Setting priorities in Canadian regional health authorities: a survey of key decision makers.
BACKGROUND
The aims of this study were, within three Canadian health regions, to identify existing resource management techniques, to elicit ways in which the current process of setting priorities could be improved and to determine if an economic framework, used internationally, would have merit in Canada.


METHODS
Structured, face-to-face interviews were conducted with 62 of 73 key decision makers. This sample included all senior executives and medical directors involved in setting priorities. Descriptive statistics and content analysis were utilised.


RESULTS
Key decision makers reported that a clear process of setting priorities does not exist. Allocation of resources generally occurs on the basis of historical trends; only 22% of participants stated that the process works well. Respondents were critical of the lack of transparency and a lack of meaningful inclusion of physicians in the priority setting process. Overall, 92% of respondents indicated that program budgeting and marginal analysis (PBMA) would be an appropriate and useful priority setting framework.


CONCLUSIONS
Given the political and historical influence in the process of priority setting and resource allocation, an evidence-based approach, like PBMA which explicitly attempts to identify ways of maximising health benefit within a limited budget, should have merit in the new regional structure in Canada.
Mitton
Craig
C
Department of Community Health Sciences, University of Calgary, Alta, Canada. crmitton@ucalgary.ca
Donaldson
Cam
C
D000288:Administrative Personnel; D000416:Alberta; D001291:Attitude of Health Personnel; D002017:Budgets; D003659:Decision Making, Organizational; D015276:Health Care Rationing / Q000191:economics / Q000379:methods*; D006286:Health Planning Councils; D006292:Health Priorities / Q000145:classification* / Q000191:economics; D006801:Humans; D007407:Interviews as Topic; D008486:Physician Executives; D015397:Program Evaluation; D012040:Regional Health Planning / Q000191:economics / Q000379:methods*; D012941:Social Responsibility; D013597:Systems Analysis