The real ethics of rationing

摘要

1. One part of the rationing debate maintains that NHS funding is adequate by ignoring how much rationing takes place, and another part holds that rationing is inevitable; surely the latter affects judgment of the former 2. Our goal should be to minimise the need to ration by eliminating ways that entrenched institutional, political, and professional interests lock in waste, not to figure out how to ration fairly in the context of a segmented, unintegrated system with wasted resources. This is the real ethics of rationing 3. There are extensive inequalities that lead to rationing, the largest being unexplained inequalities in how many resources different doctors use; private insurance that skims off the easy, profitable cases rather than being structured equitably; and an arrangement that rewards minimising surgery to NHS patients in order to maximise private surgery. These inequalities should be eliminated 4. A central plank of the new charter for the NHS in 1998 should be to provide effective treatments at minimal cost in an equitable manner.