Planning for the Nation's Health: A Study of Twentieth-Century Developments in the United States

The research on which this volume is based began in response to an announcement in autumn 1981 by Department of Health and Human Services spokesmen that the health planning enterprise, particularly the funding supporting health systems agencies (HSAs), was to be phased out during the forthcoming year. Some HSAs have been phased out since then. However, the majority accommodated to the new social environment which decreed that health planning in its current form was an approach whose time had come and gone. Henceforth, planning was to be carried out according to the dictates of the marketplace.

As a sociologist interested in health care delivery arrangements, I wondered how the organizations involved would respond to such an overt threat to their existence. One of my primary concerns was finding out what would happen to the knowledge and experience accumulated by the health planning agencies, so I approached one such agency to discuss the possibility of my studying its dayto-day activities as a participant-observer.

The administration and governing board of the HSA, called the Urban HSA in the text, welcomed my interest in focusing on the knowledge and experience that had accrued. However, any references to my interest in the organization's response to the newly evolving hostile environment were regarded as morbid and totally unacceptable. Thus, we agreed that the question to be addressed would be: What have we learned from our experience with health planning? (For a description of the research site and an account of the course that the case study took throughout the period spent with the HSA, see the appendix.)

In attempting to answer this question, I quickly found that health planning had a far more complex history than I had realized. I also discovered that the steps leading to prevailing health planning arrangements were recorded in scattered bits and pieces. I began by reconstructing the origins of health planning

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