BMJ  2005;330:1501-1503 (25 June), doi:10.1136/bmj.330.7506.1501

Education and debate

Programme budgeting and marginal analysis: bridging the divide between doctors and managers

Danny Ruta, senior lecturer in epidemiology and public health1, Craig Mitton, assistant professor2, Angela Bate, research associate in health economics1, Cam Donaldson, health foundation chair in health economics1

1 School of Population and Health Sciences, University of Newcastle, Newcastle upon Tyne NE2 4AA, 2 Centre for Healthcare Innovation and Improvement, Research Institute for Children's and Women's Health, University of British Columbia, Vancouver, Canada V6H 3V4

Correspondence to: D Ruta danny.ruta@ncl.ac.uk

Recent NHS reforms give doctors increased responsibility for efficient and fair use of resources. Programme budgeting and marginal analysis is one way to ensure the views of all stakeholders are properly represented

The first 150 words of the full text of this article appear below.

Introduction

Tensions between doctors and managers and the differences between medical and managerial cultures have existed since the earliest provision of organised health care.1 In a resource allocation context, doctors are caricatured as taking the role of patient advocate while managers take the corporate, strategic view. Delivery of efficient (and in the case of the NHS, equitable) health care requires doctors to take responsibility for resources and to consider the needs of populations while managers need to become more outcome and patient centred. One economic approach, called programme budgeting and marginal analysis, has the potential to align the goals of doctors and managers and create common ground between them. We describe how the approach works and why it should be more widely used.

Economic principles

Programme budgeting and marginal analysis is an approach to commissioning and redesign of services that can accommodate both medical and managerial cultures and the widest constituency of professional, . . . [Full text of this article]

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Five questions

Who decides and how?

Barriers to use

Improving the doctor-manager relationship


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