This title examines the impact of attempts to use "rational" health economic analyses on local decision-making in the National Health Service. It presents findings from an ethnographic study of one Health Authority and one Primary Care Group to present a picture of the processes and contexts of healthcare resource allocation at local level. co nclusion of the book is that it is extremely difficult to use "rational" solutions to resource allocation dilemmas at local level in the modern state. The adoption by local decision-makers of what appear to be non-rational coping strategies is essential to the maintenance of service delivery in the context of resource scarcity. Paradoxically, attempts to impose "rational" decision-making threaten to undermine the precarious stability of the very systems they seek to improve. In this sense, the pursuit of rationality may itself be an irrational act. This book is accessible to general readers as well as specialists in the field. It has been designed for use by students of health economics, health policy, public administration and health services management and will be of interest to practitioners and researchers in these fields.
Ruth McDonald is a politics graduate and former finance director in the National Health Service (NHS). She left the NHS to complete a MSc in Health Economics at York University, and is currently an NHS/PPP fellow in Primary Care research at Manchester University. Prior to this she held posts at Liverpool University and the Nuffield Institute for Health in Leeds.