Intended for healthcare professionals

Research Article

Dimensions of rationing: who should do what?

British Medical Journal 1993; 307 doi: (Published 31 July 1993) Cite this as: British Medical Journal 1993;307:309
  1. R Klein
  1. Centre for the Analysis of Social Policy, University of Bath.


    Priority setting is a complex interaction of multiple decisions at various levels in the organisation and constrained by history. There is no self evident set of ethical principles or analytical tools to determine what decisions we should take at various levels, nor is there an obvious or easy way to resolve the clash of claims on resources. To make priority setting more "rational" we should concentrate on the processes and structure of decision making and the relation of macro and micro decisions. The debate should promote reasoned, informed, and open argument, draw on a variety of perspectives, and involve a plurality of interests. The aim must be to build up, over time, the capacity to engage in continuous, collective argument.