Abstract

Public health manages the largest possible volume of resources for health. However, and regardless of the national budget for healthcare, there is a chronic incapacity to respond positively to all healthcare needs of all people, in all circumstances. This reality is aggravated in exceptional situations. When resource scarcity worsens, the need for resource allocation intensifies. “Rationing” and “Rationalization” are two different scarce resource allocation strategies. However, most authors use the two terms interchangeably, with great detriment to the establishment of ethically sound guidelines for priority setting in healthcare. Therefore, it is urgent to revisit the two concepts, particularly in the current pandemic situation in which the allocation of resources for healthcare is reaching extreme and unseen levels, with a dramatic impact on patient care. This paper presents a conceptual comparative definition of“Rationing” and “Rationalization”, stresses the different ethical requirements and implications of both, identifying the ethical principles that are at stake, and circumscribes the ethically legitimate specific fields of their application. Examples of the different outcomes deriving from either rationing or rationalization will be presented.