Purchasing and public health: the state of the union.

The purchasing role of health authorities has been in existence for two years and public health physicians are expected to play a central part within this role. While the first year was dedicated to maintaining a "steady state", differences are now appearing between authorities is the way in which purchasing is managed. Based on the views of senior managers and public health physicians working in purchasing authorities, considers how the purchasing process is developing and reports how public health medicine is perceived to be contributing to it. Identifies sub-regional resource allocation as a major factor influencing the purchasing process. Conflicting views were found on the purchasing role of public health medicine, in particular with respect to health needs assessment. As purchasing evolves it remains unclear whether pubic health medicine will come to fulfil a largely technical role, or a more wider one in which it acts as advocate for the population's health