Desperately Seeking Solutions: Rationing Health Care

by Hunter,David J.

• ISBN13: 9780582289239
• ISBN10: 0582289238
• Format: Nonspecific Binding
• Copyright: 1998-02-13
• Publisher: Routledge

Summary

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.

Table of Contents

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