ABSTRACT
Health economists offer an input into the rationing process from the perspective of efficiency, but this does not always concur with what is equitable or with the views of the public. Health economists have focused on developing explicit, technical and rational frameworks based on efficiency to facilitate rationing choices, and economic evaluation is a theme which runs throughout this book. Undoubtedly, there are a number of health economists who dream of a health service where resource decisions are made using equity-weighted quality adjusted life years, but this denies the constraints and contingencies of the real world. The traditional interpretation of rationing was a positive concept, donating a share or portion of a predetermined size to which each qualified recipient was entitled. More recently, rationing has become a metaphor with negative, prerogative overtones - scarcity, denial, withdrawal and inevitable suffering. Priority setting is used as a less prerogative term. The intervention is available but not accessible to all patients.
