Rationing: Constructed Realities and Professional Practices

This volume examines health care rationing in action using recent case studies from the United Kingdom, Europe and North America. Drawing on data from a variety of hospital and community settings, the contributors show how prioritisation and access to care depend on organisational arrangements and professional practices, which are often invisible to the service user.

Unusually for a book on this topic, many of the chapters provide detailed accounts of micro-level decision making at the point of service delivery. They seek to penetrate the 'black box' of the organisation - the emergency department, the intensive care unit, the cancer genetics clinic or the community mental health team - to shed light on processes by which access to care is denied, delayed, or otherwise limited. The book presents a picture of rationing processes that are 'implicit' rather than 'explicit', and closely woven into the fabric of professional cultures and modes of working.