ABSTRACT
Pulmonary rehabilitation (PR) is one of the most effective treatments for people with chronic lung disease. Unfortunately, only a minority of patients who would benefit are ever offered a referral to a programme. Facilities for PR vary by country, but generally programme capacity is inadequate in terms of number and size of facilities. In spite of the recognized benefits of PR, many healthcare systems still fail to commission adequate provision. This deficiency may be due to economic constraints or lack of understanding of the benefits. This generally means that commissioners (payers) may need to be persuaded of the benefits in order to encourage them to provide a service. A good business case is necessary to demonstrate that PR not only provides individual benefits in terms of exercise performance and quality of life but delivers good outcomes for the served population. Most commissioners will also appreciate that there are additional societal and health economic benefits, particularly in terms of hospital admissions and possibly mortality. When making a business case it will be important to understand both the geography and the presence of inequalities in the local population.
