PBMA (programme budgeting marginal analysis)--its role in the future purchasing arrangements for health care services.

The movement of the purchasing process in health care from a central to local level has to be accompanied by an accountability process which makes local purchasers accountable within an agreed national and area framework for their decisions and implementation of change. This paper focuses on PBMA and its applicability to health boards and general practitioner fundholders in future purchasing arrangements. It is argued that it is a useful tool which may provide a basis for more rational discussion about use of resources, both at a micro and macro level, than the current arrangements.