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HEALTH PLANNING IN THE UNITED STATES: SELECTED POLICY ISSUES Studies of National, State, and Local Relationships and of Consumer Participation Volume One Report by a Committee of the INSTITUTE OF MEDICINE January 1981 National Academy Press Washington, D.C.

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NOTICE The pro j ect that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the Councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. This report has been reviewed by a group other than the authors accord- ing to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate profes- sions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 Congressional charter responsibility to he an advisor to the Federal Government, and its own initiative in identifying issues of medical care, research, and education. Supported by the Health Resources Administration Contract No. 282-78-0163-EJM 2101 Constitution Avenue, N.W., Washington, D.C. 20418 Area (202) 389-6187 Publication TOM 8102 — 11

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COMMITTEE ON HEALTH PLANNING GOALS AND STANDARDS Rashi Fein, Chairman Professor, Economics of Medicine Harvard Medical School Robert A. Derzon Vice President Lewin & Associates, Inc. Henry A. DiPrete Vice President John Hancock Mutual Life Insurance Company Jean L. Harris Secretary of Human Resources Commonwealth of Virginia John K. Iglehart Vice President Kaiser Foundation Health Plan James R. Kimmey Executive Director Institute for Health Planning Ben R. Lawton President Marshfield Clinic Roslyn Lindheim Professor of Architecture University of California Theodore Marmor Chairman Center for Health Studies Yale University Walter J. McNerney President Blue Cross and Blue Shield Associations Anthony Mott Executive Director Finger Lake Health Systems Agency Nora Piore Senior Program Consultant The Commonwealth Fund William C. Richardson Professor and Associate Dean University of Washington Bruce C. Vladeck Assistant Commissioner of Health State of New Jersey Liaison Members from the National Council on Health Planning and Development: S. Philip Caper Vice Chancellor for Health Affairs and Professor of Medicine University of Massachusetts Medical Center L. Emmerson Ward Professor of Medicine Mayo Medical School

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STAFF Helen Darling, Study Director Dorothy SO Poole, Research Associate MaryAnne Cunningham, Secretary Jessica Townsend, Consultant COMMISSIONED PAPERS by Lawrence Brown The Brookings Institution Barry Checkoway University of Illinois at Urbana Donald Cohodes Johns Hopkins University George Downs University of California at Davis Dorothy Ellenburg The Coalition for Effective Human Services James Morone University of Chicago Gregory Raab Health Care Financing Administration Harvey Sapolsky Massachusetts Institute of Technology — 1V -