The Paradoxes of Health Planning

Abstract

of 1974 designated 200 Health Systems Agencies (HSAs) nationally and a State Health Planning and Development Agency in each state. Components of the law are analyzed to illustrate its ambiguities and contradictions. The components analyzed are: the findings which led to the passage of the law; the law's purpose; the ten national health priorities; the National Guidelines for Health Planning; the purposes of the HSAs and the data they are to assemble and analyze. The major contradiction is that agencies designated to focus on cost containment in health care are expected to make health care services more accessible and acceptable, and improve their quality. These agencies are also expected to improve the health of the population, including ill health attributable to environmental factors. Social policy regarding prevention is discussed, particularly the current trend toward blaming the victim. Contradictions and ironies in planning for cost containment are also pointed out: patients are blamed for utilization that is provider-induced; there is no constituency for cost containment; consumers (i.e., purchasers) with the greatest potential clout are large employers and organized labor, but such labor-management coalitions are just beginning to be developed; Certificates of Need require no proof of need; and current anti-regulation fervor may not distinguish state health planning regulations for cost containment, such as those adopted in New Jersey, from the cost-generating regulations of most government agencies.