The Government should take "a more active interest" in ensuring that patient care is not being rationed, a report suggests.
The Department of Health has "no way" of getting assurances from local healthcare commissioners that patient care is not being restricted, according to the National Audit Office (NAO).
While the Department has made clear that blanket bans on procedures are not permitted, it still needs to develop ways of getting assurances that procedures are not being inappropriately restricted, according to the report.
There was public outcry when it emerged that some trusts had put restrictions on operations, including knee and hip replacements, cataracts surgery and tonsillectomies, to cut costs.
The report, which is examining the efficiency drive in the health service, states: "The aim is to control demand without inappropriately restricting patients' access to care, but the Department has no way of routinely gaining assurance that this is being achieved."
The authors added: "The Department should take a more active interest in demand management and develop ways of gaining routine assurance that patients' access to healthcare is not being inappropriately restricted.
"Monitoring access is not straightforward but the Department needs more evidence on the impact of demand management.
"It should also ensure that local policies on access to care are transparent so that commissioners can be held to account."
A Department of Health spokesman said: "We have been absolutely clear that rationing services on the basis of cost alone is completely unacceptable.
"Decisions on treatments, including suitability for surgery, should be made by clinical experts taking the needs of each patient into account. We have already written to the NHS to set out clearly that access to services should not be restricted on the basis of cost."