Rationing health care

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7079.514 (Published 15 February 1997) Cite this as: BMJ 1997;314:514

Several other markers of fairness exist, besides age

  1. Michael M Rivlin, PhD candidatea
  1. a Department of Philosophy, University of Leeds, Leeds LS2 9JT
  2. b Royal Devon and Exeter Hospital (Wonford), Exeter EX2 5DW
  3. c 43 Cliff Gardens, Scunthorpe DN15 7PH
  4. d 28 Oakfield Road, Bradford BD9 4PY
  5. e NHS Executive West Midlands, Birmingham B15 3DP
  6. f Selly Oak Hospital, Birmingham B29 6JD

    Editor—Once again it seems that elderly people are being asked to bear the brunt of the rationing of scarce resources in the NHS.1 I am not surprised that an economist suggests that it is fair to transfer funds from elderly to young patients; what is surprising, however, is the reasons that Alan Maynard gives for his views.

    Maynard writes, “One possible definition of ‘fairness’ in health care is that decision makers will use the NHS to reduce inequalities in people's lifetime experience of health.” He then suggests that one of the ways that this can be achieved is by use of the “fair innings” argument. I accept that fairness is a difficult concept to define. But why has Maynard chosen to use only age as a marker of fairness, and not other things that are more relevant? Take the case of two people, one aged 25 and the other aged 75. The younger person may have already used up large amounts of NHS resources owing to a reckless lifestyle, whereas the older person may not have used the NHS at all but, at an advanced age, needs the hip replacement to which Maynard refers. Why would it be considered fair to give the younger person preference in such a situation?

    Furthermore, it is not the function of the NHS to reduce inequalities in health. Surely the purpose of the NHS is to treat people who are ill, or, as Maynard suggests in his article, “to improve the health of the population.” I appreciate that the population has a better record of health in countries where the distribution of income is narrow than in countries where inequalities in wealth are greater,2 but it is the business of the government to address this matter (if it wishes to) and not …

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