Ian Dey

Age-based rationing in the allocation of health care.

Objectives:This article seeks to review debates about age-based rationing in health care. Methods:The article identifies four different levels (or types) of decisionmaking in health resource allocation—societal, strategic, programmatic, and clinical— and assesses how the issues of rationing vary in relation to each level. Results:The article concludes that rationing is least defensible at the clinical level, where it is also most covert. The role of rationing at other levels is more defensible when based on grounds of cost-effectiveness rather than equity. The article emphasizes the importance of fairness in health allocation and suggests that efficiency criteria need to be considered in that context. Discussion:The article suggests that rationing is most problematic where it is least overt. This raises further questions about how rationing can be made more explicit at different levels of decision making.

Wearing Out the Work Ethic: Population Ageing, Fertility and Work–Life Balance

In response to population ageing, the UK intends to increase female labour supply. To this end, the Chancellor has announced a ten-year strategy designed to allow parents to combine work with family responsibilities more easily. The policies proposed centre on extending parental leave and childcare provision, while promoting greater flexibility in employment. While these policies may improve labour supply in the short term, this article looks at their implications for fertility, which if negative may reduce the labour supply in the longer term. Recent demographic studies suggest that measures which allow women more readily to combine childbearing with paid employment may also stabilise or improve fertility rates, so mitigating the trend to population ageing. However, the evidence is not conclusive, for relationships between female employment and fertility are complex and context dependent. The article suggests several factors that might therefore merit further consideration. These include gender inequities in the domestic division of labour, long working hours and a re-evaluation of unpaid work in the home. Enthusiasm for the work ethic may have to be balanced by a more explicit acknowledgement of a care ethic.