Health care priority setting: principles, practice and challenges

Cost Effectiveness and Resource Allocation

Cam Donaldson²  Craig Mitton¹ 

[1] Centre for Healthcare Innovation & Improvement, B.C. Research Institute for Children's and Women's Health, and Dept. of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada;Centre for Health Services Research, School of Population & Health Sciences and Business School (Economics), University of Newcastle upon Tyne, UK

关键词: marginal analysis;    program budgeting;    priority setting;   

Others  :  822337
DOI  :  10.1186/1478-7547-2-3

 received in 2004-02-03, accepted in 2004-04-22,  发布年份 2004

【 摘 要 】

Background

Health organizations the world over are required to set priorities and allocate resources within the constraint of limited funding. However, decision makers may not be well equipped to make explicit rationing decisions and as such often rely on historical or political resource allocation processes. One economic approach to priority setting which has gained momentum in practice over the last three decades is program budgeting and marginal analysis (PBMA).

Methods

This paper presents a detailed step by step guide for carrying out a priority setting process based on the PBMA framework. This guide is based on the authors' experience in using this approach primarily in the UK and Canada, but as well draws on a growing literature of PBMA studies in various countries.

Results

At the core of the PBMA approach is an advisory panel charged with making recommendations for resource re-allocation. The process can be supported by a range of 'hard' and 'soft' evidence, and requires that decision making criteria are defined and weighted in an explicit manner. Evaluating the process of PBMA using an ethical framework, and noting important challenges to such activity including that of organizational behavior, are shown to be important aspects of developing a comprehensive approach to priority setting in health care.

Conclusion

Although not without challenges, international experience with PBMA over the last three decades would indicate that this approach has the potential to make substantial improvement on commonly relied upon historical and political decision making processes. In setting out a step by step guide for PBMA, as is done in this paper, implementation by decision makers should be facilitated.

【 授权许可】

   
2004 Mitton and Donaldson; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

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