Table 4 Methods of rationing

Selection

Using this method, recipients of care are selected on the basis of clinical benefit they will obtain, or the amount of time required to treat them.

Denial

This method involves the exclusion of certain patient populations because they are deemed unworthy, or because their needs are not seen as sufficiently important.

Deflection

This involves referring patients to other institutions. It is a form of rationing when a patient’s needs can be met by other health or social services.

Deterrence

This involves deterring patients from accessing healthcare by the imposition of complex logistical/administrative requirements, such as inconvenient opening times, incomprehensible paperwork, and unhelpful staff. This type of rationing tends to disadvantage less educated and more vulnerable people.

Delay

This method includes the use of waiting lists. It is the most recognised form of implicit rationing in healthcare, and discourages patients from accessing health services.

Dilution:

In this situation access to services is not denied, but the provision of services is reduced, such as the frequency of home visits.

Interruption

This is the premature termination of a service or a treatment based on a maximum time limit for a given treatment, such as premature discharge from hospital or case closure.