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Defining Our Terms

David C. Hadorn, MD, MA; Robert H. Brook, MD, ScD

JAMA. 1991;266(23):3328-3331.

Abstract
The problem of health care distribution in the United States demands immediate action. Many different solutions have been proposed to slow rising health care costs and to improve access to care for the poor and uninsured. Debate among proponents of these various proposals might be advanced if a common language were adopted with regard to certain key terms instead of the various meanings currently assigned to these terms. For this reason, we propose and defend the following three definitions: (1) rationing is the societal toleration of inequitable access to health services acknowledged to be necessary by reference to necessary-care guidelines; (2) health care needs are desires for services that have been reasonably well demonstrated to provide significant net benefit for patients with specified clinical conditions; and (3) basic benefit plans are insurance packages that provide for all and only acknowledged health care needs, again by reference to appropriate clinical guidelines.

(JAMA. 1991;266:3328-3331)

Author Affiliations
From the Department of Social Policy, RAND, Santa Monica, Calif (Drs Hadorn and Brook) and the Department of Medicine and Health Services, UCLA Center for Health Services, Los Angeles, Calif (Dr Brook).

Footnotes
Reprint requests to Department of Social Policy, RAND, 1700 Main St, PO Box 2138, Santa Monica, CA 90406 (Dr Hadorn).

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