Desperately Seeking Solutions: Rationing

Following the Governments health reforms in 1991 rationing has been put firmly on the agenda. This book identifies and clarifies the numerous political and ethical issues surrounding rationing in healthcare. Drawing upon international examples it offers a critical overview of the approaches to rationing and makes practical proposals for its management. Desperately Seeking Solutions challenges the assumption that all health services are inherently subject to rationing as demand invariably outstrips supply and examines this within a comparative framework. The author critically evaluates the extent to which rationing has always existed and should exist within the NHS, although until recently it operated on an implicit rather than explicit basis and was bound up with clinical judgements rather than purely financial considerations. The author questions whether calls for explicit rationing are actually desirable and potentially feasible.

Preface

ix

(2)

Acknowledgments

xi

PART ONE The Dilemma of Rationing Health Care: Origins and Definitions

1

(40)

1 Introduction

3

(13)

Rationing: the health policy challenge

5

(2)

Should rationing be explicit or implicit?

7

(2)

The globalization of new public management

9

(1)

The argument so far

10

(2)

The approach

12

(1)

Structure of book

13

(3)

2 Defining terms

16

(25)

Introduction

16

(1)

The problem

17

(13)

The options

30

(3)

The rhetoric of rationing

33

(2)

From priority-setting to rationing

35

(3)

Conclusion

38

(3)

PART TWO The Health-Care Rationing Debate in the UK: a Review

41

(54)

3 The management agenda

43

(16)

Introduction

43

(1)

The 1991 NHS changes

44

(4)

From hierarchies to markets

48

(7)

Management and the medical profession

55

(1)

Conclusion

56

(3)

4 Rationing: a national or local matter?

59

(36)

Introduction

59

(1)

A national approach

60

(5)

A local approach

65

(27)

Conclusion

92

(3)

PART THREE Health-Care Rationing: Lesson-learning and Future Prospects

95

(53)

5 International approaches to rationing health care

97

(21)

Introduction

97

(1)

On the Oregon trail

98

(5)

New Zealand: defining core services

103

(4)

The Netherlands: defining key principles

107

(5)

Sweden: principles and priorities

112

(2)

International experience: what can be learned?

114

(4)

6 Issues and prospects

118

(30)

Introduction

118

(1)

Policy options

119

(27)

A concluding comment

146

(2)

References

148

(10)

Index

158

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Desperately Seeking Solutions: Rationing Health Care

Summary

Table of Contents

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Desperately Seeking Solutions: Rationing Health Care

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