OXFORD - The World Health Organization has concluded that the imperative to provide universal health care requires rationing of health services in even the world's richest nations, where market-oriented approaches should be replaced by a "new universalism" managed by the public sector.

"WHO cannot support market-oriented approaches that ration health services to those with the ability to pay," said WHO Director-General Gro Harlem Brundtland at last week's launch of the "World Health Report 1999: Making a Difference." "Not only do market-oriented approaches lead to intolerable inequity with respect to a fundamental human right, but growing bodies of theory and evidence indicate markets in health to be inefficient as well,"