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Mindstretcher 2

Bandolier 2 featured the first of a series of articles by David Eddy from JAMA called "Three battles to watch in the 1990s". The second article of the series is entitled "Principles for making difficult decisions in difficult times"; like the first, it is a hard but worthwhile read.

Although directed at US healthcare systems the way in which Eddy tackles the difficulties which limited resources bring to health care delivery are equally applicable to the UK. Purchasers and providers should both take note of this powerful article - what is highlighted is the inevitable tension between the needs of the individual and the needs of the population as a whole, and the sometimes unpalatable alternative choices that result.

Eddy is careful not to overuse the word rationing - but decisions about how to make effective decisions about the use of limited healthcare resources is what this article is all about, as summarised in the figure. Whichever part of the system you occupy, this will help on good and bad days.


DM Eddy. Principles for making difficult decisions in difficult times. Journal of the American Medical Association 1994, 271: 1792-8.

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