Problems and prospects for comprehensive health planning

Health planning in the United States and the decline of public-interest policymaking

In the 1960s and 1970s, health planning formed a major theme of American health policy. Planners aimed to improve health services and make them broadly available while using resources efficiently. This article provides a history, both intellectual and political, of the origins of planning, its rise, and--in the face of mounting problems--its decline. The story also illustrates broader changes in the culture of policymaking in American health care. From the Progressive Era through the 1960s, reform-minded experts in health worked to advance the public interest. Thereafter, they increasingly left behind public-interest ideals and their underlying extramarket values in favor of organizing and improving health care markets. Whatever the deficiencies of traditional policymaking may be, this study suggests the need to resurrect extramarket values in health policy.

Travel for primary care: expectation and performance in a rural setting

Data and findings are presented pertaining to the expressed travel limits for general medical care of a rural population and the degree to which their observed travel behavior reflects these limits. Considerable variation in expressed reasonable and maximum travel distances and times was observed among respondents in a countywide cross-section sample of the resident population in western Maine. A substantial proportion of the respondents' visits for general medical care exceeds their reasonable travel limits and some visits exceed the travel limits they considered maximal. Additionally, a comparison of expectations from this study with those of a similar population in another section of the county reveals significant differences. The findings suggest that health planning could be considerably enhanced by a better understanding of patient preferences for medical care travel behavior, the origins of these preferences, and their relationship to the use of available medical care opportunities. This is particularly true if stated goals of incorporating patient preferences into the health planning process are to be realized.

Trade-offs and conflicts in evaluation of health system alternatives: methodology for analysis

Images

Health planning as a managerial ideology

This paper examines health planning as a form of technocratic ideology in use both by proponents inside government and by outside interest groups in the health field. Ideology and the nature of technocratic power are defined. Health planning is analyzed as occupation, process, and ideology. The ideology in use is analyzed for the following American programs: Hill-Burton, Comprehensive Mental Health Planning, OEO Neighborhood Health Centers, Regional Medical Program, Comprehensive Health Planning. It is concluded that health planning cannot operate in the present sociopolitical context except as an ideology to justify the status quo in health services.