Rationing: how it is done with community services for the older disabled

A number of studies have estimated the prevalence of needs for long-term community services. However, these needs inevitably exceed the services available, and little has been done to show how the supply of services is actually rationed. In 1973, allocations were studied among the patients of a well-provided rural group practice. All those aged 65 and over who had, on a fixed date, been receiving home help, home nursing, meals service, or day care in the previous two months were interviewed (N = 145), together with a comparison group composed by a 1 in 6 random sample of practice patients in the same age group (N = 149). The needs regularly considered by local agents of referral were analysed and ordered by severity. Assuming that a less severe category of cases was not normally accepted in the place of more severe categories known to be waiting, it was possible to show what categories of cases constituted a normal claim on services at this level of resources, together with the numbers of these cases per 1000. The method used is suitable for comparing the rationing process in areas with different levels of resources or needs, and for identifying the categories who suffer as a result of a given difference of resources.