Developing a prioritisation framework: experiences from a Scottish Health Authority.
OBJECTIVE
To describe the development of the Prioritisation Scoring Index (PSI) and its use in a prioritisation framework, providing examples where it has been used to prioritise between bids from different specialities and to assist in decision-making regarding funding of service developments. To outline lessons learned for other health authorities when developing their own prioritisation methodologies.


BACKGROUND
The PSI was designed for prioritising: investments and dis-investments; non-recurring and recurring monies as well as differing specialities, care groups and types of intervention.


METHODS
The PSI consists of a 'basket' of utility criteria and takes account of the numbers of people that would receive the proposed intervention and the marginal cost for each additional person receiving the intervention. A multidisciplinary panel scored and ranked the bids. Two rankings were produced for each intervention according to (1) the average panel score for the utility criteria and (2) the cost per additional person receiving the intervention. An average of these two rankings produced the overall PSI rankings.


RESULTS
Almost 200 bids, with a total value of pound 50 million, were ranked, using the PSI, to prioritise developments worth approximately pound 17.5 million that could be funded in a phased implementation through the Health Improvement Programme.


CONCLUSIONS
Use of the PSI has allowed explicit prioritisation of development bids in substantial exercises for both non-recurring and recurring funding. We describe steps to be considered when other health authorities are developing their own prioritisation frameworks.
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Argyll and Clyde Health Board, Ross House, Hawkhead Road, Paisley PA2 7BN, UK.
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D003362:Cost-Benefit Analysis; D003657:Decision Making; D015276:Health Care Rationing; D006292:Health Priorities / Q000145:classification / Q000191:economics*; D006801:Humans; D012606:Scotland; D014850:Waiting Lists