Rationing health care by waiting list: an extra-welfarist perspective

Waiting lists are the predominant rationing mechanism for non-urgent health care services under the British NHS. Academic and political debate over waiting lists has until now focused on the rationing process itself with little consideration of the health consequences of rationing by waiting list. Extra-welfarism provides a framework for comparing social welfare in alternative states of the world, more specifically here, the health-related-welfare to society. It provides a perspective with which to view the efficiency and equity consequences of how we are currently rationing health care by waiting list, and how we might go about it in the future. This paper examines, in both process and outcome terms, alternative performance criteria for evaluating the waiting list rationing mechanism. It describes a new waiting list simulation model that has been developed to further the debate on waiting lists, and presents results from a pilot data set, suggesting some philosophical and pragmatic implications.