Across a range of health care systems there is a responsibility placed on meso-level budget holders to set priorities and allocate resources within constrained budgets. The literature suggests that these organizations have typically defaulted to historical and/or political processes for decision making. Whilst the literature on resource allocation in health care attests to the political nature of decision making, this has remained largely under-theorized and therefore priority setters may be unfamiliar with the analytic benefits of applying insights from the broader political sciences. Conversely, policy scientists may know relatively little about existing research on how healthcare Downloaded from organizations make allocative and redistributive decisions. This paper aims to open a dialogue between these solitudes by exploring political effects on health care priority setting, using the interpretive concepts ideas, interests and institutions.

BackgroundResource allocation is a key challenge for healthcare decision makers. While several case studies of organizational practice exist, there have been few large-scale cross-organization comparisons.MethodsBetween January and April 2011, we conducted an on-line survey of senior decision makers within regional health authorities (and closely equivalent organizations) across all Canadian provinces and territories. We received returns from 92 individual managers, from 60 out of 89 organizations in total. The survey inquired about structures, process features, and behaviours related to organization-wide resource allocation decisions. We focus here on three main aspects: type of process, perceived fairness, and overall rating.ResultsAbout one-half of respondents indicated that their organization used a formal process for resource allocation, while the others reported that political or historical factors were predominant. Seventy percent (70%) of respondents self-reported that their resource allocation process was fair and just over one-half assessed their process as ‘good’ or ‘very good’. This paper explores these findings in greater detail and assesses them in context of the larger literature.ConclusionData from this large-scale cross-jurisdictional survey helps to illustrate common challenges and areas of positive performance among Canada’s health system leadership teams.

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