Priority-setting and rationing in healthcare: Evidence from the English experience

Suzanne Robinson*, Iestyn Williams, Helen Dickinson, Tim Freeman, Benedict Rumbold

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

63 Citations (Scopus)


In a context of ever increasing demand, the recent economic downturn has placed further pressure on decision-makers to effectively target healthcare resources. Over recent years there has been a push to develop more explicit evidence-based priority-setting processes, which aim to be transparent and inclusive in their approach and a number of analytical tools and sources of evidence have been developed and utilised at national and local levels. This paper reports findings from a qualitative research study which investigated local priority-setting activity across five English Primary Care Trusts, between March and November 2012. Findings demonstrate the dual aims of local decision-making processes: to improve the overall effectiveness of priority-setting (i.e. reaching ‘correct’ resource allocation decisions); and to increase the acceptability of priority-setting processes for those involved in both decision-making and implementation. Respondents considered priority-setting processes to be compartmentalised and peripheral to resource planning and allocation. Further progress was required with regard to disinvestment and service redesign with respondents noting difficulty in implementing decisions. While local priority-setters had begun to develop more explicit processes, public awareness and input remained limited. The leadership behaviours required to navigate the political complexities of working within and across organisations with differing incentives systems and cultures remained similarly underdeveloped.
Original languageEnglish
Pages (from-to)2386-2393
Number of pages8
JournalSocial Science and Medicine
Issue number12
Early online date20 Sept 2012
Publication statusPublished - Dec 2012


  • Priority setting
  • Decision making
  • Resource allocation
  • Rationing
  • Primary care
  • Healthcare
  • England
  • Disinvestment


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