Rationing health care: the political perspective.

The politics of rationing are messy and treacherous. As long as rationing remained implicit, politicians were shielded from the impact of decisions about who to treat and who not to treat. Explicit rationing changes all this by making the process of reaching choices more visible. However, implicit rationing may actually be a better way of dealing with difficult and complex issues. There is, nevertheless, scope for improving the process and making it more open and accountable. While efforts to terminate ineffective treatments are welcome and overdue, they are not a substitute for rationing. Finally, while politicians are being called upon to set national priorities and guidelines for rationing care, there is resistance to doing so when the decisions are so context specific and can only be made effectively at a micro level.