Health planning in the united states: Where we stand today

Abstract

This paper reports on the status of the implementation of the national health planning program mandated by Congress in the National Health Planning and Resources Development Act of 1974 (P.L. 93-641). The law created and financed a two-tiered planning network of more than 260 local and state planning agencies. The paper gives a very brief history of previous efforts in health planning and describes some of the environmental factors — rampant cost inflation and proliferation and redundancy of high cost technology and facilities — which triggered interest in controlling capital investment in the health sector.

The major structural features of the statute and the progress made by 1977 in constructing the program are described. The rationale and the requirements related to particular Plan documents are explained, as are the Certificate of Need law provisions and Appropriateness Review.

The authors argue that this program is different from previous planning efforts in several fundamental respects including who the major actors are, the importance given to an empirical, population-based, systems approach to planning, the availability of technical assistance and the emphasis on plan implementation.

While there is evidence of progress in health planning, some persistent policy problems such as unrealistically high expectations, the inadequacy of the knowledge base, insufficient time and patience to allow for agency maturation, conflicts in governance, assuring public accountability, and the desirability of further regulation of the health industry still remain unresolved. The authors conclude that, compared to the apparent alternatives, this health planning program is the best way to go and should succeed.