ABSTRACT
From the day the National Health Service (NHS) was set up and the Government took responsibility for financing the nation's health care it also took responsibility for rationing it. Effectiveness can be used as a criterion for rationing more easily in some cases than in others. This chapter shows how rationing decisions must resolve tensions between the individual and the wider public. Rationing has been hidden and decisions are taken by 'pluralistic bargaining between different lobbies modified by shifting political judgements made in the light of changing pressures'. Medical profession is in some cases becoming less willing to play its implicit rationing role any longer. Both general practitioners and hospital doctors have seen their roles change dramatically. Clinical discretion will remain – it is ingrained deeply within the culture of the system. Doctors are likely to continue rationing, as they have traditionally, on their perception of need. Thus monitoring and openness are crucial.
