title: Renal dialysis: counting the cost versus counting the need.
abstract: The relatively "lean and mean" provision of renal dialysis in Britain is a notorious example of "covert rationing", apparently achieved by a lack of central policy. Then in its first experiment in "target-setting" in the NHS in 1984, central government used the profession's preferred measure of need, thus promoting expansion of renal services, at almost exactly the time when the "quality-adjusted life year" (QALY) developed by health economists indicated that renal dialysis scored low in cost-benefit terms. This chapter examines these conundrums in terms of centre-periphery relations, clinical autonomy versus collective direction, and the politics of competing ways of counting need and cost.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stanton
mesh_terms: D015276:Health Care Rationing / Q000266:history*; D006291:Health Policy / Q000266:history*; D049673:History, 20th Century; D006801:Humans; D019057:Quality-Adjusted Life Years; D006435:Renal Dialysis / Q000191:economics / Q000266:history*; D006113:United Kingdom