Health Planning Proposals and Programs
The discussion to follow concerns health planning efforts during the twentieth century. Health planning, as indicated in the preceding chapter, is concerned with health care services available to individuals, as opposed to public health measures, which would benefit the community as a whole. In effect, interest in the delivery of health care services to individuals is a twentieth-century phenomenon. Histories of health planning usually begin by discussing the impact produced by the Flexner Report of 1910 ( Stebbins and Williams 1972; Hyman 1975).
Included in this outline are proposals, reports, and programs that address the structure of health care delivery systems. The outline employs the four-phase analytical framework discussed in chapter 1. The phases demarcate a shift in thinking regarding health care across three dimensions: first, in the definition of the problem; second, in the mechanisms created to address the problem; and, third, in the preferred locus of social control for implementing the solution. The first two dimensions are the focus of this chapter. The third dimension, locus of social control, is discussed in chapter 3, where the effects of health planning over time are examined.
Historical overviews of health planning begin by discussing the Flexner Report of 1910 for several reasons: first, because it marks a major turning point in thinking regarding the value that medical care had to offer to an individual; second, because the changes in the system of medical education that it signaled played a major part in shaping the health care delivery system for decades to