This article discusses New Zealand's experiences with health care rationing policy. It reviews attempts to define ‘core services’, the development of prioritisation techniques for service access and funding, new technology assessment, and the management of subsidised pharmaceuticals. The New Zealand experience offers various lessons: that rationing policy development is, by nature, a ‘messy’ process; that central coordination of rationing policy is crucial unless differentiation in regional initiatives and service access are desired; and that through ongoing highlighting of the need for it, rationing policy development is likely to become an accepted reality.