Global Challenge of Health Care Rationing

Introduction - international experience of rationing (or priority setting). Part 1 How to set priorities: setting priorities - what is holding us back; inadequate information or inadequate institutions?. Part 2 Governments and rationing: developments in the Nordic countries; goodbye to the simple solutions; reactivation of the prioritization process in Finnish health care; Israel's basic basket of health services - the importance of being explicitly implicit; setting priorities "American style". Part 3 Priorities in developing countries: health priority dilemmas in developing countries; public health priorities and the social determinants of ill health. Part 4 Ethical dilemmas: accountability for reasonableness in private and public health insurance; tragic choices in health care - lessons from the Child B case; fairness as a problem of love and the heart - a clinician's perspective on priority setting; the ethics of decentralizing health care priority setting in Canada. Part 5 Techniques for determining priorities: priority setting and health technology assessment - beyond evidence based medicine and cost effectiveness analysis; the rationing of surgery - clinical judgement versus priority access scoring. Part 6 Involving the public: public involvement in health care priority setting - are the methods appropriate and valid?; rationing health care in New Zealand; how the public has a say; explicit rationing, deprivation disutility and denial disutility - evidence from a qualitative study. Part 7 Rationing specific treatments: priority setting in practice; when sentiments run high - the Di Bella case and others; increasing demand for accountability - is there a professional response?; conclusion - where are we now?.