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Priority-setting and rationing in healthcare: Evidence from the English experience

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Author Info

  • Robinson, Suzanne
  • Williams, Iestyn
  • Dickinson, Helen
  • Freeman, Tim
  • Rumbold, Benedict
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    Abstract

    In a context of ever increasing demand, the recent economic downturn has placed further pressure on decision-makers to effectively target healthcare resources. Over recent years there has been a push to develop more explicit evidence-based priority-setting processes, which aim to be transparent and inclusive in their approach and a number of analytical tools and sources of evidence have been developed and utilised at national and local levels. This paper reports findings from a qualitative research study which investigated local priority-setting activity across five English Primary Care Trusts, between March and November 2012. Findings demonstrate the dual aims of local decision-making processes: to improve the overall effectiveness of priority-setting (i.e. reaching ‘correct’ resource allocation decisions); and to increase the acceptability of priority-setting processes for those involved in both decision-making and implementation. Respondents considered priority-setting processes to be compartmentalised and peripheral to resource planning and allocation. Further progress was required with regard to disinvestment and service redesign with respondents noting difficulty in implementing decisions. While local priority-setters had begun to develop more explicit processes, public awareness and input remained limited. The leadership behaviours required to navigate the political complexities of working within and across organisations with differing incentives systems and cultures remained similarly underdeveloped.

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    File URL: http://www.sciencedirect.com/science/article/pii/S0277953612006776
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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 75 (2012)
    Issue (Month): 12 ()
    Pages: 2386-2393

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    Handle: RePEc:eee:socmed:v:75:y:2012:i:12:p:2386-2393

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    Related research

    Keywords: Priority setting; Decision making; Resource allocation; Rationing; Primary care; Healthcare; England; Disinvestment;

    References

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    Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
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    1. Suzanne Robinson & Helen Dickinson & Tim Freeman & Iestyn Williams, 2011. "Disinvestment in health— the challenges facing general practitioner (GP) commissioners," Public Money & Management, Taylor & Francis Journals, vol. 31(2), pages 145-148, March.
    2. Helen Dickinson & Tim Freeman & Suzanne Robinson & Iestyn Williams, 2011. "Resource scarcity and priority-setting: from management to leadership in the rationing of health care?," Public Money & Management, Taylor & Francis Journals, vol. 31(5), pages 363-370, September.
    3. Peacock, Stuart & Mitton, Craig & Bate, Angela & McCoy, Bonnie & Donaldson, Cam, 2009. "Overcoming barriers to priority setting using interdisciplinary methods," Health Policy, Elsevier, vol. 92(2-3), pages 124-132, October.
    4. Abelson, Julia & Forest, Pierre-Gerlier & Eyles, John & Smith, Patricia & Martin, Elisabeth & Gauvin, Francois-Pierre, 2003. "Deliberations about deliberative methods: issues in the design and evaluation of public participation processes," Social Science & Medicine, Elsevier, vol. 57(2), pages 239-251, July.
    5. Kapiriri, Lydia & Norheim, Ole F. & Martin, Douglas K., 2009. "Fairness and accountability for reasonableness. Do the views of priority setting decision makers differ across health systems and levels of decision making?," Social Science & Medicine, Elsevier, vol. 68(4), pages 766-773, February.
    6. Niessen, Louis W. & Grijseels, Els W. M. & Rutten, Frans F. H., 2000. "The evidence-based approach in health policy and health care delivery," Social Science & Medicine, Elsevier, vol. 51(6), pages 859-869, September.
    7. Daniels, Norman & Sabin, James E., 2008. "Setting Limits Fairly: Learning to share resources for health," OUP Catalogue, Oxford University Press, edition 2, number 9780195325959.
    8. Reeleder, David & Goel, Vivek & Singer, Peter A. & Martin, Douglas K., 2006. "Leadership and priority setting: The perspective of hospital CEOs," Health Policy, Elsevier, vol. 79(1), pages 24-34, November.
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