997) Cite this as: BMJ 1997;314:1901
Allocating resources only to treating present dangers would ruin preventive health care and jeopardise future lives
- Tom Marshall, Senior registrar in public health medicinea
- a Northamptonshire Health Authority, Northampton NN1 5DN
- b London W14 9TB
- c London N6 6JR
- d Centre for Health Informatics and Multiprofessional Education, University College London Medical School, The Whittington Hospital, London N19 5NF
Editor—In his article on the objectives of the NHS John Harris argues that “there is a good principle that real and present dangers should be met before future and speculative ones.”1 Has he really thought about the implications of this? Immunisation, health promotion, and preventive interventions would all be swept away in favour of curative treatments. As the lives lost by such a shift in resources would be future lives and the people not identifiable beforehand, they would count for nothing. The state's obligation to protect the “citizen against threats to her life and liberty” only applies to immediate threats.
Harris argues that the health budget should be larger, as if a larger budget will somehow allocate itself and obviate the need for choosing between competing alternatives. He also claims that health care (and he means curative care) should be afforded a high priority in the state budget. This presents a simple dilemma: should the state spend more on raising the income of impoverished families or on resources to provide more intensive care beds? Since raising the income of poor families has no impact on immediate threats to health, according to Harris we must clearly prefer spending more on providing more intensive care beds.
Harris fails to recognise the first problem in identifying healthcare needs. If resources are not the immediate constraint on a healthcare system then rationing takes place on the basis of whether a need (or a want) can be …