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Book Review: Setting Priorities in Health Care

Priority-setting has leapt to the forefront of health care debates in recent years. Whilst the reasons for its new-found prominence have been widely debated, at one extreme prioritysetting (explicit rationing!) is welcomed as being positively desirable, at the other extreme it is dismissed as a dangerous diversion from the real political issues the middle ground being occupied by those conceding it to be inevitable. Priority-setting methodologies range from simplistic technical exercises to all-embracing, complex, value-laden projects. To some, the lack of adequate information, especially about the effectiveness of health care interventions, undermines the whole process of rational priority-setting in health care. Into this debate comes this promising book, published simultaneously with the conference from which the papers it contains were selected. These papers, claims the editor, have the merit of highlighting 'the unacceptability of the customary approach of avoiding explicit choice'. The wide range of approaches and topics demonstrated by the papers serves to highlight the multifaceted nature of priority-setting, although a few papers would appear to stretch even the most elastic definition. Alan Maynard starts the book with an interesting discussion of effectiveness analysis and a critical review of approaches to prioritization. This is followed by an apparently post-modernist view of priority-setting. Some papers sidestep the prioritization problem by discussing ways of increasing income, regulating costs and health care expenditure and contracting out services. Others turn to organizational and process Bookreviews