Priority Setting in Action: Purchasing Dilemmas

Content: Intro
 Title Page
 Copyright Page
 Contents
 List of contributors
 Participants
 Foreword
 Preface
 1 The international context
 Oregon
 The Netherlands, New Zealand and Sweden
 United Kingdom
 Issues arising
 2 The Southampton experience
 Simulation seminar of 1991
 The growth of commissioning
 Rational planning and decision making --
1994
 Trial run
 Development of the health strategy
 Stakeholder consultation
 Identifying criteria
 Views of experts
 Determining importance of criteria
 Preliminary ranking of 49 options
 Ranking of the options
 Purchasing plan
 Rankings compared Comparison with GP rankingsApproach to disinvestment
 Overview of procedure
 3 Lessons learned
 Relevance of the Southampton experience
 No quick fix
 Coping with many options
 Rational planning
 Limited cost-utility data rule out marginal analysis
 Needs assessment essential
 Clearer definition of criteria
 Assigning weights to criteria
 Health gain versus equity
 No clear way to relate criteria to choices
 Pragmatic criteria strongly influence rankings
 Protection for chronic sick and deprived groups
 Stakeholder consultation necessary and needs more care
 The public\'s role GPs can help decide prioritiesMore involvement by provider groups
 Efficiency before exclusions
 Disinvestments cannot always be ignored
 4 Emergent themes
 Health economics and priority setting: nonsense on stilts?
 How not to ration health care: the moral perils of utilitarian decision making
 The strengths and limitations of programme budgeting
 Reflections on a brief return to strategic planning
 The view from a small plane over Hampshire
 Promoting equity and avoiding prejudice
 The future strategic role of commissions
 When the elephants fight, it is the grass which suffers Reflections of the non-executive members5 Outstanding issues
 National direction or local discretion?
 How to involve stakeholders
 How to involve providers
 How to make better use of economic evaluation
 Protection for the chronic sick and vulnerable groups
 How to guard against age and lifestyle discrimination
 Appendix A Local health problems
 Appendix B Options for change and indicative costs
 Appendix C Marginal value
 Appendix D Health benefits
 Appendix E Other benefits
 Appendix F Stakeholder consultation results
 Appendix G Expert panel: personal profiles
 Index