priority setting meets multiple streams: a match to be further examined?; comment on “introducing new priority setting and resource allocation processes in a canadian healthcare organization: a case study analysis informed by multiple streams theory”

With demand for health services continuing to grow as populations age and new technologies emerge to meet health needs, healthcare policy-makers are under constant pressure to set priorities, ie, to make choices about the health services that can and cannot be funded within available resources. in a recent paper, smith et al apply an influential policy studies framework – kingdon’s multiple streams approach (msa) – to explore the factors that explain why one health service delivery organization adopted a formal priority setting framework (in the form of programme budgeting and marginal analysis [pbma]) to assist it in making priority setting decisions. msa is a theory of agenda-setting, ie, how it is that different issues do or do not reach a decision-making point. in this paper, i reflect on the use of the msa framework to explore priority setting processes and how the framework might be applied to similar cases in future.