The Global Challenge of Health Care Rationing

The Global Challenge of Health Care Rationing

The Global Challenge of Health Care Rationing

The Global Challenge of Health Care Rationing


Rationing or priority setting occurs in all health care systems. Doctors, managers, and politicians are involved in making decisions on how to use scarce resources and which groups and patients should receive priority. These decisions may be informed by the results of medical research and cost effectiveness studies but they also involve the use of judgement and experience. Consequently, priority setting involves ethics as well as economics and decisions on who should live and who should die remain controversial and contested.

This book seeks to illuminate the debate on priority setting by drawing on experience from around the world. The authors are all involved in priority setting, either as decision makers or researchers, and their contributions demonstrate in practical terms how different countries and disciplines are approaching the allocation of resources between competing claims. Accessible to general readers as well as specialists, The Global Challenge of Health Care Rationing summarizes the latest thinking in this area and provides a unique resource for those searching for a guide through the maze.


Health services in many developed countries have come under critical scrutiny in recent years. In part this is because of increasing expenditure, much of it funded from public sources, and the pressure this has put on governments seeking to control public spending. Also important has been the perception that resources allocated to health services are not always deployed in an optimal fashion. Thus at a time when the scope for increasing expenditure is extremely limited, there is a need to search for ways of using existing budgets more efficiently. A further concern has been the desire to ensure access to health care of various groups on an equitable basis. In some countries this has been linked to a wish to enhance patient choice and to make service providers more responsive to patients as 'consumers'.

Underlying these specific concerns are a number of more fundamental developments which have a significant bearing on the performance of health services. Three are worth highlighting. First, there are demographic changes, including the ageing population and the decline in the proportion of the population of working age. These changes will both increase the demand for health care and at the same time limit the ability of health services to respond to this demand.

Second, advances in medical science will also give rise to new demands within the health services. These advances cover a range of possibilities, including innovations in surgery, drug therapy, screening and diagnosis. The pace of innovation quickened as the end of the century approached, with significant implications for the funding and provision of services.

Third, public expectations of health services are rising as those . . .

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