26 March 2019 - Cost effectiveness body should stick to what it’s good at.

All health care systems ration care. The creation of the NHS in 1948 as a universal tax-funded system, largely free at the point of use, was an explicit rejection of rationing based on price and the ability to pay. But the need to decide between competing demands on a limited budget remained.

For half a century, the NHS grappled with this rationing dilemma through a combination of, as Rudolf Klein has characterised it, delay, dilution, deterrence, denial, and deflection. This solved the problem after a fashion, but inconsistently and opaquely. The creation in 1999 of what is now the National Institute for Health and Care Excellence (NICE) was an attempt to tackle that through a systematic, evidence based, and economic approach.

Read BMJ editorial