Abstract

1.1. A major purpose in nationalizing the provision of health care in the UK was to affect its distribution between people, and, in particular, to minimize the impact of willingness and ability to pay upon that distribution. It has never been clear, however, what alternative distribution rule is to apply. There is no shortage of rhetoric about ‘equality’ and ‘need’, but most of it is vacuous, by which I mean it does not lead to any clear operational guidelines about who should get priority and at whose expense. The closest we have got so far to such explicit guidelines has been the formulae which determine the geographical distribution of NHS funds, the driving force behind which is a notion of need based on relative mortality rates and on the demographic structure. The avowed objective is to bring about equal access for equal need irrespective of where in the UK you happen to be.