Health planning as a managerial ideology

The involvement of the behavioral sciences in American medicine: a historical perspective

This paper discusses the medical profession's underlying motivations in initiating recent changes in medical education in the United States. The first part briefly examines the transition from a holistic to a scientific theory and practice in American medicine. The second part of the paper analyzes and interprets the increasing incorporation of behavioral scientists into medical education in recent decades. A review of the debate on reforms in medical education, appearing in The Journal of the American Medical Association since the 1940s, indicates that the primary function of these behavioral scientists is to provide future physicians with techniques for managing problems in the physician-patient relationship. The concluding interpretation is that behavioral science expertise is actually used to strengthen and legitimize the traditional status of the medical profession in the existing structure of health care delivery.

Health planning as a regulatory strategy: a discussion of its history and current uses

Federally mandated health planning is one of the most significant responses to the cost crisis of American medicine. Portrayed as an objective and rational mechanism of determining the future, planning is a socially acceptable means of exerting third-party control over a sector of the economy long able to escape meaningful controls on its growth and development. However, far from being the neutral science which it is heralded to be, the planning process serves the interests that are able to control its use. Health planning agencies must be studied in the context of the current emphasis on cost containment and reorganization of health services. Supported and enfranchised largely by major third-party payors, planning smooths the implementation of changes in the health sector. Despite its progressive potential, planning serves the interests of these third-party payors by masking their attempts to control the future development of the health system.

Observations on potential contributions of health planning

The passage of the National Health Planning and Resources Development Act in the United States in 1974 is used to set the context for a new assessment of health planning as a change agent. In reviewing the record of health planning the most striking conclusion is that even its friends have been unable to establish that it has had any quantifiable impact. The authors suggest, however, that comprehensive health planning may have stimulated the belief that changes in medical care organization are crucial to improving the health care system. The authors next consider the role of health planning inferred from three widely espoused "models" of the health care system: professional, central planning, and market. Although market advocates generally deemphasize health planning as contrasted to those supporting a centrally planned system, none of the models is sufficiently developed to indicate specific roles and functions fro health planning. Basing their argument on goals for health care reform generally espoused by students of medical care organization, the authors assert that health planning agenices will be most effective if they are organizationally linked to general-purpose governments, encourage the formation of Health Maintenance Organizations, consciously involve themselves in health system reorganization, and design their policies so they can be effectively evaluated.

Quality control and the community physician in England: an American perspective

The quality of health care is becoming an issue of increasing public importance in both England and the United States. As the government role in providing health care grows and citizen demands increase, the effective and efficient use of health care resources and their equitable distribution become crucial. Although government responsibilities, particulary for health care, differ in both countries, as do traditions of quality control, cross-national comparisons are nonetheless useful. An examination of the role of the new English community medicine specialist and his potential for quality control may indicate what tools and powers should be introduced into a health planning and quality control system in the United State. The study concludes that at the district level of the National Health Service, where the basic planning, monitoring, and evaluation of services are to take place, the District Community Physician has very limited tools to carry out his quality control function. Although he has formal position in the unified decision-making structure, it is unlikely that he will be able to effect any substantial reallocation of resource without the voluntary support and copperation of the consultants, general practitioners, and other health providers.

The political context of health service regulation

Can regulation work in health services, given the present political context? General issues in the regulatory process are discussed, followed by a consideration of the relevance of these issues to the health care field. Regulatory processes are reviewed for the United States in four areas: credentialling of people, surveillance of delivery systems, quality of materials and technology, and rate-setting or cost control. It is concluded that the process cannot work. Four alternatives are presented and briefly evaluated: tinkering, centralized regulation, national health service, and general nationalization of most major economic sectors.