ABSTRACT
In this chapter, the authors offer their personal observations on some wider themes which emerge from, or are illustrated by, the Purchasing Dilemmas exercise. They present the alternative frameworks offered by a 'Benthamite' utilitarian approach and an egalitarian approach based on human rights. The authors examine the methods of programme budgeting and marginal analysis, questioning particularly their applicability to disinvestment, and suggest how this work will be taken forward in Southampton. They discuss the usefulness and validity of the approach adopted in Southampton from their different viewpoints. What lessons can be learned from the general experience of applying methods of economic evaluation in health authority priority setting and the specific experience of Southampton and South West Hampshire Health Commission? There was awareness of the danger of some projects being more likely to secure funding simply because health gain or cost-benefit information was available for them.
