Elsevier

Social Science & Medicine

Volume 42, Issue 7, April 1996, Pages 1021-1025
Social Science & Medicine

Rationing health care: Views from general practice

https://doi.org/10.1016/0277-9536(95)00213-8Get rights and content

Abstract

General practitioners (GPs) in the United Kingdom are central to the commissioning of health care services. A qualitative study of their views was therefore designed, which incorporated an in-depth (open) interview technique carried out on a 20% sample of all GPs (n = 100) in one United Kingdom Health District. The data from these interviews indicated that GPs were aware of, but had mixed feelings about the need for rationing. They expressed disquiet about the dilemma faced in rationing health care at the time of the consultation and readily associated issues of cost in their practice with rationing. Some of the currently adopted methods of rationing (waiting lists, co-payments and ability to pay) were commented upon. The respondents also made suggestions on how rationing could be carried out, which included: maximizing efficiency to reduce the need for rationing; using a third party committee to make rationing decisions, with a membership of clinicians, managers, and possibly public representatives, and; being explicit about how rationing is done. Fundholding brought rationing decisions to the fore, and worried most who discussed it in the context of rationing. The conclusion of this paper is that current implicit rationing policies in the National Health Service are flawed as they assume that GPs will ration health care at the time of the consultation. The involvement of GPs in the rationing process is important (particularly given the present expansion of GP fundholding), so there is a need for an alternative to the present system.

References (17)

  • P.D. Toon

    Justice for gatekeepers

    The Lancet

    (1994)
  • R. Maxwell

    Gatekeepers and goalkeepers: general practice advice to purchasers [editorial]

    Br. J. Gen. Pract.

    (1992)
  • NHS Management Executive

    Developing NHS purchasing and GP fundholding EL(94)79

    (1994)
  • Electoral Reform Ballot Services
  • Bradford Health

    The Quality of Health Services in Bradford

    (1991)
  • P.J. Ayres

    Prioritising services: GPs views, fundholders vs non-fundholders

    J. Mgmt Med.

    (1994)
  • R and D sub-Committee on Qualitative Research

    Qualitative research—a summary of the concepts involved

    J. Market Res. Soc.

    (1979)
  • W. Gordon et al.

    The individual ‘depth’ interview

There are more references available in the full text version of this article.

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Disclaimer: the comments and conclusions drawn from this work are those of the author, and not necessarily those of Wakefield Healthcare.

Current address: Division of Public Health, Nuffield Institute for Health, 71–75 Clarendon Road, Leeds LS2 9PL, England.

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