Klein R, Day P, Redmayne S
Centre for the Analysis of Social Policy, University of Bath, UK.
Br Med Bull. 1995 Oct;51(4):769-80. doi: 10.1093/oxfordjournals.bmb.a072992.
The 1991 reforms of the National Health Service set up the expectation that rationing would in future be explicit instead of, as in the past, implicit. This has not happened. Research carried out at the University of Bath shows that very few health authorities are rationing by exclusion on the Oregon model. Instead, both central Government and health authorities are continuing to diffuse responsibility among the medical profession. This paper analyses the reasons why. Rationing by delay and dilution are more significant-as well as less visible-than rationing by exclusion. And it is the medical profession which controls the flow of patients through waiting lists and the way in which resources are used during treatment. Similarly, it is in the self-interest of both central Government and health authorities that their resource decisions should continue to be disguised behind the veils of clinical discretion. Despite pressures for greater transparency, Britain's opaque form of rationing may therefore survive.
1991年英国国民医疗服务体系（National Health Service）改革设定了一个预期，即未来的医疗资源分配将变得明确，而不是像过去那样隐晦。但这一预期并未实现。巴斯大学开展的研究表明，采用俄勒冈模式通过排除法进行医疗资源分配的卫生部门少之又少。相反，中央政府和卫生部门仍在继续将责任分散到医疗行业中。本文分析了其中的原因。相较于通过排除法进行资源分配，拖延和稀释资源分配的做法更为显著，也更不易被察觉。而且，正是医疗行业控制着候诊名单上患者的流量以及治疗过程中资源的使用方式。同样，中央政府和卫生部门都出于自身利益考虑，使得他们的资源决策继续隐藏在临床自主权的面纱之后。尽管面临要求提高透明度的压力，但英国这种不透明的资源分配形式可能仍会持续存在。
