Table 1 The matrix of Maybin and Klein’s NHS rationing strategies^a [8]

Rationing by denial

This is the most headline-catching form of rationing. Specific forms of intervention are excluded from the NHS services on offer, on the grounds of lack of effectiveness, high cost or a combination of the two.

Rationing by selection

Service providers select those patients who are most likely to benefit from interventions or raise the threshold of eligibility for treatment.

Rationing by delay

The traditional form of rationing in the NHS, designed to control access to the system and match demand to supply by making patients wait.

Rationing by deterrence

If patients are not put off by queues, there are other ways of raising barriers to, and the costs of, entry into the health care system. Receptionists may be unhelpful, and information leaflets may be unavailable, or access may be difficult.

Rationing by deflection

All else failings, patients may be shunted off to another institution, agency or program. ‘Difficult cases’ may be referred to another hospital or specialist.

Rationing by dilution

Services or programs continue to be offered, but there are fewer nurses on the ward, doctors order fewer tests, the palatability of hospital food plunges, and the quality of care and treatment declines.