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...be carried out. Others however, question the whole notion of rationing health care at all. They claim that health care rationing is unnecessary and a diversion from the real problem of the funding and delivery of health care. In addition, they argue that the automatic acceptance of the need for rationing leads to pessimism and a series of undesirable consequences. While some health authorities are very determined to implement rationing as the national policy, others are avoiding difficult decisions about rationing by tinkering at the edges. Is it necessary to ration health care? Based on economic theory that demand will always exceed supply - greater efficiency, increased resource allocation, reduction of waste, and elimination of totally ineffective treatments will not individually eliminate the need for rationing (in some form or another). It may well be that no society can, or would wish to, provide absolutely every medical service that is available. Rationing or priority setting in the presence of a generous resource allocation will need fewer 'hard choices' than rationing in the face of severely limited resources. Should Health Care Be Rationed? If the argument that rationing is necessary because it will never be possible to provide sufficient resources to meet demand is accepted, it seems unnecessary to debate whether health care should be rationed. However, we should consider alternative points of view. For example, is there already a tendency to assume that additional expenditure on one health care service must automatically be at the expense of another? If this is the case, we should be debating priority setting and the efficiency with which resources are used. It is also claimed that the rationing debate serves as a diversion from questions of efficiency and the cost of delivering care. Rationing may mean that there is less incentive to seek cost reductions and the removal of inefficiencies. Policies to address 'efficiency' savings and price reductions should prevent this from occurring. Arguments for rationing are often put forward in the name of social justice. Such rationing aims to secure a fair share for all, rather than letting the price of a scarce commodity rise, allowing the rich to purchase as much as they want and denying any to the poor. However, for this to stand up within health care, it would be necessary to forbid anyone to purchase care which is excluded from those who are rationed or it would appear that health officials are restricting access based on ability to pay rather than on category of illness. The Public Debate New Zealand is ahead of most other countries in publicly debating the need to ration health resources. Rationing has always occurred, but people realised it had to be done openly and that getting the public involved was important. Unlike other countries, New Zealand faced the problem head on and talked about it. Public debate about the need for rationing of health services was desirable, even though it was uncomfortable because it meant confronting the issue that there were not enough resources to pay for all that patients may need. What cannot be lost sight of is the emotional stress placed on medical staff, patients and their families when decisions need to be made on whether medical care will be given in all situations. In the most extreme cases care may not be given to prolong life where the extra time gained is short-term. This is an example of directing the resources to cases where the care is considered to be of more benefit in the longer term in the overall interests of the country. Many cases have been debated in the media and opinions formed on both sides of the arg...