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


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


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.

Suggested Citation

  • Robinson, Suzanne & Williams, Iestyn & Dickinson, Helen & Freeman, Tim & Rumbold, Benedict, 2012. "Priority-setting and rationing in healthcare: Evidence from the English experience," Social Science & Medicine, Elsevier, vol. 75(12), pages 2386-2393.
  • Handle: RePEc:eee:socmed:v:75:y:2012:i:12:p:2386-2393
    DOI: 10.1016/j.socscimed.2012.09.014

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    References listed on IDEAS

    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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.
    6. Daniels, Norman & Sabin, James E., 2008. "Setting Limits Fairly: Learning to share resources for health," OUP Catalogue, Oxford University Press, edition 2, number 9780195325959.
    7. 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.
    8. 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.
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    Cited by:

    1. Angell, Blake & Pares, Jennie & Mooney, Gavin, 2016. "Implementing priority setting frameworks: Insights from leading researchers," Health Policy, Elsevier, vol. 120(12), pages 1389-1394.
    2. Smith, Neale & Mitton, Craig & Hall, William & Bryan, Stirling & Donaldson, Cam & Peacock, Stuart & Gibson, Jennifer L. & Urquhart, Bonnie, 2016. "High performance in healthcare priority setting and resource allocation: A literature- and case study-based framework in the Canadian context," Social Science & Medicine, Elsevier, vol. 162(C), pages 185-192.
    3. Rooshenas, Leila & Owen-Smith, Amanda & Hollingworth, William & Badrinath, Padmanabhan & Beynon, Claire & Donovan, Jenny L., 2015. "“I won't call it rationing…”: An ethnographic study of healthcare disinvestment in theory and practice," Social Science & Medicine, Elsevier, vol. 128(C), pages 273-281.
    4. Garpenby, Peter & Nedlund, Ann-Charlotte, 2016. "Political strategies in difficult times – The “backstage” experience of Swedish politicians on formal priority setting in healthcare," Social Science & Medicine, Elsevier, vol. 163(C), pages 63-70.


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