The state of health care priority setting and public participation

A structured questionnaire survey of all 131 health authorities in England, Wales and Scotland was carried out between September 1995 and January 1996. The priority setting questionnaire was sent to chairpersons or chief executives of each health authority, although respondents had a variety of job titles. The objectives of the survey was to assess (i) To assess the extent to which health authorities in England, Wales and Scotland perceive themselves as involved in setting priorities for health service resource allocation; (ii) the importance of different criteria and sources of opinion in current resource allocation priority setting by health authorities, the importance of additional information needs and changes in the input of different sources of opinion; (iii) the involvement of the public in priority setting. 121 health authorities completed and returned the questionnaire (92% response rate). Priority setting was claimed not to be adopted in only 4 authorities. High numbers of important/very important ratings were given for equity, health gain and cost-effectiveness criteria, and clinicians, GPs, public health doctors and health authority managers sources of opinion. Over 75% of authorities wanted more input in priority setting from the public, although health authority experience of involving the public was generally mixed. The pursuit by health authorities of explicit priority setting in resource allocation is generating needs for more information on key decision making criteria, and the structured input of a variety of sources of opinion, especially the public. Achieving these aims are likely to be fraught with difficulty. In a discussion section, we focus on the conceptual and practical difficulties facing the greater involvement of the public in priority setting.