Evaluation of the impact of program budgeting and marginal analysis in Vancouver Island Health Authority.

OBJECTIVE: The objective of this research was to provide further insights into the ability of Program Budgeting and Marginal Analysis (PBMA) to help health care decision-makers in deciding where to allocate scarce resources so as to best meet their organizational objectives. METHODS: We report on a case study of PBMA implementation. The main source of information was two sets of semi-structured evaluation interviews conducted with senior decision-makers after each of the first two years of PBMA implementation in Vancouver Island Health Authority (VIHA), Canada. These interviews were analysed thematically, with initial coding based upon themes that had been identified in the previous stage of the research. RESULTS: Many of the initial problems with PBMA implementation resolved themselves over time as participants became more familiar with the process. However, some problems needed to be addressed explicitly through changes in procedures. Establishing procedures for handling 'must-dos' (i.e. spending priorities, that are externally mandated) did not replace the need to define explicitly the extent of the organization's discretionary spending authority. CONCLUSION: Faced with claims that typically outstrip available resources, health care decision-makers need a process to guide allocation decisions. PBMA has demonstrated at VIHA an ability to handle some of the key issues associated with this challenge. Our analysis has produced lessons that should facilitate future implementation but has also shown that resource allocation criteria selection and the extent of executive discretion are likely to be ongoing challenges.