The Practice of Rationing Health Care in the United Kingdom

  • David J. Hunter
Chapter
Part of the Wissenschaftsethik und Technikfolgenbeurteilung book series (ETHICSSCI, volume 13)

Abstract

The rationing of health care is one of those ‘wicked issues’ to which there is no easy solution and possibly none at all. In the British National Health Service (NHS) rationing only entered common currency in the early 1990s when the Conservative government introduced its internal market changes. At this point, the process of allocating resources, which had up until then been shrouded in mystery and notions of clinical judgement, became more explicit as a result of the purchaser-provider separation and the emergence of a contract culture between the funders and planners of services on the one hand and those providing them on the other.

Keywords

Europe Assure Expense Smoke Infertility 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Aaron, Hi, Schwartz WB (1984) The painful prescription: rationing hospital care. The Brookings Institution, WashingtonGoogle Scholar
  2. British Medical Journal (1995) Rationing revisited: a discussion paper. Health Policy and Economic Research Unit Discussion Paper No. 4. BMA, LondonGoogle Scholar
  3. Bynoe I (1996) Beyond the citizen’s charter. Institute for Public Policy Research, London Califano JA (1992) Rationing health care — the unnecessary solution. University of Pennsylvania Law Review, 140, pp 1525–38CrossRefGoogle Scholar
  4. Carr-Hill RA (1989) Assumptions of the QALY procedure. Social Science and Medicine, 28, pp 469–77Google Scholar
  5. Cooper L, Coote A, Davies A, Jackson C (1995) Voices off: tackling the democratic deficit, Institute for Public Policy Research, LondonGoogle Scholar
  6. Coote A, Hunter DJ (1996) New agenda for health. Institute for Public Policy Research, London Coulter A, Ham C (eds) ( 2000 ) The global challenge of health care rationing. Open University Press, BuckinghamGoogle Scholar
  7. Doyal L, Gough I (1991) A theory of human need. Macmillan, LondonGoogle Scholar
  8. Eddy D (1994) Health systems reform: will controlling costs require rationing services? Journal of American Medical Association, 272, pp 324–8CrossRefGoogle Scholar
  9. Gillon R (1994) Introduction. In: Principles of health care ethics (ed. R Gillon ). Wiley & Sons, ChichesterGoogle Scholar
  10. Grimley Evans J (1993) Summary. In: Grimley Evans J, Goldacre MJ, Hodkinson HM, Lamb S, Savory M. Health and function in the third age. Papers prepared for the Carnegie Inquiry into the Third Age. Nuffield Provincial Hospitals Trust, LondonGoogle Scholar
  11. Ham C, Coulter A (2000) Conclusion: where are we now? In: Coulter A, Ham C (eds) The global challenge of health care rationing. Open University Press, BuckinghamGoogle Scholar
  12. Harrison S, Hunter DJ (1994) Rationing health care. Institute for Public Policy Research, London House of Commons Health Committee (1995) Priority-setting in the NHS: purchasing. First report, session 1994–95, volume II, minutes of evidence and appendices, HC 134-II. HMSO, LondonGoogle Scholar
  13. Hughes D, Griffiths L (1996) “But if you look at the coronary anatomy…”: risk and rationing in cardiac surgery, Sociology of Health and Illness 18, pp 172–97Google Scholar
  14. Hunter DJ (1993) Rationing dilemmas in health care. Research paper number 8. National Association of Health Authorities and Trusts, BirminghamGoogle Scholar
  15. Hunter DJ (1998) Desperately seeking solutions: rationing health care. Longman, Harlow Klein R (1992) Dilemmas and decisions. Health Management Quarterly, xiv, pp 2–5 Klein R (1995) The new politics of the NHS. 3rd edition. Longman, HarlowGoogle Scholar
  16. Klein R (1997) Defining a package of healthcare services the NHS is responsible for: the case against. British Medical Journal, 314, pp 506–9PubMedCrossRefGoogle Scholar
  17. Klein R, Day P, Redmayne S (1996) Managing scarcity: priority-setting and rationing in the NHS. Open University Press, BuckinghamGoogle Scholar
  18. Lenaghan J (1997) Citizens juries: towards best practice, British Journal of Health Care Management 3, pp 20–22Google Scholar
  19. Loughlin M (1996) Rationing, barbarity and the economist’s perspective. Health Care Analysis, 4, pp 146–56PubMedGoogle Scholar
  20. Mechanic D (1995) Dilemmas in rationing health care services: the case for implicit rationing. British Medical Journal, 310, pp 1655–9PubMedCrossRefGoogle Scholar
  21. Ministry of Welfare, Health and Cultural Affairs (1992) Choices in health care. A report by the Government Committee on Choices in Health Care, The Netherlands. Ministry of Welfare, Health and Cultural Affairs, RijswijkGoogle Scholar
  22. Moore W (1996) Hard choices: priority-setting in the NHS. National Association for Health Authorities and Trusts, BirminghamGoogle Scholar
  23. New B, Le Grand J (1996) Rationing in the NHS: principles and pragmatism. King’s Fund, LondonGoogle Scholar
  24. Richardson A (1997) Determining priorities for purchasers: the public response to rationing within the NHS, Journal of Management in Medicine 1 I, pp 222–232Google Scholar
  25. Roberts C, Crosby D, Dunn R, Evans K, Grundy P, Hopkins R, Jones JH, Lewis P, Vetter N, Walker P (1995) Rationing is a desperate measure. Health Service Journal, 105, p 15PubMedGoogle Scholar
  26. Smith R (1995) Editorial: rationing: the debate we have to have. British Medical Journal, 310, p 686PubMedCrossRefGoogle Scholar
  27. Stewart J (1998) Advance or retreat from the traditions of public administration to the new public management and beyond. Public Policy and Administration, 13, pp 12–27CrossRefGoogle Scholar
  28. Stewart J, Kendall E, Coote A (1994) Citizens’ juries. Institute for Public Policy Research, London Wildaysky A ( 1979 ) The art and craft of policy analysis. Macmillan, LondonGoogle Scholar
  29. World Health Organisation (1996) European health care reform: analysis of current strategies. WHO Regional Office for Europe, CopenhagenGoogle Scholar
  30. Zimmern R (1996) Beyond effectiveness: the appropriateness of clinical care — what needs to happen now. Transcript of a speech to the National Medical Directors and Directors of Public Health Meeting, NovemberGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2002

Authors and Affiliations

  • David J. Hunter

There are no affiliations available

Personalised recommendations