Editorials

Rationing health care

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7129.410 (Published 07 February 1998) Cite this as: BMJ 1998;316:410

A logical solution to an inconsistent triad

  1. Albert Weale, Professor of government (weala@essex.ac.uk)a
  1. a Department of Government, University of Essex, Wivenhoe Park, Colchester CO4 3SQ

    The basic principle of the NHS is simply that comprehensive, high quality medical care should be available to all citizens on the basis of professionally judged medical need without financial barriers to access. In seeking to enact this principle, the NHS is not alone. The same aspiration is to be found in nearly all economically developed societies outside the United States. Yet, in the face of increasing healthcare costs this basic principle threatens to become what logicians call an inconsistent triad; a collection of propositions, any two of which are compatible with each another but which, when viewed together in a threesome, form a contradiction. Perhaps we can have only a comprehensive service of high quality, but not one available to all. Or a comprehensive service freely available to all, but not of high quality. Or a high quality service …

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