MESSAGES FROM MID GLAMORGAN - A MULTI-PROGRAM EXPERIMENT WITH MARGINAL ANALYSIS

This paper discusses the issues and problems arising from the first at tempt to apply marginal analysis across a full range of health care ac tivities within a UK Health District. Following a brief description of the two stage process undertaken in Mid Glamorgan, the paper focuses on the importance of a conducive environment to a successful applicati on of the approach and to three key issues of group composition, group dynamics and openness/explicitness. The paper also addresses two part s of the Mid Glamorgan process which might be of questionable importan ce; the need for programme budgets prior to the exercise and the relev ance of stage II which attempted to interfere with the expressed prior ities identified by the expert groups in stage I. The main message is that marginal analysis works in practice as well as being attractive i n theory and that much can be achieved even when only crude data on ma rginal costs and benefits are available. It is more important that pri ority setting be addressed within an appropriate framework than with a ccurate data. Marginal analysis provides such a framework.