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

By Grace Budrys | Go to book overview

7
The Emergence of Groups

A review of the process-oriented literature shows that a high level of consensus regarding the assessment that one of the major obstacles to attaining greater success in health planning was the dominance providers were exerting over consumers. The solutions recommended in this literature revolved around mechanisms to enhance consumer participation. In fact, the 1979 amendments to PL 93-641 advocated a number of measures which were designed to do exactly that. The amendments recommended selecting consumer representatives to speak for identifiable interest groups, including certain social, ethnic, economic, geographic, and disabled communities. These correctives were expected to improve representation by making the individual consumer representatives accountable to a specific group of consumers with a vested interest. However, no one who has studied health planning from a process-oriented perspective has ventured to say that health planning agencies performed any better after the 1979 amendment was legislated. The outcome-oriented researchers, who found that greater cost savings had been attained as a result of health planning than earlier research had indicated, have also given us little reason to think that improved consumer representation was responsible. In any case, the recent reversal in findings regarding the relationship between health planning and cost containment has had surprisingly little impact on the thinking exhibited in the process-oriented branch of the literature with regard to the role played by providers. The assumptions contributing to the formulation of the 1974 planning act have remained intact. The basic assumption that providers are self-interested and single-minded in their determination to resist all efforts to control the expansion of the health care sector apparently has become so firmly rooted in the thinking of those who observe the process of planning that there has been no sense of need to verify it. A related assumption that providers would be consistent in their support for

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

Table of contents

  • Title Page iii
  • Contents v
  • Tables vii
  • Preface ix
  • 1 - The Topic of Health Planning 1
  • Part I - The History of Health Planning 9
  • 2 - Health Planning Proposals and Programs 11
  • 3 - The Effects of Health Planning over Time 27
  • 4 - The Rise and Decline of Professional Control 37
  • 5 - Evaluating Health Planning 51
  • Part II - The Urban HSA 73
  • 6 - The Participants' Evaluation of Success 75
  • 7 - The Emergence of Groups 87
  • 8 - The "Teeth" in the Law That Didn't Work 103
  • Part III - Summary and implications 111
  • 9 - Conclusions 113
  • Appendix 135
  • References 139
  • Index 155
  • About the Author *
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