Rational rationing?

Age-based rationing in the allocation of health care

OBJECTIVES

This article seeks to review debates about age-based rationing in health care.

METHODS

The article identifies four different levels (or types) of decision-making in health resources allocation--societal, strategic, programmatic, and clinical--and assesses how the issues of rationing vary in relation to each level.

RESULTS

The article concludes that rationing is least defensible at the clinical level, where it is also most covert. The role of rationing at other levels is more defensible when based on grounds of cost-effectiveness rather than equity. The article emphasizes the importance of fairness in health allocation and suggests that efficiency criteria need to be considered in that context.

DISCUSSION

The article suggests that rationing is most problematic where it is least overt. This raises further questions about how rationing can be made more explicit at different levels of decision making.

Public involvement in health care priority setting: an overview of methods for eliciting values

There is increasing interest, in the UK and elsewhere, in involving the public in health care priority setting. At the same time, however, there is evidence of lack of clarity about the objectives of some priority setting projects and also about the role of public involvement. Further, some projects display an apparent ignorance of both long-standing theoretical literature and practical experience of methodologies for eliciting values in health care and related fields. After a brief examination of the context of health care priority setting and public involvement, this paper describes a range of different approaches to eliciting values. These approaches are critically examined on a number of dimensions including the type of choice allowed to respondents and the implications of aggregation of values across individuals. Factors which affect the appropriateness of the different techniques to specific applications are discussed. A check-list of questions to be asked when selecting techniques is presented.