Rationing in the NHS

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39218.599109.80 (Published 24 May 2007) Cite this as: BMJ 2007;334:1068
  1. Rudolf Klein, visiting professor
  1. London School of Economics, London WC2A 1AE
  1. rudolfklein30{at}aol.com

    The BMA asks the right questions but answering them will be difficult

    Over the past two decades or so rationing has been debated more than almost any other area of health policy. However, the debate has been punctuated by periods of relative silence when policy makers have been reluctant to tackle the key problems. The past few years have been one such period as new money appeared to have flushed away old concerns. Now, however, those concerns are back, underlined by the hectic race to balance the National Health Service's books and the realisation that the days of rapid growth in its budget are almost over.

    A new factor is adding to these concerns. If in the past the NHS was a model of economy, it was partly because no one had an incentive to maximise activity. But as the new model NHS emerges, payment by results to hospital providers will provide such an incentive. As the NHS inevitably becomes a demand generating machine, so the challenge of accommodating competing demands within a constrained budget will become more acute.

    The BMA has therefore …

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