Health Planning in the United States Selected Policy Issues, Report of a Study, Volume I (1981) / Chapter Skim
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III. National, State and Local Roles and Relationships
III. National, State and Local Roles and Relationships
Pages 31-52
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From page 31... ...
Public agencies at each level are engaged in financing, regulating, and delivering traditional public health services and coexist with a substantial private voluntary system for delivering similar services. The majority of personal health care services are delivered by individual or organizational providers on a voluntary fee-for-service basis, but a significant portion of medical care services, particularly for the poor and disadvantaged, are delivered through public hospitals and clinics financed by general tax revenues of state and local governments, and through federal programs.
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From page 32... ...
* The federal statute prescribes the structure and functions of both local and state level planning agencies, and establishes a complex of administrative regulations, operating policies, and program guidelines promulgated and administered by the Department of Health and Human Services (DHHS)
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From page 33... ...
The functional components of agency activities -- plan development, project review, decision-making -- are either not limited by federal authority or protected from arbitrary federal action by due process and administrative review requirements. Consistent with the pluralistic nature of the health delivery system, the health planning legislation allocates specific functions to the local and state agencies and mandates linkages between them in carrying out these functions.
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From page 34... ...
One was the existence of voluntary community health planning agencies. Another was distrust of state and local government on the part of key individuals involved in drafting the 1974 legislation (see Raab and Brown)
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From page 35... ...
The substantive committees dealing with health planning had no jurisdiction over such related matters as the Veteran's Administration's health program, Medicare and Medicaid financing, quality review under the Professional Standards Review Organization program, Section 1122 capital expenditure review under the Social Security Act, or antitrust responsibilities related to nonregulatory plan implementation. As a result, linkages between the health planning agencies and the Veteran's Administration or PSROs took the weak form of coordination and cross-representation.
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From page 36... ...
The committee heard considerable testimony in the public hearings suggesting "over-management" of the program by the federal administrative agency, and an emphasis on achieving program compliance rather than providing assistnace to enhance program effectiveness. This testimony echoed problems identified earlier by observers of the health planning program.
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From page 37... ...
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From page 38... ...
Examples include the 1979 amendment that will prohibit state certificateof-need laws from covering HMOs, and bypasses state government in the proposed use-of-federal-funds review, giving only HSAs the review authority. o State officials alleged federal indifference to state legislative timetables.
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From page 39... ...
Federal officials at the regional office level are accused of conducting process-oriented checklist reviews of plans because they are not familiar with local priorities and needs and cannot properly or fairly judge the stature of the agency or the quality of the plans. o State agency reversal of local recommendation on capital project review sometimes is perceived by the RSAs to be caused by political pressure.
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From page 40... ...
vary among the states. Some councils actively participate in plan development and review state and local planning agency performance.
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From page 41... ...
* Apart from such inter and intra state differences, a recent study by the American Health Planning Association, "Analysis of Health Planning Agency Activity under CON and 1122" HEW Contract Number 100-790121 noted that some differences in such as types of applications-received or approved and volume of expenditures required and approved appear to be associated in some cases with such local characteristics as the size of RSA population, the extent to which USA areas as rural and the hospital bed-to-population ratio of the RSA area.
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From page 42... ...
. The absence of technical certainty, limitations in knowledge concerning efficacy of treatment and the appropriate supply of services, planning technology limitations, and inadequate data make CON decisions complicated and ultimately the product of value judgments by the decison makers.
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From page 43... ...
Research should be initiated to discover and disseminate information on good institutional planning models and on successful linkages between institutional and area planning. Because the planning program is more than regulation, and because the impact of CON and 1122 programs is more complete than mere disapproval of capital expenditures, the committee concluded that an assessment of the planning program on the narrow criteria of approvals and disapprovals under CON or 1122 project reviews is inappropriate and likely to be unsatisfactory.
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From page 44... ...
While a decentralized planning approach, such as this one, is unlikely as discussed earlier to constrain cost increases, other state and federal actions could more favorably influence planning agencies functions. For example, reimbursement schedules for physicians and hospitals which today favor expensive technology and procedures might be modified centrally to change the incentives.
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From page 45... ...
The committee hopes that the Council will move expeditiously to begin this important task. Recommendations Concerning Agency Diversity The co~mittee's consultants and persons appearing at the public hearing emphasized a need for federal administrators to exhibit more flexibility in the conduct of the health planning program.
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From page 46... ...
The current "controlling" approach being pursued by the federal administration denies the federal government, state government, and localities the opportunity to learn while doing, an essential ingredient to any program, but especially one aimed at creating local institutions with complex missions. The choices of experiments should be made by the planning agencies, according to size of grant, composition of staff, and priorities and interests of the governing body and the state.
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From page 47... ...
For example, some areas could be encouraged to test the placing of planning units in rate-setting agencies, or of programs to buy out, convert, and eliminate unneeded services. Other areas with low health care costs and little excess capacity might be excellent locations for raising the capital expenditure review threshold.
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From page 48... ...
If a special reimbursement program adequately contained expansion, experiments could be conducted in temporarily suspending CON for some elements of the health system. Recommendations for Stability and Funding Health planning agency efforts are directed largely to making changes in the health care services and facilities of communities.
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From page 49... ...
But, the committee felt strongly that any actions by the federal government based on an assumption that state and local governments or others would pick up funding would be illusory at best. The committee recommends that the National Council on Health Planning and Development undertake a special study of the planning agency funding issue, with the goal of producing recommendations for consideration by the Congress during the 1982 review of the authorizing legisation.
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From page 50... ...
, there is a statutory mandate for the planning agency to exchange information and otherwise involve them in its activities.* Among the most important of these relationships from the perspective of the committee are those with local official health agencies which are not directly required to deal with the planning agencies.
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From page 51... ...
The committee recommends that the National Professional Standards Review Council and the National Council on Health Planning and Development jointly develop a position concerning data and other information exchange which meets the legitimate need for such data for health planning purposes while observing legitimate concerns regarding confidentiality of individual patient data. In this chapter the issues of state, local and national relationships and relationships among agencies at the three levels were discussed.
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