Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-26T05:43:07.542Z Has data issue: false hasContentIssue false

Setting Health Priorities: A Review of Concepts and Approaches*

Published online by Cambridge University Press:  20 January 2009

Abstract

The setting of health priorities is primarily concerned with the equitable distribution of resources and is now more than ever an important part of strategic planning within the National Health Service (NHS). The basic information which can be used to assist in such decision-making and the process by which different agencies become involved are important aspects of priority-setting; this article is based on a major review of the research literature on these aspects and provides a discussion and an analysis of experience within health and other fields. From this material a number of possible approaches to priority-setting are identified and discussed. The article concludes that, before it can be decided how priorities should be set in the future, outstanding questions about how far rational approaches are feasible, about who is to be involved and what role they should play, and about how far such decisions are to be taken nationally or locally will need further consideration.

Type
Article
Copyright
Copyright © Cambridge University Press 1978

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Logan, R. F., Ashley, J. S., Klein, R. E. and Robson, D. M., ‘Dynamics of Medical Care: The Liverpool Study into the Use of Hospital Resources’, Memoir 14, London School of Hygiene and Tropical Medicine, 1972.Google Scholar

2 Bradshaw, J., ‘The Concept of Social Need’, New Society, 30 03 1972, 640–3.Google Scholar

3 Forder, A., Concepts in Social Administration: A Framework for Analysis, Routledge and Kegan Paul, London, 1974.Google Scholar

4 Cooper, M. H., Rationing Health Care, Croom Helm, London, 1975.Google Scholar

5 Logan et al., op. cit.

6 Culyer, A. J., Need and the National Health Service: Economics and Social Choice, Martin Robertson, London, 1976.Google Scholar

7 Majone, G., ‘On the Logic of Standard Setting in Health and Related Fields’, in Bailey, N. and Thompson, M. (eds), Systems Aspects of Health Planning: Proceedings of the IIASA Conference, Baden, Austria, 1974, North Holland Publishing Company, Amsterdam, 1975.Google Scholar

9 Draper, P. and Smart, A., ‘Lessons from the National Health Service Reorganisation, Part B: Looking Forward’, in Jones, K. (ed.), The Yearbook of Social Policy in Britain 1975, Routledge and Kegan Paul, London, 1976.Google Scholar

10 Robinson, D., The Process of Becoming III, Routledge and Kegan Paul, London, 1971.Google Scholar

11 See Buxton, M. J. and Klein, R. E., ‘Distribution of Hospital Provision: Policy Themes and Resource Variations’, British Medical Journal, 1 (1975), 345–7.CrossRefGoogle ScholarPubMed

12 See Cooper, op. cit.

13 See for example ‘The NHS: How Well does it Work?’, Which, August 1975.Google Scholar

14 Buxton, M. J., ‘Patterns of Inequality: Inequality within Nations’, Unit 13, Health and Inequality, Open University Press, Milton Keynes, 1976.Google Scholar

15 Scottish Health Authorities Revenue Equalisation (SHARE Report), Scottish Home and Health Department (SHHD), HMSO, Edinburgh, 1977.Google Scholar

16 Report of the Resource Allocation Working Party: Sharing Resources for Health in England (RAWP Report), Department of Health and Social Security (DHSS), HMSO, London, 1976.Google Scholar

17 For a useful overview of the work in this field, see Townsend, Peter, ‘Inequality and the Health Service‘, The Lancet, 15 06 1974, 1, 179–90Google Scholar; SirBrotherston, John, ‘Inequality: Is it Inevitable?’, in Carten, C. O. and Peel, John (eds), Equalities and Inequalities in Health, Academic Press, London, 1976Google Scholar; and Buxton, op. cit.

18 See Nelignan, G., Prudham, D. and Steiner, H., The Formative Years, Oxford University Press and the Nuffield Provincial Hospitals Trust, London, 1974.Google Scholar

19 See Brotherston, op. cit.

20 Lee, K., ‘Public Expenditure, Planning and Local Democracy’, in Barnard, K. and Lee, K. (eds), Conflicts in the National Health Service, Croom Helm, London, 1977.Google Scholar

21 See for example Cochrane, A. L., Effectiveness and Efficiency: Random Reflections on Health Services, Nuffield Provincial Hospitals Trust, London, 1972.Google ScholarPubMed

22 SHHD, The Way Ahead, HMSO, Edinburgh, 1976Google Scholar; and DHSS, Priorities for Health and Personal Social Services in England: A Consultative Document, HMSO, London, 1976.Google Scholar

23 Which, op. cit.

24 See for example Robb, B. (ed.), Sans Everything: A Case to Answer, Thomas Nelson and Sons, London, 1977.Google Scholar

25 World Health Organization, Approaches to National Health Planning, WHO Public Health Papers no. 46, WHO, Geneva, 1972.Google ScholarPubMed

26 Comaish, J. S., ‘How to Set Priorities in Medicine’, The Lancet, 2 (1976), 512–14.CrossRefGoogle Scholar

27 Bryant, J. H., ‘Moral Issues and Health Care’, Healing (Newsletter of the Christian Medical Council, 476 Riverside Drive, New York, NY 10027), 7 (1970).Google Scholar

28 See for example Cooper, op. cit.

29 SHHD, The Way Ahead.Google Scholar

30 See Williams, C. J. H. and Rothwell, T. A., ‘Could the Consultative Document Have its Priorities Wrong?’, British Medical Journal, 16 10 1976, 956–7.CrossRefGoogle ScholarPubMed

31 See Klein, R., ‘The National Health Service’, in Klein, R. (ed.), Social Policy and Public Expenditure 1975. Inflation and Priorities, Centre for Studies in Social Policy, London, 1975.Google Scholar

32 See for example Cochrane, op. cit.; and Townsend, op. cit.

33 Kelman, H. R., ‘Evaluation of Health Care Quality by Consumers’, International Journal of Health Services, 6:3 (1976), 431–42.CrossRefGoogle Scholar

34 See Cochrane, op. cit.

35 See Pole, J. D., ‘The Use of Outcome Measures in Health Service Planning’, International Journal of Epidemiology, 2:1 (1973), 2330.CrossRefGoogle Scholar

36 McKeown, T., The Role of Medicine: Dream, Mirage or Nemesis?, The Rock Carling Fellowship, and Nuffield Provincial Hospitals Trust, London, 1976.Google Scholar

37 See for example Culyer, op. cit.

38 Klein, , ‘The National Health Service’.Google Scholar

39 See for example McDonald, A. G., Cuddeford, G. C. and Beale, E. M., ‘Balance of Care: Some Mathematical Models of the National Health Service’, British Medical Bulletin, 30:3 (1974), 262–70.CrossRefGoogle ScholarPubMed

40 Illsley, R., ‘Everybody's Business?: Concepts of Health and Illness’, MRC Medical Sociology Unit, Aberdeen, November 1976, included as Appendix IV of Health and Health Policy: Priorities for Research, report of an advisory panel to the Research Initiatives Board, Social Science Research Council, London, 1977.Google Scholar

41 DHSS, Prevention and Health: It's Everybody's Business: A Re-assessment of Public and Personal Health, HMSO, London, 1976.Google Scholar

42 Lalonde, M., A New Perspective on the Health of Canadians, Government of Canada, Ottawa, 1975.Google ScholarPubMed

43 See McKeown, op. cit.

44 Illich, I., Medical Nemesis: The Exploration of Health, Calder and Boyars, London, 1975.Google Scholar

45 See McKeown, op. cit.

46 See Dunlop, D. W., ‘Benefit-Cost Analysis: A Review of its Applicability in Policy Analysis for Delivering Health Services’, Social Science and Medicine, 9 (1975), 133–9.CrossRefGoogle ScholarPubMed

47 Heclo, H. and Wildavsky, A., The Private Government of Public Money, Macmillan, London, 1974.Google Scholar

48 Central Policy Review Staff, A Joint Framework for Social Policies, HMSO, London, 1975.Google Scholar

49 Klein, , ‘The National Health Service’.Google Scholar

50 Owen, D., In Sickness and in Health, Quartet Books, London, 1976.Google Scholar

51 Which, op. cit.

52 See Pole, op. cit.

53 See Griffith, J. A. G., Central Departments and Local Authorities, Allen and Unwin, London, 1966.Google Scholar

54 Crossman, R. H. S., ‘A Politician's View of Health Service Planning’, thirteenth Maurice Bloch lecture, delivered at the University of Glasgow, 28 April 1972.Google Scholar

55 Maddox, G. L., ‘Muddling Through: Planning for Health Care in England’, Medical Care, 9:5 (1972), 439–48.CrossRefGoogle ScholarPubMed

56 Klein, R., ‘Policy Problems and Policy Perceptions in the National Health Service’, Policy and Politics, 2:3 (1974), 219–36.CrossRefGoogle Scholar

57 Robb, op. cit.

58 Report of the Committee of Inquiry into Allegations of Ill-Treatment of Patients and other Irregularities at the Ely Hospital, Cardiff, Cmnd 3975, HMSO, London, 1969.Google Scholar

59 Klein, , ‘Policy Problems and Policy Perceptions in the National Health Service’.Google Scholar

60 See Wiseman, C., ‘Strategic Planning in the Scottish National Health Service: A Mixed-Scanning Approach’, Long Range Planning, forthcoming, 1978.Google ScholarPubMed

61 See for example McKeown, op. cit.

62 Cooper, op. cit.

63 See Wiseman, op. cit.

64 See Pole, op. cit.

65 See Wiseman, C., ‘Selection of Major Planning Issues’, Policy Sciences, 9 (1978), 7186.CrossRefGoogle Scholar

66 Boddy, D., ‘Programme Planning Committees in the Greater Glasgow Health Board’, Health Bulletin, 35:5 (1977), 271–81.Google ScholarPubMed

67 D. Towell, ‘Making Reorganisation Work: Challenges and Dilemmas in the Development of Community Medicine’, in Barnard and Lee, op. cit.

68 Lee, op. cit.

69 See for example Owen, op. cit.

70 Klein, R. and Lewis, J., The Politics of Consumer Representation, Centre for Studies in Social Policy, London, 1976.Google Scholar

71 World Health Organization, Modern Management Methods and the Organisation of Health Services, WHO Public Health Papers no. 55, WHO, Geneva, 1974.Google Scholar

72 Draper, P., ‘Value Judgements in Health Planning’, Community Medicine, 23 02 1973. 372–4.Google Scholar

73 C. J. Ham, ‘Power, Patients and Pluralism’, in Barnard and Lee, op. cit.

74 Draper, P., ‘Creating Health Policies in Democracies’, Community Medicine, 21 04 1972, 27–9.Google Scholar

75 Klein and Lewis, op. cit.

76 Delbecq, A. L., Van de Ven, A. H. and Gustafson, D. H., Group Techniques for Programme. Planning: A Guide to Nominal Group and Delphi Processes, Scott, Foresman and Company, Glenview, Illinois, 1975.Google Scholar

77 Pole, op. cit.

78 See Griffith, op. cit.

79 Blum, H. L., Planning for Health: Development and Application of Social Change Theory, Human Sciences Press, New York, 1974.Google Scholar

80 McCreadie, C., ‘Personal Social Services’, in Klein, R. (ed.). Social Policy and Public Expenditure 1975: Inflation and Priorities, Centre for Studies in Social Policy, London, 1975.Google Scholar

81 Meacher, M., ‘Scrooge Areas’, New Society, 2 12 1971.Google Scholar

82 Klein, R., ‘Accountability in the National Health Service’, Political Quarterly, 42:4 (1974). 363–75.CrossRefGoogle Scholar

83 Sumner, G. and Smith, R., Planning Local Authority Services for the Elderly, University of Glasgow Social and Economic Studies, Allen and Unwin, London, 1969.Google Scholar

84 Griffith, op. cit.

85 Sumner and Smith, op. cit.

86 Majone, op. cit.

87 See for example Williams, op. cit.

88 See Illsley, op. cit.

89 See Pole, op. cit.

90 See for example Levy, E., ‘Health Indicators and Health Systems Analysis’, in Perlman, M. (ed.), The Economics of Health and Medical Care, Macmillan, London, 1974.Google ScholarPubMed

91 Williams, op. cit.

92 World Health Organization, Modern Management Methods and the Organisation of Health Services.Google Scholar

93 Bryant, op. cit.

94 Boddy, F. A., ‘Notes on Criteria for the Assessment of Health Service Priorities’, unpublished paper prepared for the Subcommittee for Community Medicine, National Medical Consultative Committee, 1976.Google Scholar

95 Blum, op. cit.

96 See Wiseman, , ‘Selection of Major Planning Issues’.Google Scholar

97 Algie, J. and Miller, C., ‘Deriding Social Services Priorities’, Part I, Social Work Today, 6:22 (1976), 678–82Google Scholar; Part II, Social Work Today, 6:23 (1976), 717–20.Google Scholar

98 See for example Maddox, op. cit.

99 See Shills, E. (ed.). Criteria for Scientific Development: Public Policy and Notional Goals, MIT Press, Cambridge, Massachusetts, and London, 1968.Google Scholar

100 See Brotherston, op. cit.

101 See Pateman, C., Participation and Democratic Theory, Cambridge University Press, London, 1970.CrossRefGoogle Scholar

102 See McCreadie, op. cit.

103 ‘Centralisation’, Hospital and Health Services Review, 72:2 (1976), 225–6.Google Scholar

104 Report of the Layfield Committee on Local Government Finance, Cmnd 6453, HMSO, London, 1976.Google Scholar