Unusually for a book on this topic, many of the chapters provide detailed accounts of micro–level decision making at the point of service delivery. They seek to penetrate the ′black box′ of the organisation – the emergency department, the intensive care unit, the cancer genetics clinic or the community mental health team – to shed light on processes by which access to care is denied, delayed, or otherwise limited. The book presents a picture of rationing processes that are ′implicit′ rather than ′explicit′, and closely woven into the fabric of professional cultures and modes of working.
1. Introduction. A sociological perspective on rationing: power, rhetoric and situated practices (Donald Light and David Hughes).
2. Risk and Rationing. Rationing through risk assessment in clinical genetics: all categories have wheels (Lindsay Prior).
3. Governmentality and risk: setting priorities in the new NHS (Paul Joyce).
4. Rationing in Hospitals. Categorisation and micro–rationing: access to care in a French emergency department (Carine Vassy).
5. Everyday experiences of implicit rationing: comparing the voices of nurses in California and British Columbia (Ivy Lynn Bourgeault, Pat Armstrong, Hugh Armstrong, Jacqueline Choiniere, Joel Lexchin, Eric Mykhalovskiy, Suzanne Peters and Jerry White).
6. Rationing in the Community. Rationing health car to disabled people (Gary L. Albrecht).
7. Categorising to exclude: the discursive construction of cases in community mental health teams (Lesley Griffiths).
8. Professional Resistance. Subverting criteria: the role of precedent in decisions to finance surgery (John Heritage, Elizabeth Boyd and Lawrence Kleinman).
9. Clinical actions and financial constraints: the limits to rationing intensive care (Irvine Lapsley and Kath Melia).
Donald W. Light is the Professor of comparative health care systems at the University of Medicine and Dentistry of New Jersey and a fellow at the Center for Bioethics at the University of Pennsylvania. Trained as a sociologist at the University of Chicago and Brandeis, he is a Faculty Associate in the Department of Sociology at Princeton University. Professor Light has written about distributive justice in the BMJ and is co–author of Benchmarks of Fairness for Health Care Reform (1996).