Programme budgeting and marginal analysis: a case study of maternity services.

BACKGROUND This paper reports on a study which applied the framework of programme budgeting and marginal analysis (PBMA) to assist in developing a strategy for purchasing maternity services within the Grampian region of Scotland. METHODS PBMA as a process involves assessing how health care resources are currently distributed within services or programmes and making recommendations, in a resource neutral environment, about possible future changes. Data on activity and the extent of service provision within maternity care were used alongside information from national policy documents to decide on the main proposals for change in service delivery. Candidates for more resources were compared with each other and with candidates for service reduction to determine whether and what changes should go ahead. This involved 'marginal analysis' of the costs and benefits of the proposed changes. RESULTS The results demonstrate that modest changes in maternity services in line with government policy are achievable. Estimates of the cost of larger changes in line with policy appear to be feasible 'on paper'. However, it may not be possible to achieve the resource shifts required. CONCLUSIONS This paper introduces the theoretical concept of PBMA and, in describing the study of maternity services, illustrates not only its usefulness but also practical problems in its implementation.