Review

Rationing irrationality

Priority Setting in Action: Purchasing Dilemmas
F Honigsbaum, J Richards, A Lockett
Radcliffe Medical Press, 1995, £17.50

This book is particularly topical for health commissions as it deals with setting priorities for health service developments in the context of finite resources. Southampton and South West Hampshire health commission on whose experiences the book is based, has been in the position of receiving growth money annually. The task therefore has been to decide which new developments to fund with this money rather than having to consider in detail the need for disinvestment in some areas to fund new developments.

For those working on priority setting in commissions with growth money, the ‘Southampton experience’ described in the book will feel familiar, although Southampton is probably ahead of most health authorities in developing priority setting.

The book goes into some considerable detail about the process, and the summary at the end of each chapter is very useful in pulling out the main points. The reader will be left impressed (and probably worried) at the scale of resources thrown at the problem in Southampton.

The book is categorical that some national priorities with no apparently rational basis often override local priorities which are more rationally derived. However I could find no specific mention of the nonsensical effects of the efficiency index on the setting of rational priorities.

The books’s message is that those readers left with a glow of satisfaction at the end of a priority setting process would be well advised to go back and assess which factors were really important in deciding the final priority order.

The ‘lessons learnt’ and ‘emergent themes’ sections offer useful practical tips for those about to embark on priority setting. The latter section presents some personal opinions from participants in the process which are occasionally repetitive but set out clearly the different views of health economists and ethicists in the setting of priorities.

The book is a readable and practical guide to priority setting written mainly by those at the ‘coal face’ of commissioning, and deserves to succeed.