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Using programme budgeting and marginal analysis (PBMA) to set priorities: Reflections from a qualitative assessment in an English Primary Care Trust

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  • Goodwin, Elizabeth
  • Frew, Emma J.

Abstract

In England from 2002 to 2013, Primary Care Trusts (PCTs) were responsible for commissioning healthcare for their local populations. The NHS has recently undergone rapid organisational change whereby clinicians have assumed responsibility for local commissioning decisions. This change in commissioning arrangements alongside the current financial pressures facing the NHS provides an impetus for considering the use of technical prioritisation methods to enable the identification of savings without having a detrimental effect on the health of the population. This paper reports on the design and implementation of a technical prioritisation method termed PBMA applied within NHS Plymouth, an English PCT responsible for commissioning services for a population of approximately 270,000. We evaluated the effectiveness of the process, the extent to which it was appropriate for local healthcare commissioning and whether it identified budget savings. Using qualitative research methodology, we found the process produced clear strategic and operational priorities for 2010/11, providing staff with focus and structure, and delivered a substantial planned reduction in hospital activity levels. Participants expressed satisfaction with the process. NHS Plymouth adhered to the PBMA process, although concerns were raised about the evidence for some priorities, decibel rationing, and a lack of robust challenge at priority-setting meetings. Further work is required to enhance participants' understanding of marginal analysis. Participants highlighted several external benefits, particularly in terms of cultural change, and felt the process should encompass the whole local health and social care community. This evaluation indicates that the prioritisation method was effective in producing priorities for NHS Plymouth, and that PBMA provides an appropriate method for allocating resources at a local level. In order for PBMA to identify savings, cultural and structural barriers to disinvestment must be addressed. These findings will interest other healthcare commissioners in developing their own approaches to priority-setting.

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  • Goodwin, Elizabeth & Frew, Emma J., 2013. "Using programme budgeting and marginal analysis (PBMA) to set priorities: Reflections from a qualitative assessment in an English Primary Care Trust," Social Science & Medicine, Elsevier, vol. 98(C), pages 162-168.
    • Handle: RePEc:eee:socmed:v:98:y:2013:i:c:p:162-168
    DOI: 10.1016/j.socscimed.2013.09.020
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    References listed on IDEAS

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    1. Gibson, Jennifer L. & Martin, Douglas K. & Singer, Peter A., 2005. "Priority setting in hospitals: Fairness, inclusiveness, and the problem of institutional power differences," Social Science & Medicine, Elsevier, vol. 61(11), pages 2355-2362, December.
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    2. 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.
    3. Ahumada-Canale, Antonio & Jeet, Varinder & Bilgrami, Anam & Seil, Elizabeth & Gu, Yuanyuan & Cutler, Henry, 2023. "Barriers and facilitators to implementing priority setting and resource allocation tools in hospital decisions: A systematic review," Social Science & Medicine, Elsevier, vol. 322(C).
    4. Hill, Sarah R. & Vale, Luke & Hunter, David & Henderson, Emily & Oluboyede, Yemi, 2017. "Economic evaluations of alcohol prevention interventions: Is the evidence sufficient? A review of methodological challenges," Health Policy, Elsevier, vol. 121(12), pages 1249-1262.
    5. Brayan V. Seixas & François Dionne & Craig Mitton, 2021. "Practices of decision making in priority setting and resource allocation: a scoping review and narrative synthesis of existing frameworks," Health Economics Review, Springer, vol. 11(1), pages 1-11, December.

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