The Effects of Health Planning over Time
In considering the aftermath of the measures instituted to upgrade the quality of medical care available early in this century, it is important to recognize that the solution selected, and the locus of responsibility for implementing it, stayed in place for more than four decades. By contrast, during the second half of the twentieth century the definition of the problem, the solutions selected to address problems, as well as the locus of control and responsibility for resolving problems have gone through several revisions over the last three decades. The question suggested by this observation is either: Why did the first phase last as long as it did? Or, why are the more recent phases so short-lived? From one perspective, the answer to the question is obvious -- the rate at which social changes were occurring was accelerating during these years. From another perspective, the answer is more complicated. It rests on understanding the effects that were produced as a result of the measures adopted to address the problems identified in the first phase of health planning.
The reason for the stability of the first phase can be attributed to the fact that society was reasonably satisfied during that period or, at minimum, not sufficiently dissatisfied to turn its attention from other social concerns to the problem of health care delivery. In order to explicate this line of reasoning, it is necessary to return to the Flexner era.
The Flexner Report made explicit to anyone who was interested the standard against which all medical schools were being compared, namely, the Johns Hopkins Medical School. What was significant about the model provided by this institution was its commitment to basic science as an essential prerequisite for