Review

Efficient use of resources

MANAGING SCARCITY: priority setting and rationing in the National Health Service
Rudolph Klein, Patricia Day, and Sharon Redmayne
Open University Press, 1996, £13.99

In a mere 142 pages, Klein and colleagues attempt to equip the reader with the vocabulary of the rationing/resource allocation debate; place current concerns over rationing of NHS care into both a historical and international context; consider the competing solutions of more resources versus evidence-based practice; and review the options for future policy directions.

The remarkable extent to which they achieve their objectives suggests valuable skills in getting the most out of limited resources that the NHS could benefit from.

The book has two great strengths: the large amount of material it covers, and its ample use of real examples to illuminate particular points. But having said that, its major weakness is the tension between the breadth and depth of coverage. While reading it I often wished that particular points were developed further. For example, I would have liked to know more about the behaviour of GP fundholders in priority setting, but the authors leave this issue aside saying that fundholders only account for 8 per cent of total spending.

In his introduction, Chris Ham says the book(s) are intended for students, lay readers and specialists working the field. But the volume of information in the book may threaten to overwhelm the lay reader, while the limited coverage risks giving them a dangerously incomplete picture. In contrast, students and specialists are likely to find the coverage of issues disappointing. To them the book’s greatest value will be as a starting place for the ‘paper chase’ into the real literature.

Having said this, the book is a remarkable attempt to cover a vast area of work in a short space. It provides simple introductions to an enormous range of questions and, as such, is a useful resource to have on one’s bookshelf.