ABSTRACT
The increasing demands for high quality health care delivery (e.g. as a result of progressive ageing and consumerism of our populations), and rising costs of health care (due to the greater demand, and technological advances) are pressurising governments to allocate a greater proportion of their national gross domestic product to health care. However, governments are not responding. The feared sequelae are that the quality of health care will be compromised and that health care will be rationed. Indeed, despite the fact that most governments would like to deny it, health care rationing has become a real entity (Hope et al., 1998). In some countries, such as the United Kingdom, important decisions about what to fund or not fund, have been made at the local level by health authorities, fundholding general practices, and, under the provision of the new white paper, primary care groups. There is little central guidance on how these decisions are to be made. Health authorities (and hospitals) are continually confronted with reasonable requests for extra funding (e.g. to provide a new, more effective, but more expensive drug). However, to fund something new generally means that something else of value is sacrificed, despite all efforts to eliminate ineffective health care.
