• Bonnie Urquhart, Craig Mitton, and Stuart Peacock.
• Strategic Initiatives and Project Support, Northern Health Authority, 299 Victoria Street, Prince George, British Columbia, Canada. bonnie.urquhart@northernhealth.ca
• J Health Serv Res Policy. 2008 Jan 1; 13 Suppl 1: 41-5.

ObjectiveTo use evidence from research to identify and implement priority setting and resource allocation that incorporates both ethical practices and economic principles.MethodProgram budgeting and marginal analysis (PBMA) is based on two key economic principles: opportunity cost (i.e. doing one thing instead of another) and the margin (i.e. resource allocation should result in maximum benefit for available resources). An ethical framework for priority setting and resource allocation known as Accountability for Reasonableness (A4R) focuses on making sure that resource allocations are based on a fair decision-making process. It includes the following four conditions: publicity; relevance; appeals; and enforcement. More recent literature on the topic suggests that a fifth condition, that of empowerment, should be added to the Framework. The 2007-08 operating budget for Home and Community Care, excluding the residential sector, was developed using PBMA and incorporating the A4R conditions.ResultsRecommendations developed using PBMA were forwarded to the Executive Committee, approved and implemented for the 2007-08 fiscal year operating budget. In addition there were two projects approved for approximately $200,000.ConclusionPBMA is an improvement over previous practice. Managers of Home and Community Care are committed to using the process for the 2008-09 fiscal year operating budget and expanding its use to include mental health and addictions services. In addition, managers of public health prevention and promotion services are considering using the process.

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