caa a22 4500 397576811 CHVBK 20180308164858.0 cr unu---uuuuu 161202e199606 xx s 000 0 eng 10.1093/oxfordjournals.pubmed.a024477 doi (NATIONALLICENCE)oxford-10.1093/oxfordjournals.pubmed.a024477 Programme budgeting and marginal analysis: a case study of maternity services [Elektronische Daten] [Julie Ratcliffe, Cam Donaldson, Susan Macphee] Background This paper reports on a study which applied the framework of programme budgeting and marginal analysis (PBMA) to assist in developing a strategy for purchasing maternity services within the Grampian region of Scotland. Methods PBMA as a process involves assessing how health care resources are currently distributed within services or programmes and making recommendations, in a resource neutral environment, about possible future changes. Data on activity and the extent of service provision within maternity care were used alongside information from national policy documents to decide on the main proposals for change in service delivery. Candidates for more resources were compared with each other and with candidates for service reduction to determine whether and what changes should go ahead. This involved ‘marginal analysis' of the costs and benefits of the proposed changes. Results The results demonstrate that modest changes in maternity services in line with government policy are achievable. Estimates of the cost of larger changes in line with policy appear to be feasible ‘on paper'. However, it may not be possible to achieve the resource shifts required. Conclusions This paper introduces the theoretical concept of PBMA and, in describing the study of maternity services, illustrates not only its usefulness but also practical problems in its implementation. © Oxford University Press Articles nationallicence economics nationallicence programme budgeting nationallicence marginal analysis nationallicence maternity services nationallicence Ratcliffe Julie Health Economics Research Unit, University of Aberdeen, University Medical Buildings, Foresterhill Aberdeen AB9 2ZD aut Donaldson Cam Health Economics Research Unit, University of Aberdeen, University Medical Buildings, Foresterhill Aberdeen AB9 2ZD aut Macphee Susan Grampian Health Board Summerfield House, 2 Eday Road, Aberdeen AB9 1RD aut Journal of Public Health Oxford University Press 18/2(1996-06), 175-182 1741-3842 18:2<175 1996 18 pubmed https://doi.org/10.1093/oxfordjournals.pubmed.a024477 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1093/oxfordjournals.pubmed.a024477 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Ratcliffe Julie Health Economics Research Unit, University of Aberdeen, University Medical Buildings, Foresterhill Aberdeen AB9 2ZD aut NATIONALLICENCE 700 1- Donaldson Cam Health Economics Research Unit, University of Aberdeen, University Medical Buildings, Foresterhill Aberdeen AB9 2ZD aut NATIONALLICENCE 700 1- Macphee Susan Grampian Health Board Summerfield House, 2 Eday Road, Aberdeen AB9 1RD aut NATIONALLICENCE 773 0- Journal of Public Health Oxford University Press 18/2(1996-06), 175-182 1741-3842 18:2<175 1996 18 pubmed Metadata rights reserved CC BY-NC-4.0 http://creativecommons.org/licenses/by-nc/4.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-oxford