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British Medical Bulletin 51:769-780 (1995)
© 1995 The British Council

research-article

Rationing in the NHS: the dance of the seven veils—in reverse

R Klein, P Day and S Redmayne

Centre for the Analysis of Social Policy, University of Bath Claverton Down, Bath BA2 7AY, UK

Abstract

The 1991 reforms of the National Health Service set up the expectation that rationing would in future be explicit instead of, as in the past, implicit. This had not happened. Research carried out at the University of Bath shows that very few health authorities are rationing by exclusion on the Oregon model. Instead, both central Government and health authorities are continuing to diffuse responsibility among the medical profession. This paper analyses the reasons why. Rationing by delay and dilution are more significant-as well as less visible-than rationing by exclusion. And it is the medical profession which controls the flow of patients through waiting lists and the way in which resources are used during treatment. Similarly, it is in the self-interest of both central Government and health authorities that their resource decisions should continue to be disguised behind the veils of clinical discretion. Despite pressures for greater transparency, Britain's opaque form of rationing may therefore survive.


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