POLICY DEVELOPMENT IN THE UK NHS

Policy Development in the UK NHS



Policy Development in the UK NHS

Introduction

Rationing and equity of health service provision have lately come into the limelight through well-publicized situations of one-by-one exclusion such as progeny B who was denied care for leukaemia and finally obtained care in the USA (Laurance 1998). Cases such as this and other ones have been sensationalized but have increased the profile of rationing and put it in the public domain. The debate about equity and rationing in healthcare has become more public since the advent of the NHS interior market (Bradshaw 1996), but has yet to completely engage the public. The confrontation surrounding if rationing is essential in today's NHS and how it should happen is convoluted and difficult to resolve. Despite a change in government which has supplied additional funds for waiting registers and is pledged to removing the internal market and waiting lists (Light 1997), it is improbable that the debate on rationing will become sterile. This paper will first characterise equity and rationing as they are glimpsed inside the wellbeing service, then discover the historical means of rationing before analyzing equity and rationing in the post-reform NHS.

Defining equity and rationing

Equity has been characterised in different ways encompassing: 'equal expenditure for identical need', 'identical get access to for identical need', 'identical utilization of wellbeing services' or 'people having a right to equal health' (Mooney 1992). Each delineation will have its own exclusive charges and benefits, and adversities in implementation and measurement. In healthcare the highly rated form of equity is a fairness of circulation of services and is expressed as identical access for equal need (McGuire et al. 1988; Bradshaw & Bradshaw 1995; Donaldson & Mooney 1997).

Rationing is the method by which prioritizing care is achieved (Paton 1996) and may be accomplished through exclusion, denying services, hold up and termination or early release (Klein 1997). It has been proposed that the term rationing is not befitting when directed to healthcare as it is too emotive (Klein 1992) and that a favoured term would be priority setting. However, Wells (1995) argues that this period is deceptive because the political blame for provision or non-provision of funding publicly provided services is then ignored.

Conflict in the rationing debate

The rationing argument focuses on a confrontation between utilitarianism and egalitarianism (Coombs 1990). Explicit rationing is based on cost-benefit analysis, and is utilitarian in outlook as it attempts to achieve the most good for most people, which Culyer (1997) advocates is the principal objective of the NHS. Egalitarianism refers to doing the most for the one-by-one and is founded on equity as equal health. Harris (1997) accepts as true this to be the primary objective of the NHS, proposing beneficial healthcare on the cornerstone of individual need; that is healing people as identical with with equal worth. Coombs (1990), although, believes this is in confrontation with the reality of gathering expanded healthcare demands inside finite ...