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This work provides a guide to how economics can be used to manage scarcity of resources in health services. It outlines the principles of economics in a non-technical manner, before going on to address the issues of how to apply the principles in day to day health services management

Despite denials of politicians and other advisors, trade-offs have already been apparent in many policy decisions addressing the coronavirus disease 2019 pandemic and its social and economic consequences. Here, we illustrate why it is important, from a wellbeing perspective, to recognise such trade-offs, and provide a framework, based on the economic concept of 'marginal analysis', for doing so. We illustrate its potential through consideration of optimising the balance between reducing the reproductive rate (R) of the virus and further opening of the economy. The framework accommodates both perspectives in the health-vs-economy debate whereby, depending on where we are within the marginal analysis framework, either health issues are allowed to dominate or, below some threshold of R and/or background level of infection, health and economic considerations can be traded off against each other. Given the inevitability of such trade-offs, the framework exposes crucial questions to be addressed, such as: the critical value of R and/or background infection, above which health considerations predominate, and which may vary from jurisdiction to jurisdiction; and the value of lives forgone resulting from the small increases in R and/or background infection levels that may have to be tolerated as the economy is gradually opened.

Since its introduction to the USA, the Triple Aim is now being adopted in the healthcare systems of other advanced economies. Verma and Bhatia (2016) (V&B) argue that provincial governments in Canada now need to step up to the plate and lead on the implementation of a Triple Aim reform program here. Their proposals are wide ranging and ambitious, looking for governments to act as the "integrators" within the healthcare system, and lead the reforms. Our view is that, as a vision and set of goals for the healthcare system, the Triple Aim is all well and good, but as a pathway for system reform, as articulated by V&B, it misses the mark in at least three important respects. First, the emphasis on improvement driven by performance measurement and pay-for-performance is troubling and flies in the face of emerging evidence. Second, we know that scarcity can be recognized and managed, even in politically complex systems, and so we urge the Triple Aim proponents to embrace more fully notions of resource stewardship. Third, if we want to take seriously "population health" goals, we need to think very differently and consider broader health determinants; Triple Aim innovation targeted at healthcare systems will not deliver the goals.

"Health systems across the world face multiple pressures. Input costs are soaring, systems are struggling to keep-up with increasing demand for their services and areas of the world still lack universal health coverage. All of this whilst health inequalities between the best and worst-off within countries persist and, in some countries, are even widening. There is a need to think of new initiatives in response to these global health challenges. One such response is social finance. Social finance is about creating social returns. This innovative and rapidly growing sector promotes new ways of banking and funding social and public services. However, social finance has an underrecognised, and potentially underexploited, role in responding to specific aspects of global health challenges: funding and facilitating access to health (care) services and acting on health. The objectives of this book are to conceptualise and evidence different forms of social finance - microfinance and impact bonds - acting in these ways and to critically engage with current debates and challenges. With such evidence to hand, we can either avoid adoption of new trends in financing public services or, more hopefully, attract greater policy support and resources for new tools for public health and in supporting more precarious, but potentially essential, parts of the finance sector. This book will be essential reading to students, researchers, policymakers and the general public alike who are interested in, or who work in, and across, health systems and social finance"--

One response to the major societal challenge of financial exclusion in the United Kingdom (UK) is microcredit lending for enterprise. Typically delivered via Community Development Finance Institutions (CDFIs) in the UK, these lending institutions can be conceptualised as 'alternative' economic spaces. Yet the nature of their alterity is unclear as categorisations of alternative-oppositional or alternative-substitute institutions are possible and could also be influenced by complexities in the UK relating to the welfare system and sustainability. Alterity is rarely static, being influenced by policies and regulation, and the nature of institutions' alterity could have consequences for wellbeing, as different values and ideals underpin different conceptions of alterity which affect how these institutions operate. In this paper, the complexities of microcredit for enterprise lending within the UK are explored through in-depth interviews with UK 'supply-side' stakeholders. Conceptions of alterity are then used as an analytic lens to examine these results. Results suggest that these lenders remain in opposition to the mainstream as the needs of low-income individuals are embedded within their operating model. Microcredit lending is conceptualised in terms of responsible lenders offering fair credit to financially-excluded individuals using relationship banking practices. Such a conceptualisation provides a touchstone against which to assess shifts in lenders' alterity and a platform from which to introduce legislative and regulatory changes to protect these 'alternative-oppositional' economic spaces. This paper begins to outline these responses that could help to ensure and grow a more community-engaged and varied local financial infrastructure within the UK.

Innovative interventions that address the social determinants of health are required to help reduce persistent health inequalities. We argue that microcredit can act in this way and develop a conceptual framework from which to examine this. In seeking to evaluate microcredit this way we then examine how randomized controlled trials, currently considered as the 'gold standard' in impact evaluations of microcredit, compare with developments in thinking about study design in public health. This leads us to challenge the notion of trials as the apparent gold standard for microcredit evaluations and contend that the pursuit of trial-based evidence alone may be hampering the production of relevant evidence on microcredit's public health (and other wider) impacts. In doing so, we introduce new insights into the global debate on microfinance impact evaluation, related to ethical issues in staging randomized controlled trials, and propose innovations on complementary methods for use in the evaluation of complex interventions.

Purpose This intentionally polemical paper will aim to re-examine what is meant by social enterprise and try to assert its role within the current economic system. It is well over a decade since John Pearce's Social Enterprise in Anytown was first published. Since then the term "social enterprise" has been used in multiple ways by politicians, practitioners and academics – very often for their own ideological ends. Design/methodology/approach This paper will outline the context and challenges currently facing social enterprise both from outside and from inside the social enterprise movement. Findings This paper re-affirms a paradigm for social enterprises through re-imagining how social enterprise should and could contribute to the creation of a fairer and more just society. Originality/value Finally, this paper will conclude with a reflection on what Pearce argued and how the social enterprise movement has to position itself as a viable alternative way of creating goods and services based on socially responsible values.

Given limited resources, priority setting or choice making will remain a reality at all levels of publicly funded healthcare across countries for many years to come. The pressures may well be even more acute as the impact of the economic crisis of 2008 continues to play out but, even as economies begin to turn around, resources within healthcare will be limited, thus some form of rationing will be required. Over the last few decades, research on healthcare priority setting has focused on methods of implementation as well as on the development of approaches related to fairness and legitimacy and on more technical aspects of decision making including the use of multi-criteria decision analysis. Recently, research has led to better understanding of evaluating priority setting activity including defining 'success' and articulating key elements for high performance. This body of research, however, often goes untapped by those charged with making challenging decisions and as such, in line with prevailing public sector incentives, decisions are often reliant on historical allocation patterns and/or political negotiation. These archaic and ineffective approaches not only lead to poor decisions in terms of value for money but further do not reflect basic ethical conditions that can lead to fairness in the decision-making process. The purpose of this paper is to outline a comprehensive approach to priority setting and resource allocation that has been used in different contexts across countries. This will provide decision makers with a single point of access for a basic understanding of relevant tools when faced with having to make difficult decisions about what healthcare services to fund and what not to fund. The paper also addresses several key issues related to priority setting including how health technology assessments can be used, how performance can be improved at a practical level, and what ongoing resource management practice should look like. In terms of future research, one of the most important areas of priority setting that needs further attention is how best to engage public members.

Given limited resources, priority setting or choice making will remain a reality at all levels of publicly funded healthcare across countries for many years to come. The pressures may well be even more acute as the impact of the economic crisis of 2008 continues to play out but, even as economies begin to turn around, resources within healthcare will be limited, thus some form of rationing will be required. Over the last few decades, research on healthcare priority setting has focused on methods of implementation as well as on the development of approaches related to fairness and legitimacy and on more technical aspects of decision making including the use of multi-criteria decision analysis. Recently, research has led to better understanding of evaluating priority setting activity including defining 'success' and articulating key elements for high performance. This body of research, however, often goes untapped by those charged with making challenging decisions and as such, in line with prevailing public sector incentives, decisions are often reliant on historical allocation patterns and/or political negotiation. These archaic and ineffective approaches not only lead to poor decisions in terms of value for money but further do not reflect basic ethical conditions that can lead to fairness in the decision-making process. The purpose of this paper is to outline a comprehensive approach to priority setting and resource allocation that has been used in different contexts across countries. This will provide decision makers with a single point of access for a basic understanding of relevant tools when faced with having to make difficult decisions about what healthcare services to fund and what not to fund. The paper also addresses several key issues related to priority setting including how health technology assessments can be used, how performance can be improved at a practical level, and what ongoing resource management practice should look like. In terms of future research, one of the most important areas of ...