CLEARING THE FOG ON THE TYNE - PROGRAM BUDGETING IN NEWCASTLE-AND-NORTH-TYNESIDE-HEALTH-AUTHORITY

When the internal market was introduced, the National Health Service M anagement Executive envisaged purchasing as a process by which contrac ts would be developed from information concerning current services, mo dified in the light of strategic purchasing objectives, epidemiologica l needs assessment and indicators of comparative performance and effic iency, Our concern in this paper is with the promotion of efficiency. We distinguish between three levels and, in particular, discuss how th e programme budgeting and marginal analysis framework can be used in t he promotion of efficiency at 'top-level' decision making. PB/MA can b e used to give a focus to needs assessment and forge explicit links be tween individual contracts within a well defined health strategy. The objectives of the current research and development ongoing within Newc astle and North Tyneside Health Authority are outlined. The intention is to achieve programme budgeting which is more responsive to decision makers' needs and is consistent with the contracting cycle. However, a number of constraints are expected to impede development. They inclu de transferability of national and international information; absence of local information on epidemiology, effectiveness and cost-effective ness; limitations on the accuracy and precision of programme budgets; and whether purchasers make strategic decisions based on macro budgets . The contribution of each of these constraints is explored.