Using Health Economics in Health Services: Rationing Rationally? (State of Health)

"Using Health Economics in Health Services" examines the impact of attempts to use 'rational' health economic analyses on local decision-making in the National Health Service. The book presents findings from an ethnographic study of one Health Authority and one Primary Care Group to present a rich picture of the processes and contexts of healthcare resource allocation at local level. The conclusion of the book is that it is extremely difficult to use 'rational' solutions to resource allocation dilemmas at local level in the modern state. The adoption by local decision-makers of what appear to be non-rational coping strategies is essential to the maintenance of service delivery in the context of resource scarcity. Paradoxically, attempts to impose 'rational' decision-making threaten to undermine the precarious stability of the very systems they seek to improve. In this sense, the pursuit of rationality may itself be an irrational act. Written in an engaging and lively style, the book will be accessible to general readers as well as specialists in the field. It has been designed for use by students of health economics, health policy, public administration and health services management, and will be of interest to practitioners and researchers in these fields.