The Health Care Resource Allocation Debate

The problem of health care distribution in the United States demands immediate action. Many different solutions have been proposed to slow rising health care costs and to improve access to care for the poor and uninsured. Debate among proponents of these various proposals might be advanced if a common language were adopted with regard to certain key terms instead of the various meanings currently assigned to these terms. For this reason, we propose and defend the following three definitions: (1)rationingis the societal toleration of inequitable access to health services acknowledged to be necessary by reference to necessary-care guidelines; (2)health care needsare desires for services that have been reasonably well demonstrated to provide significant net benefit for patients with specified clinical conditions; and (3)basic benefit plansare insurance packages that provide for all and only acknowledged health care needs, again by reference to appropriate clinical guidelines. (JAMA. 1991;266:3328-3331)