Priority setting in health care: should we ask the tax payer?BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7250.1679 (Published 17 June 2000) Cite this as: BMJ 2000;320:1679
- David J Torgerson, senior research fellow,
- Toby Gosden, research fellow
- University of York
- University of Manchester
It is popular and politically correct to involve the public in healthcare priority setting. But it may not necessarily be a good thing to involve it in rationing decisions.
It is almost an article of faith among many United Kingdom health economists that a publicly funded and provided healthcare service is more efficient than if left to the free market. Several reasons sustain this view. An important one is the low level of knowledge by the potential healthcare consumer of the relative utility of a healthcare service with respect to its price—or in economists' jargon—informational asymmetry. Consumers tend to choose the most expensive procedure they can afford on the basis that the most costly will be the best. Hence, in the context of hip replacements consumers may choose the most expensive prosthesis in the belief that this must be better.
Rationing is painful, complicated, and difficult
This phenomenon partly explains the reason that the United …