Health Planning in the United States Selected Policy Issues, Report of a Study, Volume I (1981) / Chapter Skim
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V. Summary of Recommendations and Conclusions
V. Summary of Recommendations and Conclusions
Pages 71-84
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From page 71... ...
The intentionally decentralized process for planning and resources development should be viewed as an opportunity for learning how to help deploy health resources in this country. Expectations for planning agencies must be consistent with the tools provided them.
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From page 72... ...
To date, evaluation has focused almost exclusively on capital expenditure control. But the planning program was not intended to be a major cost containment device and it lacks the authority needed to effectively control expenditures.
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From page 73... ...
Clearly developed goals and expectations should protect the planning program from criticism that results from conflicting values and changing priorities. It is the committee's judgement that the purposes of the program for which the program could be and should be held accountable, in the order of their importance, based in the program's nature and authority, are: To establish and maintain an open, participatory structure for articulating community health needs and desirable alternatives for meeting those needs, to be used in advising both governmental and private sector decisionmakers who control health resources at the local, state, and national levels; 2.
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From page 74... ...
, through efforts to improve the health status of the population, especially through programs that promote health and prevent disease, and efforts to limit unnecessary capital investment and direct such investment toward more cost-effective facilities and services. It is important that this use of "cost containment" not be confused with budget cuts for health and social services, particularly for low income, old, and disabled citizens.
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From page 75... ...
These include: (1) the fragmented, diversely controlled health enterprise which contains public agencies engaged in financing, regulating and delivering traditional public health services which in turn coexist with a substantial voluntary system for delivering similar services; (2)
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From page 76... ...
Expanded efforts to link planning and state rate review programs should be fostered by the federal government so that the most effective models can be identified. The Congress explicitly required health planning agencies to implement plans to regionalize health services and reduce redundant services.
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From page 77... ...
The committee believes that to enable such experiments to be performed Congress, in reauthorizing the planning program, should make explicit its interest in allowing experimental approaches to test different ways of health services planning and locally designed methods for advising on the deployment of health resources, especially new technology. The current "controlling" approach to administration being pursued by the federal administration denies the federal government, state government, and localities, the opportunity to learn while doing, essential in any complex program but especially one aimed at creating local institutions.
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From page 78... ...
Among the considerations that should enter into development of improved legislation are the length of program authorization, the possibility of developing a stable financial base through use of a trust fund approach for at least a portion of the funding, and the use of guaranteed future funding to enable agencies to budget more effectively. The committee explored the potential for alternative funding sources for health planning, and particularly for HSAs.
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From page 79... ...
The committee recognizes the differences between the missions of the PSROs and the planning bodies and the real problems which exist concerning data confidentiality In fact, the committee felt that there is too much attention paid to their working together when their tasks are quite different and the real opportunities for working together are limited. 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
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From page 80... ...
Reductions in services are not likely to fall evenly on all citizens. The health planning agencies with their carefully constituted governing bodies can make a special effort, working with providers, to pool their skills and capacities to find new imaginative ways to adapt resources to unattended health needs and ensure that the underserved and politically powerless remain priorities.
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From page 81... ...
The attributes of clearly defined constituencies, experience in organizational politics, and resources can be used by individual board members. The task at hand is to overcome political imbalance within the HSA governing body to ensure that planning agencies satisfactorily address a wide range of community concerns.
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From page 82... ...
Training should cover many of these matters, as well as methods of decision making, leadership, and conflict resolution that can be employed by governing boards. The Health Resources Administration should explore possibilities for enhancing consumer participation.
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From page 83... ...
The committee also discussed the possibility of recommending requirements for more insurers and third party payers on governing bodies. Some of the committee felt strongly that third party payers, insurers, and other major health services purchasers should play major roles in health planning.
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From page 84... ...
—84— Locations In which there are strong links between planning decisions and third party payment should be studied. Locations where the board includes a larger proportion of payers, insurers or purchaser should also be studied to see whether or not there are dif ferences in the effectiveness of these agencies.
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