Desperately seeking solutions: rationing dilemmas in health care

Rationing health care is high on the policy agenda in many countries as the demand for care apparently outstrips supply. There are calls for the public to become more actively involved in determining priorities along the lines of the Oregon experiment in the United States. In Britain rationing has always been a feature of the National Health Service (NHS) although it has become implicit rather than explicit. The NHS reforms, principally the purchaser-provider separation, is making rationing much more explicit. The paper reviews the debate in Britain and concludes that there are no quick fixes or simple panaceas to a complex issue. It questions the extent to which the public can or should be involved in deciding who should or who should not get treated and argues that doctors have a central role to play in finding a better way of allocating resources effectively.