What is a priority? Paul Spicker Journal of Health Services Research and Policy 2009 14(2) 112-6 Abstract. What does it mean to say that something is a “priority”? Priority setting is used to balance competing claims for resources, but the nature of the exercise is ambiguous. The priorities which are claimed might be for time, resources, process, rights or service. The setting of priorities might refer to importance, relative value, precedence, special status, or lexical ordering. And there are different ways of ranking priorities within different understandings of the term, including simple ordering, optimisation, triage, and satisficing. There is a fundamental distinction to be made between preference rankings and precedence rankings, which can lead to strongly different conclusions from the same information base. Because there is no definitive understanding of priority, there can be no authoritative formula for deciding between competing claims. The idea of prioritisation is associated with the exercise of judgement between competing claims. Part of the literature on priority setting in health care is concerned with the political process of negotiating for resource allocation (e.g 1, 2), and there is a specialised literature concerned with the methods used to distinguish between priorities. In both, “priorities” are mainly identified by establishing the preferences and views of stakeholders (practitioners, managers or the public). Ham, for example, identifies “priority setting” partly with the kind of initiative established in Oregon, the Netherlands and the UK (3) - which attempt to establish criteria for funding - as well as schemes in New Zealand and Sweden, which are attempts to choose between conflicting claims. Some studies focus on establishing a framework for eliciting and drawing together competing views, such as programme budgeting and marginal analysis (PBMA)(4), Multi-Criteria Decision Analysis (MCDA)(5) and even qualitative analysis based on grounded theory (6). Studies seem to assume that the main issue in setting priorities is to establish what stakeholders think is important, or some kind of criteria for evaluation: once values and criteria have been established, the setting of priorities in some sense follows (e.g. 7) Balancing competing claims is consequently a technical exercise: examples include discrete choice modelling (8), conjoint analysis (9), or various forms of decision analysis (10,11). The purpose of this paper is not to review this kind of method, or to examine the political process, but to ask a simpler, more basic question. What does it mean to say that something is a “priority”? There are several different understandings of the term, and unless we can work out what priority setting is supposed to do, a system which sets out to establish priorities is unlikely to reflect the issues and concerns it is intended to resolve. Priority of what? A useful initial illustration of priority ranking might be one of the general statements 1