ABSTRACT
This chapter seeks to review the fundamental forces shaping health care decision-making, and apply them to the development of the new decision-making paradigms. The levers for change in medical decision-making have been classified as information which provides evidence for professional change, customer change, and economic levers. The use of professional levers tends to make the decision-making processes technocratic, with a bias towards utilitarianism. In order to minimize the possible effects that these processes may have on medical practice, it is important that the reasons why and the purposes of the decision under scrutiny are reviewed. The decision-making process, together with the levers applied, enables a description of the processes in rationing. These processes are important from a philosophical and ethical viewpoint, as any one of them can be used to make a viable resource allocation system. Resource allocation systems may be technocratic, bureaucratic, market-based, and democratic.
