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Grasping the nettle and enduring the pain: healthcare priority setting and disinvestment in the context of prudent healthcare / Pippa Anderson

Swansea University Author: Pippa Anderson

DOI (Published version): 10.23889/SUthesis.59382

Abstract

Since the financial crisis of 2008 economic pressures mean that healthcare budgets were and still are substantially constrained. The NHS in Wales has had to face the reality of rationing healthcare. Implementation of fair and equitable rationing is a challenge, however. This is a situation where the...

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Published: Swansea 2017
Institution: Swansea University
Degree level: Doctoral
Degree name: Ph.D
Supervisor: Phillips, Ceri., Fitzsimmons, Deborah.
URI: https://cronfa.swan.ac.uk/Record/cronfa59382
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spelling v2 59382 2022-02-11 Grasping the nettle and enduring the pain: healthcare priority setting and disinvestment in the context of prudent healthcare 128cdedfba6e5e6374fdc85d5c78c428 Pippa Anderson Pippa Anderson true false 2022-02-11 FGMHL Since the financial crisis of 2008 economic pressures mean that healthcare budgets were and still are substantially constrained. The NHS in Wales has had to face the reality of rationing healthcare. Implementation of fair and equitable rationing is a challenge, however. This is a situation where the economic concepts of scarcity, opportunity cost and the margin can support effective prioritisation and resource reallocation decisions. In this context, the aim of this research was to develop pragmatic prioritisation and resource reallocation frameworks for the Welsh Health Specialised Services Committee (WHSSC) who commission highly specialised technologies for Wales and commissioning boards in Abertawe Bro Morgannwg University Health Board (ABMUHB). The prioritisation and resource reallocation methods for WHSSC were developed over a series of prioritisation meetings resulting in a framework based on based on multi-criteria decision analysis methods. In ABMUHB, programme budgeting marginal analysis (PBMA) was the approach used and two pilot PBMAs run in different service areas. Disinvestment and ‘doing less’ to invest in more beneficial activities within budget were accomplished in one pilot project; the other project managed resource reallocation but revealed issues in achieving service standards. Both pilots enabled development of a PBMA Framework for ABMUHB. Group decision support methods were an important feature of implementation of decision making in all three projects. The research conducted for this thesis has shown it has been possible to develop and deliver robust, evidence based, effective and practical frameworks based on economic concepts for prioritisation, disinvestment and resource reallocation. Both organisations have taken ‘ownership’ of the frameworks and will make them a ‘way of working’ for the future rather than an academic exercise. A key learning of the research was that pragmatism must prevail if prioritisation and resource reallocation methods are to gain traction and become embedded in commissioning. E-Thesis Swansea NHS Wales, Wales, frameworks, resource allocation 7 11 2017 2017-11-07 10.23889/SUthesis.59382 COLLEGE NANME Medicine, Health and Life Science - Faculty COLLEGE CODE FGMHL Swansea University Phillips, Ceri., Fitzsimmons, Deborah. Doctoral Ph.D 2023-06-28T15:55:25.5177051 2022-02-11T17:38:30.4687113 Faculty of Medicine, Health and Life Sciences School of Health and Social Care - Healthcare Science Pippa Anderson 1 59382__22362__870175ace7a64ed3b28dad8f09325580.pdf P. Allen final version PhD 3.01.17.pdf 2022-02-11T18:00:21.8341644 Output 3643413 application/pdf Version of Record true 2022-11-07T00:00:00.0000000 Copyright, The Author, 2017. true eng
title Grasping the nettle and enduring the pain: healthcare priority setting and disinvestment in the context of prudent healthcare
spellingShingle Grasping the nettle and enduring the pain: healthcare priority setting and disinvestment in the context of prudent healthcare
Pippa Anderson
title_short Grasping the nettle and enduring the pain: healthcare priority setting and disinvestment in the context of prudent healthcare
title_full Grasping the nettle and enduring the pain: healthcare priority setting and disinvestment in the context of prudent healthcare
title_fullStr Grasping the nettle and enduring the pain: healthcare priority setting and disinvestment in the context of prudent healthcare
title_full_unstemmed Grasping the nettle and enduring the pain: healthcare priority setting and disinvestment in the context of prudent healthcare
title_sort Grasping the nettle and enduring the pain: healthcare priority setting and disinvestment in the context of prudent healthcare
author_id_str_mv 128cdedfba6e5e6374fdc85d5c78c428
author_id_fullname_str_mv 128cdedfba6e5e6374fdc85d5c78c428_***_Pippa Anderson
author Pippa Anderson
author2 Pippa Anderson
format E-Thesis
publishDate 2017
institution Swansea University
doi_str_mv 10.23889/SUthesis.59382
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care - Healthcare Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care - Healthcare Science
document_store_str 1
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description Since the financial crisis of 2008 economic pressures mean that healthcare budgets were and still are substantially constrained. The NHS in Wales has had to face the reality of rationing healthcare. Implementation of fair and equitable rationing is a challenge, however. This is a situation where the economic concepts of scarcity, opportunity cost and the margin can support effective prioritisation and resource reallocation decisions. In this context, the aim of this research was to develop pragmatic prioritisation and resource reallocation frameworks for the Welsh Health Specialised Services Committee (WHSSC) who commission highly specialised technologies for Wales and commissioning boards in Abertawe Bro Morgannwg University Health Board (ABMUHB). The prioritisation and resource reallocation methods for WHSSC were developed over a series of prioritisation meetings resulting in a framework based on based on multi-criteria decision analysis methods. In ABMUHB, programme budgeting marginal analysis (PBMA) was the approach used and two pilot PBMAs run in different service areas. Disinvestment and ‘doing less’ to invest in more beneficial activities within budget were accomplished in one pilot project; the other project managed resource reallocation but revealed issues in achieving service standards. Both pilots enabled development of a PBMA Framework for ABMUHB. Group decision support methods were an important feature of implementation of decision making in all three projects. The research conducted for this thesis has shown it has been possible to develop and deliver robust, evidence based, effective and practical frameworks based on economic concepts for prioritisation, disinvestment and resource reallocation. Both organisations have taken ‘ownership’ of the frameworks and will make them a ‘way of working’ for the future rather than an academic exercise. A key learning of the research was that pragmatism must prevail if prioritisation and resource reallocation methods are to gain traction and become embedded in commissioning.
published_date 2017-11-07T15:55:21Z
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score 11.012678

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