As the needs and demands of patients, and the costs of health care of populations, have risen sharply in recent years, governments and health-care providers – whether tax-funded, insurance-based, employer-provided or a mix of these – face the dilemma of what services a country or a community can afford to provide. As a result, various techniques for deciding priorities of care and treatment are evolving. In the United Kingdom, priorities were for many years based on the decisions of individual clinicians who had wide freedom to prescribe the most appropriate care. Increasingly, this clinical freedom is being restricted by managerial, community and political decisions driven by the availability of resources and by what people want. Rationing services, however, is not popular and as yet no broadly agreed consensus has emerged, either in Western Europe or in North America, as to how priorities can be decided that have broad community support and which can be afforded. (See CLINICAL GOVERNANCE; EVIDENCE-BASED MEDICINE; NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE (NICE).)