ABSTRACT
Priority setting processes are tending to rely increasingly on the use of clinical guidelines rather than the exclusion of services. Guidelines are more likely to win public acceptance, which makes the technique more attractive to politicians. Politicians and the public alike find it more comfortable to stimulate the development of clinical guidelines. Guidelines are difficult and time-consuming to prepare, but even harder to implement. Guidelines may be subject to local variation so that the procedures offered varies from place to place or even from clinician to clinician. In the face of the rising costs of health care and the financial pressures facing governments everywhere, more explicit forms of rationing may eventually have to be considered. Priority setting based on guidelines inevitably involves local discretion, whereas exclusions may be decided either nationally or locally. Although a trend towards local discretion seems to be under way, countervailing pressures may arise from the development of expensive, life-saving technologies.
