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Suggested Citation:"Preface." Institute of Medicine. 1981. Health Planning in the United States: Selected Policy Issues, Report of a Study, Volume I. Washington, DC: The National Academies Press. doi: 10.17226/9938.
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Page viii Cite
Suggested Citation:"Preface." Institute of Medicine. 1981. Health Planning in the United States: Selected Policy Issues, Report of a Study, Volume I. Washington, DC: The National Academies Press. doi: 10.17226/9938.
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Suggested Citation:"Preface." Institute of Medicine. 1981. Health Planning in the United States: Selected Policy Issues, Report of a Study, Volume I. Washington, DC: The National Academies Press. doi: 10.17226/9938.
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Suggested Citation:"Preface." Institute of Medicine. 1981. Health Planning in the United States: Selected Policy Issues, Report of a Study, Volume I. Washington, DC: The National Academies Press. doi: 10.17226/9938.
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Suggested Citation:"Preface." Institute of Medicine. 1981. Health Planning in the United States: Selected Policy Issues, Report of a Study, Volume I. Washington, DC: The National Academies Press. doi: 10.17226/9938.
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Suggested Citation:"Preface." Institute of Medicine. 1981. Health Planning in the United States: Selected Policy Issues, Report of a Study, Volume I. Washington, DC: The National Academies Press. doi: 10.17226/9938.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

PREFACE In the few months since the Committee on Health Planning Goals and Standards met for the last time, there have been substantial changes in the leadership of our country. There is a new President. There will be new administrators of the program with which this report is concerned, and there are changes in the composition and power centers of the Congress that will re-evaluate and determine the future of the health planning program. These events increase the importance Of this docu- ment. Certainly the timing is fortuitous as task forces and individu- als, yet unburdened by previous policies and commitments, cast a fresh eye on a variety of national policies. The health planning effort, though quite modest by any standard except local citizen involvement, is a particularly vulnerable govern- ment program. First, its funds are not tied to any entitlement pro- gram. Its elimination thus would give the appearance of saving money. Second, because it is a compromise program of many interests and values in the health sector, it has no natural or defined constituency. Third, while its planning mission is carried out locally by a citizen- dominated local advisory mechanism, the mission and its goals are poorly understood especially in Washington. Understanding of that mission was not enhanced by the executive branch's efforts to redefine the program into one that was expected to carry out the federal govern- ment's desire for "cost containment" and efforts to reduce the number of hospital beds. Since some of the major recommendations of this report are aimed at helping to sort out some of the misunderstandings and unrealistic expectations of the planning program, and explaining about its unusual local citizen-controlled structure for advising on health investments, the committee and I hope that those charged with responsibility for reviewing and implementing the health planning Act will read this report and the commissioned papers with care. This TOM document was produced by a group of citizens who gave their time and effort because of their concern about health care and the problems that health planning is aimed at ameliorating, in partic- ular, and about government programs in general. . . — Vll —

This preface is written by the chairman. Let me state my perspec- tive on the work of the committee. We did not view our charge as listed on page two in narrow terms. We did not limit our inquiry to ways in which the health planning program might be improved. Rather, we began at an earlier stage discussing the rationale for health plan- ning, asking how the program should be judged, whether it can measure up to that which some expect of it, and whether its realized and poten- tial benefits justify its costs. I believe we started with a premise: that government programs should not be supported simply because their goals were worthy or condemned simply because they used nonmarket decisionmaking mechanisms. We concluded that, by itself, the health planning effort, as constituted or even with the improvements we recommended, could not accomplish what some desired of it: significant control of health care costs. The cost containment rationale for plan- ning and regulation has assumed greater importance in the years since the enactment of the original legislation and has been used, primarily in Washington, as the criterion by which to assess the performance of health planning. The committee believes that the forces at work in the American health care system, including the various reimbursement mechanisms, cannot be countered by a health planning effort that is divorced, among other limiting factors, from the flow of funds. to expect more of health planning than it can possibly deliver is unfair and not only to those who work hard to make health planning work. It is unfair to all those Americans whose expectations are aroused, and whose hopes subsequently are dashed. It may be convenient to "oversell' in order to enact and renew legislation and to pass appropriation measures, but such overselling is harmful in the long rune There is a day of reckoning, and in that day of reckoning, the program in question loses its supporters. Yet even more than that occurs: the public grows cynical, feels it has been duped, and loses faith in its institutions. If setting criteria that guarantee disappointment is irresponsible and damaging to public confidence and trust in government leadership and government programs--it would be similarly irresponsible for this committee not to set forth criteria that it believes are appropriate. We have stated that, by itself, health planning cannot serve as a major cost containment program. But we have gone further. We asked: "What can an effective health planning program accomplish?" and "Are those objectives worth the effort?" We concluded that the health planning activity can make a number of important contributions. Health planning can bring existing disparities in access to our attention and can help plan for a more equitable distribution of services. It can assist in the attainment of a more effective and efficient health care system and thus contribute to cost containment. Containing costs through increased system efficiency--not by denying care to persons who need and can benefit from care or by arbitrary cost cutting or budget cuts that reduce services that have long run benefits--is an objective worth pursuing. · . — — vet Il —

Furthermore, health planning can contribute to other objectives which this committee believes are important. These objectives reflect our faith in the value inherent in giving voice to those whose needs cannot be adequately articulated through political or economic power. The health care system touches every American, and health planning pro- vides an opportunity for many who would otherwise be left out to ex- press their concerns and priorities. Does the contribution that health planning makes and can make to the attainment of those objectives justify the effort? This committee is convinced that the answer to that question is yes. We do not reach that conclusion simply because of our admiration for the thousands of individuals in communities across the country who, on a volunteer basis, have given of their time to make health planning work--though we do note the fact that so many have done so, and continue to do so, is not an irrelevant datum. Nor did we reach this conclusion simply because there is evidence that, in some areas, health planning has made a contribution to the rationalization of resources. That daters, too, is important. Nonetheless, it is an insufficient rationale for a federal program that is national in scope. Our conclusion that the health plan- ning effort is justified was reached on the basis of a careful review of the papers contributed by our consultants, on the basis of our own reviews and discussions and experience. Our assessment is not as quan- titative as some would like it to be. We are aware of this "short- coming." We believe, however, that this is in the nature of the pro- gram. Much of what it can accomplish involves the democratic process, the creation of an informed citizenry and changes in the climate of opinion. At this point, in the history of the program, the pro- gram will have to be monitored and assessed for understanding, improve- ments, and insights, rather than evaluated in a rigorous scientific manner. But while the program should be sustained, that does not mean it cannot be improved upon. We offer some specific recommendations of ways by which program performance could be improved in the two areas that we examined closely. The reader will note that many of the recommenda- tions call for greater flexibility. The committee is convinced that the health planning effort is complex and that it is necessary to cast many of its activities in a quasi-experimental mode. There is little reason to believe that present arrangements necessarily are optimal or that arrangements which are effective in one area or region will necessarily be effective elsewhere. Our statement that we favor flexibility and experimentation has a corollary: that a purposeful effort be made to learn from these various experiments, from these differences. Unless the various experiments and the research concerning them are planned, we will not maximize the knowledge gained and will be only slightly better off in the future than we are today. Finally, it is important to note that the committee has concluded that, if health planning is to succeed, it is necessary that those ax —

volunteers and staff people in Washington and in all fifty states be given a period of fiscal and temporal stability in which they are permitted to do their jobs. No program can succeed if it is constantly subjected to changing guidelines, altered priorities, and mixed sig- nals. Nor is morale enhanced if the program and the required appropri- ations are constantly in jeopardy. It is possible to ensure failure by underfunding programs, harassing administrators, showing little appreciation for the thousands of citizens involved, and setting un- attainable goals. It also possible to foster a perception that govern- ment does not work and leaders cannot lead if those who enact legis- lation were to fail to support it and if those who oppose it, having lost, continue to try to scuttle activities. Whatever one's views are on the appropriate role for government and the private sector, surely all agree that it is unhealthy for the body politic to ask people to do a job and then create situations that make it impossible for them to succeed. The reader should note that all of the above is in the preface. Perhaps all of my colleagues on the committee agree with what I have written, but the tone and the exact wording should not be ascribed to my colleagues. One of the privileges a chairman has is to write the preface. I have tried to sum up my thoughts as they developed during the committee work. The committee document, however, does not rest on my ideas or on my formulation, and it is the committee document that is important and that should be reviewed and considered. I know, however, that I speak for all members of the committee when I express our deep thanks to all those who worked so very hard to produce this report on time. We especially thank Helen Darling. Few committees have had as able a study director. The laws of probability ensure that that is the case because there are few study directors as able as Helen Darling. All that I said about her in our first report still holds true. Our second year together underlines that which we noted then. I know that if I am again asked to serve as chairman of an TOM committee, my first question will be: Who is the study director? I suspect that is the question my colleagues will also ask. Thanks are due as well to David Hamburg, who was President of the ION during almost all of the life of this study, and Frederick Robbins, the current President. Karl Yordy, William Lybrand and Carleton Evans have provided continuing administrative support that has made it pos- sible for the staff to concentrate on the study. In addition, through- out the two years of this study we have enjoyed the strong encourage- ment and cooperation of key officials in the Health Resources Adminis- tration including Henry Foley, formerly Administrator. Dr. Foley's per- sonal support and interest from the study's inception has been gratify- ing. Special thanks are due to Laurel Shannon who has been an able and committed project officer throughout the life of the study. More re- cently, James Stockdill and Iris Schneider have assisted us in reviews by the program's federal administrators. x

In addition to the authors who contributed papers, I would also like to recognize the assistance of many people too numerous to name who have given freely of their advice, critical reviews and assistance over the past two years. In particular, Dan Zwick, Harry Cain, Robert Sigmond, and Katherine Bauer have reviewed different parts of the re- port and their comments have been appreciated. Finally, as Chairman, I want to thank all committee members. As in the first year of the committee's life, they made my task most plea- sant and stimulating. When we began we were members of a committee, when we concluded, after two years together, we were friends. My thanks to them for making what might have been a chore a rewarding activity. /- / Rashi Fein Chairman — X1

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