ABSTRACT
The essence of the National Health Service (NHS) is providing access to healthcare on the basis of need. Of course, this concept has to be defined with care. This perspective increasingly dominates resource allocation advice through regulatory mechanisms such as the National Institute for Health and Clinical Excellence (NICE). The desire to achieve equity in access to cost-effective healthcare has led to the use of regulatory mechanisms that inevitably centralise control. This chapter argues that because of this egalitarian goal and related factors, local freedom to vary service delivery will always be highly constrained. Failure to identify what works cost-effectively and to incentivise its delivery is commonplace in many public and private healthcare systems. The chapter discusses the challenge of designing and implementing efficient national rationing mechanisms and presents incentives for the translation into practice of evidence of cost-effectiveness.
