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Priority setting in healthcare: Towards guidelines for the program budgeting and marginal analysis framework

Lookup NU author(s): Dr Stuart Peacock, Dr Danny Ruta, Professor Cam Donaldson, Dr Angela Bate


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Economists approaches to priority setting focus on the principles of opportunity cost, marginal analysis and choice under scarcity. These approaches are based on the premise that it is possible to design a rational priority setting system that will produce legitimate changes in resource allocation. However, beyond issuing guidance at the national level, economic approaches to priority setting have had only a moderate impact in practice. In particular, local health service organizations - such as health authorities, health maintenance organizations, hospitals and healthcare trusts - have had difficulty implementing evidence from economic appraisals. Yet, in the context of making decisions between competing claims on scarce health service resources, economic tools and thinking have much to offer. The purpose of this article is to describe and discuss ten evidence-based guidelines for the successful design and implementation of a program budgeting and marginal analysis (PBMA) priority setting exercise. PBMA is a framework that explicitly recognizes the need to balance pragmatic and ethical considerations with economic rationality when making resource allocation decisions. While the ten guidelines are drawn from the PBMA framework, they may be generalized across a range of economic approaches to priority setting. © 2010 Expert Reviews Ltd.

Publication metadata

Author(s): Peacock S, Mitton C, Ruta D, Donaldson C, Bate A, Hedden L

Publication type: Review

Publication status: Published

Journal: Expert Review of Pharmacoeconomics and Outcomes Research

Year: 2010

Volume: 10

Issue: 5

Pages: 539-552

Print publication date: 01/10/2010

ISSN (print): 1473-7167

ISSN (electronic): 1744-8379


DOI: 10.1586/erp.10.66