Rationing health careBMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7137.1092b (Published 04 April 1998) Cite this as: BMJ 1998;316:1092
Patients need to be prioritised
- Brian Davis, Consultant ear, nose, and throat surgeon,
- Steve Johnson, Consultant orthopaedic surgeon
- Carmarthen and District NHS Trust, West Wales General Hospital, Carmarthen SA31 2AF
- Calderdale and Kirklees Health Authority, Huddersfield, West Yorkshire GD4 5RH
EDITOR—In his editorial on rationing health care Weale refers to an “inconsistent triad.”1 He argues that it is a contradiction to propose that a healthcare service can be fully comprehensive, of high quality, and freely available to all within a finite resource allocation, although any two of these ideals may be achieved at the expense of the third.
In the NHS all three ideals are, theoretically, supported, although in practice none are supported fully. The range and quality of treatments offered are limited by a lack of equipment, training, and support. In addition, long waiting lists are a haphazard means of excluding patients from access to treatment; for various reasons some patients “drop out” and never reach the point of receiving NHS treatment. In our opinion, a random, …