Rationing and the health authority

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.2^–4 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.