Age-based rationing in the allocation of health care.
OBJECTIVE
This article seeks to review debates about age-based rationing in health care.


METHODS
The article identifies four different levels (or types) of decision-making in health resources allocation--societal, strategic, programmatic, and clinical--and assesses how the issues of rationing vary in relation to each level.


RESULTS
The article concludes that rationing is least defensible at the clinical level, where it is also most covert.  The role of rationing at other levels is more defensible when based on grounds of cost-effectiveness rather than equity.  The article emphasizes the importance of fairness in health allocation and suggests that efficiency criteria need to be considered in that context.


CONCLUSIONS
The article suggests that rationing is most problematic where it is least overt.  This raises further questions about how rationing can be made more explicit at different levels of decision making.
Dey
I
I
University of Edinburgh, United Kingdom.
Fraser
N
N
D000367:Age Factors; D003362:Cost-Benefit Analysis; D003657:Decision Making; D015276:Health Care Rationing; D006801:Humans; D006113:United Kingdom; D014481:United States