ABSTRACT
The National Health Service (NHS) has always been accompanied by some private practice of medicine, largely by practitioners who work mainly for the NHS, but to some extent by practitioners wholly outside NHS. The ideological issues in the provision of health care have been admirably dissected by Donabedian. His 'viewpoint A' may loosely be termed the 'libertarian' approach, under which access to health care is part of society's reward system, and, at the margin at least, people should be permitted to use their income and wealth to gain more or better health care if they so desire. His 'viewpoint B' may loosely be termed the 'egalitarian' approach, under which access to health care is a citizen's right, which ought not to be influenced by income and wealth. At a fundamental level, pure Paretian welfare economics is relevant only to those who hold to viewpoint A, and therefore useful only for appraising different ways of organising a system from that standpoint.
