British medical bulletin
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The politics of rationing are messy and treacherous. As long as rationing remained implicit, politicians were shielded from the impact of decisions about who to treat and who not to treat. Explicit rationing changes all this by making the process of reaching choices more visible. ⋯ There is, nevertheless, scope for improving the process and making it more open and accountable. While efforts to terminate ineffective treatments are welcome and overdue, they are not a substitute for rationing. Finally, while politicians are being called upon to set national priorities and guidelines for rationing care, there is resistance to doing so when the decisions are so context specific and can only be made effectively at a micro level.
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British medical bulletin · Oct 1995
ReviewRationing in the NHS: the dance of the seven veils-in reverse.
The 1991 reforms of the National Health Service set up the expectation that rationing would in future be explicit instead of, as in the past, implicit. This has not happened. Research carried out at the University of Bath shows that very few health authorities are rationing by exclusion on the Oregon model. ⋯ And it is the medical profession which controls the flow of patients through waiting lists and the way in which resources are used during treatment. Similarly, it is in the self-interest of both central Government and health authorities that their resource decisions should continue to be disguised behind the veils of clinical discretion. Despite pressures for greater transparency, Britain's opaque form of rationing may therefore survive.
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British medical bulletin · Oct 1995
ReviewChoices in health care: a contribution from The Netherlands.
In this paper it will be argued that choices in health care are necessary, desirable and just. An important choice that each society has to make, is: what basic services should be available to everybody independently of an individual's purchasing power? The Dutch Government Committee on Choices in Health Care advised the use of four criteria: basic care must be necessary, effective, efficient and cannot be left to the individual's responsibility. Because important decisions with respect to the second criterion-the effectiveness of care-are made by physicians in the consulting room or at the operating table, physicians do have a primary responsibility in making the right choices.