title: Fair rationing is essentially local: an argument for postcode prescribing.
abstract: In this paper I argue that resource allocation in publicly funded medical systems cannot be done using a purely substantive theory of justice, but must also involve procedural justice. I argue further that procedural justice requires institutions and that these must be "local" in a specific sense which I define. The argument rests on the informational constraints on any non-market method for allocating scarce resources among competing claims of need. However, I resist the identification of this normative account of local justice with the actual approach to local decision-making taken within the UK National Health Service. I illustrate my argument with reference to the case of provision of In Vitro Fertilisation within the UK NHS.
authors.affiliation: University of London, Institute of Health Sciences Education, 40 New Road, London El 2AX, United Kingdom. r.ashcroft@qmul.ac.uk
authors.forename: Richard E
authors.initials: RE
authors.lastname: Ashcroft
mesh_terms: D003154:Community Medicine / Q000191:economics; D028663:Ethical Theory; D004992:Ethics, Medical; D005307:Fertilization in Vitro; D015276:Health Care Rationing / Q000941:ethics / Q000592:standards*; D006801:Humans; D040841:Resource Allocation / Q000941:ethics / Q000592:standards*; D013222:State Medicine / Q000191:economics*; D006113:United Kingdom