Towards the end of 2005, a major news story broke in the British media. Under headlines such as ‘NHS denies woman life-saving drug to treat breast cancer’, ‘Why can't I have breast cancer drug now?’ and ‘Bureaucracy threatens cancer sufferers’ lives', it was reported that a number of Primary Care Trusts (PCTs) and health boards, whose responsibility it is to commission provision of healthcare services for their local populations, had refused requests to provide funding for a new ‘wonder drug’, Herceptin, for the treatment of early stage breast cancer. Journalists and commentators cited evidence that there were geographical variations in access to the treatment (an example of the so-called ‘postcode lottery’ in the provision of care), reported dissatisfaction with ‘bureaucratic’ regulatory processes which were perceived as delaying access to the treatment, and noted that a number of disappointed patients were threatening to make use of the courts in an attempt to overturn decisions to deny access to the treatment.

Across the globe, similar incidents are occurring as health systems of all types come under significant strain from the increasing demands placed upon them. Decisions on the allocation of resources for healthcare represent some of the most pressing and controversial choices faced by modern governments. Yet, this was not how it was supposed to be. For example, in the United Kingdom (UK), the belief was that the establishment of the National Health Service (NHS) would reduce the demand for healthcare services and thus offset the requirement to establish priorities for expenditure.