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

Robinson, Suzanne and WIlliams, Iestyn and Dickinson, Helen and Freeman, Tim and Rumbold, Benedict (2012) Priority-setting and rationing in healthcare: evidence from the English experience. Social Science and Medicine, 75 (12). 2386-2393. ISSN 0277-9536

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URL of Published Version: http://www.sciencedirect.com/science/article/pii/S0277953612006776

Identification Number/DOI: http://dx.doi.org/10.1016/j.socscimed.2012.09.014

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.
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.
In conclusion, while local priority-setters had begun to develop more explicit processes, public awareness and input remained limited, compromising the legitimacy of decisions. The leadership behaviours required to navigate the political complexities of working within and across organisations with differing incentives systems and cultures remained similarly underdeveloped.

Type of Work:Article
Date:01 December 2012 (Publication)
School/Faculty:Colleges (2008 onwards) > College of Social Sciences
Department:Health Services Management Centre
Keywords:Priority setting; Decision making; Resource allocation; Rationing; Primary care; Healthcare; England; Disinvestment
Subjects:H Social Sciences (General)
Institution:University of Birmingham
Copyright Holders:Elsevier Plc
ID Code:1312
Refereed:YES
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