Healthcare prioritisation at the local level: a socio-technical approach

Cost effectiveness analysis is a systematic tool to inform resource allocation decision in healthcare. There is extensive evidence, however, that the tool is difficult to apply in practice, particularly at the level of local health planners, because it is not accessible to those involved in the prioritisation process and not embeds assumptions which are felt to be unacceptable for ethical or other reasons. Pragmatic tools such as Program Budgeting and Marginal Analysis appear to be more suitable for supporting local decisions by engaging stakeholders in a deliberative process. Unlike cost-effectiveness analysis, however, these tools are hard to relate to widely accepted health economic principles. This paper presents a socio-technical approach which draws explicitly on health economic theory and in a practical and reproduceable way through an action research case study with a local healthcare planner of the English National Health Service. Through close and iterative work with those responsible for allocating resources we present a formal model to capture the objectives of the health planners, a communicative procedure and interactive elicitation methods to help key stakeholders to articulate their knowledge and values. The approach proved accessible and acceptable and has been used in making spending decisions.