Rationing: At the Cutting Edge

Abstract

It was the professor of mathematics at Southampton, Sir Bryan Thwaithes, who produced a figure that many health service managers now carry in their minds -- one that shows expectations for health care increasing exponentially and running away from supply. And it was in Southampton that the local health authority recently conducted a simulation exercise to discover how purchasers can begin to make the tough decisions that flow from the widening gap between what can be done by health services and what can be afforded....The simulation exercise began by asking the authority to think about setting priorities in its responses to coronary artery disease. This approach has been called "vertical priority setting," as it consists in making choices within one problem area. Much more difficult is choosing among different types of services or "horizontal priority setting." The authority was asked to attempt horizontal priority setting in the afternoon after spending time in the morning looking not only at coronary artery disease but also at services for elderly people with strokes, a case study with broad social overtones. The aim of the exercise was not for the authority to make decisions that would be implemented but for it to think about the criteria that might be used in making such decisions.