Education And Debate

Rationing and the health authority

BMJ 1998; 317 doi: (Published 17 October 1998) Cite this as: BMJ 1998;317:1067
  1. Tony Hope, readera,
  2. Nicholas Hicks, consultantb,
  3. D J M Reynolds, consultantc,
  4. Roger Crisp, fellowd,
  5. Sian Griffiths, directorb
  1. aDivision of Public Health and Primary Care, Institute of Health Sciences, Oxford OX3 7LF
  2. bDirectorate of Public Health and Health Policy, Oxfordshire Health Authority, Oxford OX3 7LG
  3. cDepartment of Clinical Pharmacology, John Radcliffe Hospital, Oxford OX3 9DU
  4. dSt Anne's College, University of Oxford, Oxford OX2 6HS
  1. Correspondence to: Dr Hope
  • Accepted 11 June 1998

Most governments would like to pretend that health care rationing does not exist. Those working in the NHS know that it does. There is simply not enough money for all patients to receive the best treatment.1 A few governments—the Netherlands, New Zealand, and Sweden, in particular—have grasped the nettle.24 In the United Kingdom, major decisions about what to fund or, more critically, what not to fund have been made at local level by health authorities, fundholding general practices, and, under the provision of the new white paper, primary care groups. There is very little central guidance on how these decisions are to be made. Health authorities are continually faced with reasonable requests for extra funding. To fund something new, something else of value has generally to be sacrificed, and this happens despite all efforts to eliminate ineffective health care. This paper describes one health authority's approach to this problem.

Summary points

Oxfordshire Health Authority has set up a priorities forum to provide advice on rationing decisions in health care

The forum aims to ensure a reasonable and evidence based process for decision making

The decision process focuses on three key areas: evidence of effectiveness, equity, and patient choice

A wide range of policy issues and individual cases has now been considered

Key issues that remain include determining relative funding for each area of health care, achieving consistency in spending for treatments with broadly similar effects, and involving the public

The priorities forum

Health authorities and primary care groups will increasingly need to be able to justify their decisions to the wider community. There are two key questions:

  • What was the process by which the decision was made?

  • What were the grounds for making the decision?

Oxfordshire Health Authority has set up a priorities forum to provide advice on rationing decisions. One …

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