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The purpose of this chapter is to describe a method for priority setting that can be used to identify options for disinvestment, and is also meant to serve as a tool for re-allocation of resources to achieve better outcomes with a given pot of resources.

This chapter draws on findings from the application of a priority setting and resource allocation framework known as Program Budgeting and Marginal Analysis (PBMA). Case studies are used to illustrate key points around implementation including factors for success and guidelines for improving priority setting in practice.

PBMA has been applied in over 150 settings over the last 30 years. Purposes varied from focusing strictly on disinvestment to examining opportunities for re-allocation. Many organizations report continued use of the framework and decision makers typically express a desire to not revert to historical allocation or political negotiation in deciding on the funding for programs.

Practical implications of this body of work on priority setting abound in that there are significant opportunities to improve resource allocation practice including better engagement of staff, clinicians and public members, greater use of evidence in decision making and improving process transparency.

As healthcare resources are limited, particularly in predominantly publicly funded health systems, prudent use of resources is critical. Actually applying the appropriate tools to ensure that funding aligns with organizational and system objectives is paramount.

Although there is a large body of literature on priority setting particularly in countries like the United Kingdom and Canada, this chapter serves to highlight key messages specifically in the context of fiscal constraint and in relation to the concept of disinvestment or service reduction.

Objective – To present the challenges arising from the double burden of disease in developing countries, focusing on the case of Mexico, and to propose a strategy for addressing these challenges.

Methodology/approach – Mortality and morbidity data are presented for selected countries and groups of diseases. Specific examples of the pressures faced by the public health services in Mexico to provide and finance treatment for communicable and non-communicable diseases are used to illustrate the extent of the challenges in the context of a country with limited resources.

Findings – Public health systems in developing countries face strong pressure to provide and finance treatment for both communicable and non-communicable diseases, inevitably producing competition among diseases and conditions and requiring trade-offs between equity and efficiency goals.

Implications for policy – In developing countries, addressing the challenges presented by the double burden of disease requires a multidisciplinary approach to develop and strengthen the policymaking process. This involves the use of analytical tools applied to each stage of the planning cycle, in particular the use of an explicit priority setting process together with monitoring and assessment to strengthen decision making under limited resources.

The Norwegian health care system is semi-decentralized. Primary care and long-term care (LTC) are the responsibilities of the municipalities. Specialist care is the responsibility of the central government and is organised through four Regional Health Authorities (RHA). Resource use, health outcomes and severity are the three main pillars for priority setting, regularly applied in reimbursement decisions for pharmaceuticals.

The sustainability of health care is challenged in Norway. The main factors are a growing elderly population with high need of complex, coordinated services, an increasing demand for newly approved drugs and advanced technology and a potential shortage of health care personnel.

We present recent trials and policy reforms in Norway aimed at improving care pathways combined with cost containment. Reforms in the pharmaceutical market, both with regard to market access and reimbursement (cost-effectiveness), and regulation of prices, have resulted in cost containment. The primary care sector awaits reform initiatives to recruit and retain physicians as general practitioners. No reform in the hospital sector has had cost containment as a main focus. The sector is characterized with low productivity growth, and expenditures that have increased more than the GDP growth. Waiting times are long, and coordination between sub-sectors of health care has been poor, although the Coordination reform of 2012 has alleviated some of the challenges related to intersectoral coordination. Still, the divided responsibility for health care between the central government and the municipalities creates tensions between national ambitions and local decisions in the financing and provision of health services.

Cataloging has long been considered a fundamental component of special collections work. Beyond the ability to constantly adapt to new technologies and content standards, special collections catalogers also deal with special collections specific issues, from fragile or poorly preserved materials to the need to learn item-specific terminology, like binding descriptions, to larger security concerns. By existing within the two worlds of both special collections and technical services librarianship, there is not always a clear answer to where and whom a position should report. The institutional role and best reporting structure of the special collections cataloger has yet to be well-defined, categorized, or understood.

This chapter seeks to better understand and quantify some of the challenges current special collections catalogers face through conducting and analyzing the authors' recent survey of special collections catalogers primarily working in American cultural heritage institutions. While these findings are neither simple nor straightforward, it is possible to suggest some preliminary solutions. Overarching trends and challenges included communication between departments, security of valuable materials versus workspace locations, and priority setting.

More than 30 legal recyclables were proclaimed by Environmental Protection Administration (EPA) in Taiwan of those producers and importers are liable for paying a Resource Recycling Fee (RRF). The Resource Recycling Management Fund determines both the tariff of RRF and the subsidy rate for recycling activities based on a predetermined pricing formula and collects the revenue to finance its collection and disposal. While contemplating on whether to proclaim waste mattress as a legal recyclable, EPA is facing several critical challenges, particularly the lack of data required for setting a tariff–subsidy mix. In this chapter we critically review the formula and propose an innovative pricing rule. Also, we develop a science-based approach to demonstrate how a tariff–subsidy mix could be determined under the circumstance of data deficiency. By doing so, we avoid not only the difficulty in solving the nonhomogeneous and nonautonomous first-order difference equation that governs the stock accumulation of waste mattress but also the distributed lag model of multiperiods linking quantity of mattress discarded and the quantity of new mattress sold. Such an approach could be applied to the durables for recycling pricing particularly when relevant data are limited.

The first section of this volume is concerned with the changing context for health financing in developing and transitional countries. Two chapters address contemporary issues. The first, by Cristina Gutiérrez-Delgado and Veronica Guajardo-Barrón, describes the challenges created by the “double burden” of disease in low- and middle-income countries created by the coexistence of the persistent burden of communicable disease with emerging problems of chronic and non-communicable illness. Drawing on the Mexican experience of expanding needs for anti-retroviral therapy, renal replacement therapy, and screening and prevention of cervical cancers, they present new evidence about the burden placed by these conditions on public health budgets. They also show the potential value of adopting a risk factor approach to economic evaluation of chronic disease management, presenting estimates of the financial burden imposed by four diseases strongly associated with overweight and obesity. They conclude that strengthened stewardship functions, including generating data about disease burdens and expenditure, and greater use of explicit priority setting processes, are needed to help resolve the tensions between equity and efficiency.

This chapter explores the Scottish government policy drive for school improvement through processes such as distributed leadership, empowerment and cross-school collaboration to school settings. Compared to other nations, this shift towards collaboration has been relatively slow, but reflects the history of Scottish education, one where there is a reduced emphasis on individualist/competitive cultures and instead focuses on social justice and equity. This chapter discusses two programmes of work that were developed to foster school-to-school collaboration in the Scottish education system. In doing so, we comment on the conflict between national priority setting and the translation of this agenda at the local level by different local authorities.