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Intro -- Title Page -- Copyright Page -- Contents -- List of contributors -- Participants -- Foreword -- Preface -- 1 The international context -- Oregon -- The Netherlands, New Zealand and Sweden -- United Kingdom -- Issues arising -- 2 The Southampton experience -- Simulation seminar of 1991 -- The growth of commissioning -- Rational planning and decision making - 1994 -- Trial run -- Development of the health strategy -- Stakeholder consultation -- Identifying criteria -- Views of experts -- Determining importance of criteria -- Preliminary ranking of 49 options -- Ranking of the options -- Purchasing plan -- Rankings compared -- Comparison with GP rankings -- Approach to disinvestment -- Overview of procedure -- 3 Lessons learned -- Relevance of the Southampton experience -- No quick fix -- Coping with many options -- Rational planning -- Limited cost-utility data rule out marginal analysis -- Needs assessment essential -- Clearer definition of criteria -- Assigning weights to criteria -- Health gain versus equity -- No clear way to relate criteria to choices -- Pragmatic criteria strongly influence rankings -- Protection for chronic sick and deprived groups -- Stakeholder consultation necessary and needs more care -- The public's role -- GPs can help decide priorities -- More involvement by provider groups -- Efficiency before exclusions -- Disinvestments cannot always be ignored -- 4 Emergent themes -- Health economics and priority setting: nonsense on stilts? -- How not to ration health care: the moral perils of utilitarian decision making -- The strengths and limitations of programme budgeting -- Reflections on a brief return to strategic planning -- The view from a small plane over Hampshire -- Promoting equity and avoiding prejudice -- The future strategic role of commissions -- When the elephants fight, it is the grass which suffers