Economics of Need: The Experience of the British Health Service

Twenty-five years of employing ‘need’ as the main allocative device within the Health Service has demonstrated that ‘need’ is capable of almost infinite interpretation. In a zero-price market no level of provision exists to eliminate excess demand and remove the necessity for rationing. This rationing function has never been explicitly recognized, but has fallen by default upon the medical profession as the main decisionmakers of the Service. Doctors, however, have claimed the complete clinical freedom to act solely in the interests of each individual patient while being accountable only to their own personal consciences. As a consequence, rationing has taken place only implicity, resulting in inconsistencies of medical practice and in inequalities of provision. Further, need being limitless, the Service has found it easier to claim shortages of resources than to examine critically their current deployment. A better understanding of the process by which the need for medical care is determined and a re-examination of the rationality of clinical freedom is attempted.