The argument advanced in the preceding chapter was that the focus of debate for those working within the health policy community upon matters of the distribution of resources should be upon the problem of how to ration healthcare, and the related issue of who should do so. Yet, while these questions can be posed in a straightforward manner such as this, they are much less easily answered.

This chapter seeks to examine the mechanisms through which rationing of healthcare may occur, offering, first of all, a typology of the forms of rationing which might exist within a health system. This is an exercise of particular value in the context of the subject-matter of this book, in that the various rationing strategies which are employed tend to generate differing levels of patient and public opposition. They thus present contrasting challenges to the legitimacy of the body which is charged with undertaking the allocative decision, an issue which will be explored at greater length in the next chapter. Secondly, the issue of who should make the rationing decision will be canvassed, with consideration being given to the practicability and the perceived advantages and disadvantages of entrusting distributive choices to (amongst others) doctors, managers, politicians and the public. This leads to a related issue, which is fundamental to the argument presented in this text, namely that of the relative visibility of the rationing decision. The advantages and disadvantages inherent in more or less visible forms of rationing will be explored.