A puzzle for our times: using healthcare resources wisely and justly

In the past fifty years health care has become one of the most challenging, expensive and dynamic of all sectors of human activity. The author's purpose in this short paper is to suggest that the key issues in the management of this sector are about individual and collective choices, that these choices are becoming harder and more constrained and that we have to become better at making them. With less certainty, he will suggest some of the ways in which we might tackle this dilemma, including some discussion of rationing.