Public health and economics in tandem: programme budgeting, marginal analysis and priority setting in practice

In the wake of the reforms of the UK National Health Service there has been increased interest in 'getting it right' with respect to priority setting in health care. This article examines the way in which programme budgeting and marginal analysis (PBMA) were introduced into North Mersey. It provides a very practical introduction to the topic and indicates the actual processes that were gone through. It is suggested that, in terms of getting participants in the PBMA exercise to think through what programmes comprise, what they cost, what they are trying to achieve and to focus on relevant possible changes, there was considerable merit in the approach. However there are problems, particularly at the level of determining the costs of different programmes.