Categorisation and micro-rationing: access to care in a French emergency department

This paper describes how the categorisation of patients by staff in a Frenc h emergency department (ED) leads to the micro-rationing of care. Although ED staff are reluctant to acknowledge it, they refuse to treat many would-b e patients at the reception stage, and advise them to go to other care sett ings (such as general practitioners' premises or social dispensaries). The study analyses the judgmental categories staff use to decide patients' elig ibility for care, paying particular attention to their clinical, organisati onal, moral and social dimensions. Staff ration care at the point of servic e delivery but they soften the harshness of the rationing by making a posit ive discrimination in favour of those seen to be in real need. Data from ob servations and interviews are used to analyse the tensions between the diff erent models of 'local justice' employed by doctors.