The ethics of resource allocation: the views of general practitioners in Lincolnshire, U.K

Concerns about the intrusion of economic and financial considerations into patient management have increased in the United Kingdom, largely as a result of the passage of the 1990 National Health Services Act. Based on an agenda set by the British Medical Association, a questionnaire was designed to reveal general practitioners' attitudes to potential ethical problems posed by rationing and resource allocation. The questionnaire was issued to each of the 105 practices in Lincolnshire and 70 replies were returned for analysis. The survey revealed that, in certain areas, there existed a wide divergence of opinion amongst physicians. Examples included the extent to which the government was to be held responsible for full health care funding, the legitimacy or otherwise of general practice budgets and the extent to which service provision should be dependent on upon personal remuneration. On the other hand, relatively high degrees of consensus appeared to exist with respect to issues such as rationing by deterrence and service dilution. Additional, qualitative, evidence suggests that practitioners perceive themselves to be under increasing pressure from patient demand and that morale in the profession is falling. The results of the present study appear consistent with those obtained in other countries. In view of recent policy initiatives with respect to public sector health care, it is likely that the debate over the ethical dimensions of resource allocation in the U.K. will become more vigorous.