Priority Setting in Action: Purchasing Dilemmas

Description

The power of purchasers exposes the weaknesses of conventional thinking on the costs and benefits of priorities. Health policy analysts now have to develop rational criteria to support decisions in a process which may be inherently intuitive. This authoritative and practical text points the way towards clear choices in resource allocation and the implications of these choices on expenditure diverted among different health care programmes. Content: Intro Title Page Copyright Page Contents List of contributors Participants Foreword Preface 1 The international context Oregon The Netherlands, New Zealand and Sweden United Kingdom Issues arising 2 The Southampton experience Simulation seminar of 1991 The growth of commissioning Rational planning and decision making -- 1994 Trial run Development of the health strategy Stakeholder consultation Identifying criteria Views of experts Determining importance of criteria Preliminary ranking of 49 options Ranking of the options Purchasing plan Rankings compared Comparison with GP rankingsApproach to disinvestment Overview of procedure 3 Lessons learned Relevance of the Southampton experience No quick fix Coping with many options Rational planning Limited cost-utility data rule out marginal analysis Needs assessment essential Clearer definition of criteria Assigning weights to criteria Health gain versus equity No clear way to relate criteria to choices Pragmatic criteria strongly influence rankings Protection for chronic sick and deprived groups Stakeholder consultation necessary and needs more care The public's role GPs can help decide prioritiesMore involvement by provider groups Efficiency before exclusions Disinvestments cannot always be ignored 4 Emergent themes Health economics and priority setting: nonsense on stilts? How not to ration health care: the moral perils of utilitarian decision making The strengths and limitations of programme budgeting Reflections on a brief return to strategic planning The view from a small plane over Hampshire Promoting equity and avoiding prejudice The future strategic role of commissions When the elephants fight, it is the grass which suffers Reflections of the non-executive members5 Outstanding issues National direction or local discretion? How to involve stakeholders How to involve providers How to make better use of economic evaluation Protection for the chronic sick and vulnerable groups How to guard against age and lifestyle discrimination Appendix A Local health problems Appendix B Options for change and indicative costs Appendix C Marginal value Appendix D Health benefits Appendix E Other benefits Appendix F Stakeholder consultation results Appendix G Expert panel: personal profiles Index