The health care rationing debate: more clarity by separating the issues?

The health policy debate about rationing is often confused by dealing with several different issues concurrently. This contribution introduces a typology and matrix that separates two of the most important of these issues in order to improve the clarity of the debate. The first of these issues, the mode of rationing, concerns how the responsible parties allocate scarce resources. This can be achieved non-systematically, for example, via ad hoc clinical bedside reasoning, or systematically with the aid of rigorously developed and tested algorithms, possibly including elucidated public preferences which trade-off efficiency and equity. The second issue, the transparency of the debate, concerns how the debate is presented, should it happen tacitly being left to the parties involved (hidden) or should it be open to public scrutiny (open)? Thinking about mode and transparency separately may lend more clarity to the rationing debate. The paper also discusses possible implications resulting from such a separation.