Priority-setting and rationing in healthcare: Evidence from the English experience

► There has been a shift towards more explicit priority-setting within healthcare, in England. ► There is concern in relation to the instrumental effects and the wider legitimacy of priority-setting activities. ► Decision analysis and evidence are used to pursue both of the above aims. ► Rationing decisions require leadership skills around political astuteness, relationship management and coalition building. ► Priority-setting should be fully embedded in resource allocation, not just a 'bolt-on' to the distribution of spare funds.