(\Health Planning
Bibliography Series j )£ J
ealth Planning:
Annotated Bibliography
DOCUMENTS DEPARTMENT
■:0V 1 0 1980
LIBRARY
UNIVERSITY OF CALIFORNIAHEALTH PLANNING SERIES
The Bureau of Health Planning is a primary resource for current information
on a wide variety of topics related to health planning. To facilitate the
dissemination of this information to health planners, the Bureau issues
publications in the following series.
Health Planning Methods and Technology
This series focuses on the technical and administrative aspects
of health planning. Included are such areas as methods and
approaches to the various aspects of the health planning process,
techniques for analyzing health planning information and problems,
and approaches to the effective dissemination and utilization of
technical information.
Health Planning Information
This series presents information on the analysis of issues and
problems relating to health planning including trend data, data
analysis, and sources of data to support health planning
activities.
Health Planning Bibliography
Bibliographies on specific health planning subjects are published
in this series. Subject areas are selected by the frequency of
inquiries on specific topics and from suggestions by Bureau staff
and health planners throughout the Nation.
International Health Planning
This series presents information and case studies relating to
health planning methodologies and experiences of other nations
which are potentially applicable by U.S. health planners.
Health Planning in Action
Case studies of selected activities of State and local health
planning agencies are presented to highlight their achievements in
providing "equal access to quality health care at a reasonable
cost."
"Health Planning:	An Annotated Bibliography" is the eighteenth publication
in the Health Planning Bibliography Series. A list of all the publications in
this series appears on the inside of the back cover of this publication. Copies
may be purchased from the National Technical Information Service (NTIS),
Department of Commerce, 5285 Port Royal, Springfield, Virginia 22161.Health Planning:
An Annotated Bibliography
Prepared under
AID — University of Pittsburgh
Contract No. 931-1103
by
Judith A.,Sangl
and
Patricia M. Lizanec
under the direction of
Hector Correa, Ph. D.
July 1980
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
\A ,	% Health Resources Administration
' Bureau of Health Planning J	*
DHHS-Publication Ncf (HRA) 80-14024 )
HRP-0301 801(0*)^FOREWORD
This bibliography has been made available to the Bureau
for publication in the Health Planning Series in
cooperation with the Agency for International Development
(AID). The manuscript was prepared by the University of
Pittsburgh under contract to AID.
Bureau reviewers have been enthusiastic in recommending
it for health planners because of its comprehensiveness
and commendable organization of citations and abstracts.
We are certain that State and local health planning
agencies will find this bibliography a useful reference
book and appreciate the opportunity to share it with
them.
Colin C. Rorrie, Jr., Ph.I^
Director
Bureau of Health Planning
i i iTABLE OF CONTENTS
Page
Introduction	1
I	GENERAL	5
1-1 CONCEPTS IN PLANNING	5
1-2 PROCESS AND PERSPECTIVES	23
1-3 CASE STUDIES	106
1-3.1 SPECIFIC	106
1-3.2 COMPARATIVE	144
11	HEALIR ANL REALm EXE1EH GHARAEIERIEIIEE
RELAIEL IQ RLAMIES	157
III	ELAMIHG LEGISLAIIQN	169
IV	ELANNING GEQQE2	194
IV-1 GENERAL	194
IV-2 HIGH LEVEL	207
1V-3 TECHNICIANS	208
IV-4 PROVIDERS AND CONSUMERS	213
V	flRfiAmAIlQKAL AERELIE	288
VI	RLARRIRG EQRCIIQ11S	306
VI-1 DECISION MAKING	306
VI-1.1 General	306
VI-1.2 State	318
v
IVI-2 TECHNICAL
321
VI-2.1 Conceptual Problems	321
VI-2.2 Data and Statistics	363
VI-2.3 Models	407
(a)	Ambulance	407
(b)	Evaluation	413
(c)	General Planning and
Resource Allocation	417
(d)	Health Status	481
(e)	Hospital Occupancy	488
(f)	Inventories	499
(g)	Location of Facilities 505
(h)	Marketing	515
(i)	Personnel	519
(j)	Scheduling	550
(k)	Special Facilities and
Hospitals	565
(l)	Specific Diseases	581
VI-3 IMPLEMENTATION	597
VI-3.1 General	597
VI-3.2 National	599
VI-3.3 State and City	607
VI-4 CONTROL	613
VII	CQNSEiEEIiLSS Q£ ELMNINC	621
VIII	EEELISUED ELMS	623
IX	EUfiLISEED EiELIQLEAEEIES	706
Index	721
vi
kINTRODUCTION
The following is an annotated bibliography containing 591 references to
health planning. In its compilation, sources found through the Medline, a
computerized file of the National Library of Medicine, were supplemented with
materials from the Health Planning Series, published by the Bureau of Health
Planning, Health Resources Administration, other bibliographies, relevant
journals, and from a computer search of the Social Science Information Utiliza-
tion Laboratory at the University of Pittsburgh.
For the most part, the abstractions are those which appeared with the
original article. In a few instances, the original annotation was altered to
obtain relative uniformity throughout the bibliography. In cases where no
abstraction existed, one was written.
Classification
Articles are referenced in one classification only. In cases where two or
more categories are possible, the article was placed in the group which seemed
to be the most appropriate.
The total bibliography is divided into nine sections:
(1) General - The references that covered more than one category and,
therefore, could not be assigned to any one specific category were classified as
General. This first section includes entries dealing with non-technical health
planning concepts and the process of and perspectives on health planning. Case
studies of health planning, both those dealing with one region or community and
those comparing two or more regions, are also included in this section.Page 2
(2)	Health and Health System Characteristics Related to Planning - This
section contains sources that interpret health in a broader context of the
social environment and behavioral influences, together with biological charac-
teristics and medical services, and their implications for planning. Addition-
ally, features of the health system are discussed, such as types of changes in
relation to planning for health.
(3)	Planning Legislation - This section deals with the various laws
enacted in the U.S. for health planning, their provisions and their impact on
health.
(4)	Planning Groups - This category presents abstracts dealing with all
the persons involved in the health planning process:	government officials and
public administrators, technical planners and scientists, and health care
providers and consumers.
(5)	Organizational Aspects - The abstracts in this category discuss the
size, scope, type, affiliation and various other organizational features of
health planning institutions. Some of these articles suggest the use of these
criteria for evaluation of such institutions.
(6)	Planning Functions - The entries in this section describe the four
planning functions:	(a) decisionmaking; (b) technical preparation; (c) implemen-
tation; and (d) control. For decisionmaking and implementation, abstracts could
not be found for every level of aggregation (national, State and city) and,
thus, gaps exist. Those that pertain to more than one level are placed in the
general division. The technical function is subdivided into (a) those dealing
with the problems of analyzing health with quantitative techniques; (b) those
concerned with collection procedures and data requirements for health planning;
and (c) quantitative health planning models for evaluation, resource allocation,
scheduling, and so forth.Page 3
(7)	Consequences of Planning - This section considers the outcomes of the
health planning process, such as those resulting from rationalization of health
service operation.
(8)	Published Plans - This category includes actual and proposed plans for
several aggregate levels. In addition, it includes some abstracts of articles
that provide a methodology or framework for formulating plans.
(9)	Published Bibliographies - This section includes references to
bibliographies covering a wide range of topics related to health planning, such
as statistics and health planning, community planning for health, and so on.GENERAL
CONCEPTS IN PLANNING
Page 5
Relerence:
Ichak Adizes and Paul Zukin,
•’Management Approach to Health Planning in Developing
Countries/*1
itealtfc Cais. KanaasafiDi RsxisiLt voi.2/ No.i/ p.19-23/
(Winter 1977).
Barriers to effective health care planning in
developing countries are identified/ and guidelines are
presented for incorporating basic principles into health
planning systems. A distinction is made between health
planning and health care services planning. It is pointed
out that most health care service organizations in
developing countries do not consider environmental needs
in the planning process. Such planning may result in
facilities and services that do not meet actual needs or
integrate with health-related activities of nonhealth
sectors. The strengthening of management and planning
activities of health care organizations is recommended.
These activities encompass marketing/ production/ human
resources/ and financial parameters. Four functions of
marketing are! (1) assess health status and health car®
needs and demands; (2) decide on the type of service/
facility/ and program that will meet needs and demands in
a cost-effective manner; (3) design a program to promoteGENERAL
CONCEPTS IN PLANNING
Page a
the use of services and health itself; and (4) consider
the effect of price and inconvenience on the use of
services. The narketing element in health organizations
is noted as NSC, since it incorporates needs assessment/
scope of services# and client interface. The
establishment of priorities in health planning is
discussed in relation to each management and planning
activity. A planning technique known as 'synergetic
diagnosis' is described; it is designed to enhance
planning and overcome problems in planning. The
importance of coordination in planning efforts is
emphasized. (NTI5)
Reference;
Mary F. Arnold#
"Basic Concepts and Crucial issues In Planning#"
AmacicaD ilfluinal qL Eublic Hfialilu voi.59# No.9,
p.1697-87# (Sept.1969).
The American public is presently faced with several
dilemmas relating to the planning process. Recognizing#
on the one hand# that planning for the future is essentialGENERAL
CONCEPTS IN PLANNING
Page 7
if resources are to be utilized effectively, there is at
the same time a deep distrust of the concept of planning,
and fears of a planned society frequently surface- The
development of a planning society, one in which the public
is involved, may prove a solution to the problem. The
development of such a society, however, will require
changes in our concepts of cause and effect, and in our
ideas of the organization of work. It must include the
efforts of educators, community organizers, planners, and
administrators to provide to the public careful and
appropriate guidance to bring about a society in which the
citizenry can participate in the planning process. The
health field in particular can serve as a model for other
sectors of society in bringing together all segments and
interests of the public into the planning process. The
basic philosophical dilemmas must be solved if a planning,
or a planned, society is to develop. (NTIS)
Reference:
David E. Berry,
•’The Transfer of Planning Theories to Health Planning
Practice,"
Pol icv	Vol.5, p.343-361, ( 1774).GENERAL
CONCEPTS IN PLANNING
Page 3
Improvement is requi
health planning in orde
health planning practice,
are utilized in othe
rational/ the incremental
radical strategies. A1
useful in health planning
a health planning situati
red in the theoretical basis
r for needed advances to occur
Four major planning strateg
r public policy sectors:
/ the mixed scanning and
1 four strategies are potentia
and their impact is suggested
on.
o £
in
ies
the
the
11 y
in
Reference:
££!1U CaaleLsace. ca iba Mfiiimstelsaz ai ttaiiaaal iiaaLih
Elaaniaaz.
Ankara/ Turkey:	Public Relations Division/ Central Treaty
Organization/ May 1973.
Proceedings are presented of the Central Treaty
Organization (CENTO) conference held Jamuary 8-12/ 1973 in
Istanbul/ Turkey/ including papres on the status of health
planning in Iran/ Pakistan/ and Turkey as of 1973/ plus
presentations by external consultants on specific major
areas of activity in the health planning field. In
summary/ the discussions focused on:	the content of th*GENFRAL	Page 9
CONCEPTS	IN PLANNING			
planning	process, particularly	possible	me thods	for
modifying	or strengthening the	process;	and	data
requirements and data deficiencies in areas of health
manpower/ program effectiveness/ economic and social
changes effected by the programs, health status, health
problems, and quality of health care. It was stressed
that the planning process should consider the full range
of program possibilities in achieving social objectives.
Other conclusions reached were: (1) that unique problems
of health professional attitudes and behavior were of
special concern for health planning; (2) that economic
problems, including the identification of areas of common
interaction between health planning and national planning,
were seen as warranting research; (3) that health
planning was a team activity requiring skills in health
care, health sector administration and economics; and (4)
that different countries required different programs.
Recommendations included: provision of health planning
and health services research fellowhsips, at home and
abroad; support of health services and planning research
projects; provision of consultants to various research
projects; and conducting and supporting of scientific
meetings in various aspects of health planning.
Participants are listed, and a list of CENTO publications
is given. (NTIS)GENERAL
CONCEPTS IN PLANNING
Page 10
Reference:
R. Cibotti,
"Introduction to the Analysis of Development and
Planning,"
lnl££0£liaiial J&utual aJL fleal-Lb S&zxic&sr voi.i, No.3/
p.201-2299/ (1971).
Underdevelopment may be characterized in numerous
ways/ according to the vantage point from which it is
analyzed. Social/ political/ cultural/ and demographic
elements may all be taken into account. when
underdevelopment is analyzed from an economic point of
view/ emphasis is given to the phenomenon of louf
availability of goods and services for the satisfaction ot
the needs and aspirations of the population. In this
paper underdevelopment will be analyzed from the point of
view of an economic planner. Integration of health
i
services planning into the total development plan will
also be discussed. Although this paper is only an
introductory synthesis to a vast subject/ it is believed
that it may be of help to other specialists/ particularly
those whose efforts are directed towards raising the level
of health and improving sanitary conditions.GENERAL
CONCEPTS IN PLANNING
Page 11
Reference:
Stephen R. Cohen, Michael J. Nathan, and Peter Whittier,
MJ12I &U££Lli£Q iteallb ElaflDiDfl ?/
Wescosville:	Eastern Pennsylvania Comprehensive Health
Planning Board, 1975.
Two flaws in an article by Philip Reeves dealing with
a theoretical model for affecting the health and health
care problems of a community through planning are pointed
out and a different approach is suggested. The first
problem in the Reeves model relates to definitions of
long-range goal planning (LGP) and short-range priority
planning (SPP). LGP had been equated with the systems
planning process, and SPP with program planning. Due to
the fairly long time required for a new program to
appreciably effect a community, it is concluded that
program planning belongs in LGP, and that both LGP and SPp
must be systems-oriented. The second problem relates to
the practicality of the Reeves model as a planning tool.
Reeves decided that health planners should ignore problems
when a cure is non-health related because their expertise
and political clout lie in other areas. It is argued
that, rather than predicating health planning on the wa/
the community interacts with the health care sector,
health planners should be concerned with how
the healthGENERAL
CONCEPTS IN PLANNING
Page 12
service sector interacts with the community it serves.
CNTIS)
Reference:
John D. Denne,
Kudinas, io ELiocieifes jb! At£aMid£ U&ailti LUauin^'
(Ed.2),
Chicago:	Center for the Study of Patient Care and
Community Health, Illinois University, 1977.
A compilation of readings in the field of areawide
health planning is provided. The readings are designed
for practitioners in the health planning field and for
students of health planning. They primarily cover the
period from 1965 through 1976, with the exception of two
articles	dated 1873 and	1955.	The arrangement of	the
readings	is according to	six	sections: (1) general	
concepts	and definitions;	(2)	health data needs	and
interpretations? (3) procedures and organization? (4)
community input? (5) facilities considerations; and (5)
comparative international health planning. An index to
the readings is provided. (NTIS)GENERAL
CONCEPTS IN PLANNING
Page 13
Reference:
Lumiliaaal Analysis nX Unailti Heads and £e£yices*
Baltimore:	Department of International Health of Johns
Hopkins University/ 1975.
A functional approach to health planning/ developed
and tested in India and Turkey/ is described/ with a vie*
to its application in the United States. The conceptual
framework underlying the approach uses health functions as
a bridge between a community's health needs and its
available health resources. Data on the community's
health needs amd resources are gathered to fit the same
functional categories. The first four categories
medical relief/ personal preventive services/ maternity
services/ amd family planning — are personal services
stimulated by clients' felt needs. The other five
functions — communicable disease control/ environmental
sanitation/ mass population control/ mental health/ and
general education - are stimulated through provider
initiative. Depending on local conditions/ the list of
functions may be shortened or lengthened. The functional
categories are used to develop basic analytic models for
organizing data/ including a function/manpower grid/ a
similar function/cost grid/ and a more refined model
defining a functional information-generating system. TheGENERAL
CONCEPTS IN PLANNING
Page 14
refined model relates needs to service inputs for each
functional category/ specifying needs according to a
three-phase data flow. Five types of data collection and
analysis involved in the functional approach are
described; household surveys/ service records/ uorV
sampling/ patient flow analysis/ and cost analysis. The
results of applying functional analysis methods in India
are used to illustrate the utility of the approach.
(NT IS)
Reference:
John T. Gentry/
"More Rational Approach to Health Care Delivery/"
HflSfiiial E-LilSltfiSS* p.94-103, (Aug. 1973).
Various approaches to making health care more
rational/ i.e./ matching available health services with
community requirements/ ana the nature of forces affecting
change within the health system are examined. Assessment
of the level of rationality prevailing among health care
delivery systems is based on four criteria:
comprehensiveness/ continuity/ quality/ and economy. XGENERAL
CONCEPTS IN PLANNING
Page IS
conceptual model utilizing these delivery system output
criteria is described and illustrated. U.S. health
systems reflect imbalances between health problems and
health services; limited accessibility and acceptability
of services; and rapidy rising costs. Approaches to
making health care delivery systems more rational have
involved three major areas: financing and delivery/
health manpower/ and planning and regulation. Examination
of the level of rationality inherent in the delivery of
health care indicates that approaches to making delivery
systems more rational have not been very effective. Major
problems stem from the absence of effective planning and
integrating mechanisms. Inability to deal effectively
with performance requirments of a complete system appears
to underlie most of the problem areas. There is a need to
identify approaches to increasing rationality that are
more effective than those already identified. (NT1S)
Reference:
Robert M. Griffin/
"Social Structure and Urban Disease:	Need for a Broader
Base for Health Planning and Research/"
UtiLsn and Sncial Stands Esyisa* voi.8/ No.i/ p. 15-20/GENERAL
CONCEPTS IN PLANNING
Page 16
(1975).
Social	factors	are	discussed	as significant
contributing factors to the etiology of disease and as a
possible explanation for changing patterns of urban
diseases. The concept of illness is examined, with
disease being vieued as only one manifestation of illness.
Physical illness, however, is emphasized because its
symptoms tend to be more tangible than those of mental
illness and because causes underlying the changing
patterns of disease in urban industrial societies
represent a socially significant and relatively concrete
problem that is not well understood. The changing pattern
of urban diseases is noted. It is pointed out that higher
death rates from degenerative diseases are associated with
urban regions, and higher death rates from communicable
diseases are associated with rural regions. The
significance of medical intervention in reducing mortality
is assessed, and explanations for the causes of illness
are set forth. Social causes of illnesses are detailed in
relation to the etiology of disease. nrfhile social
structural change has been related to previous patterns of
communicable and acute infectious diseases, social
structural differentiation is shown to be related to newer
illness patterns, particularly coronary heart disease. ItGENERAL
CONCEPTS IN PLANNING
Page 17
is recommended that	the	concept	of	preventive health
planning be broadened	to	include	the	consideration of
social factors. (NTIS)
/
Reference:
Elliott A. Krause/
"Health Planning as a Managerial Ideology/"
siQULDdi fil itealifc	Vol.3/ No. 3,
p.445-463/ (1973).
This paper examines health planning as a form of
technocratic ideology in use both by proponents inside
government and by outside interest groups in the health
field* Ideology and the nature of technocratic power are
defined. Health planning is analyzed as occupation/
process/ and ideology. The ideology in use is analyzed
for the following: American programs: Hill-Burton/
Comprehensive Mental Health Planning/ DEO Neighborhood
Health Centers, Regional Medical Program, and
Comprehensive Health Planning. It is concluded that
health planning cannot operate in the present
sociopolitical context except as an ideology to justifyGENERAL
CONCEPTS IN PLANNING
Page Id
the status quo in health services.
Reference:
Haw Lin Lee,
"Theoretical Foundation of Hospital Planning/"
Inquiry# Vol.ll/ No.4/ p.276-281/ (Dac. 1974).
A major source of inefficiency in hospitals is
analyzed theoretically/ and a procedure for reducing
inefficiency is suggested. The problem discussed lies in
the unique economic structure of the hospital.
Ordinarily/ economies associated with increased use of
both specialized and common inputs (as are found in
hospitals) can be realized by expanding the size of the
business. However/ it is necessary that output levels for
services in which specialized inputs are used be increased
as business size increases. In the hospital/ outputs of
specific types of care do not necessarily increase with
the size of the hospital. In fact/ levels of outputs of
care for most disease groups remain low even in large
general hospitals/ implying considerable underutilization
of specialized inputs and a lac< of economies of
a lac< of economiesGENERAL
CONCEPTS IN PLANNING
Page 19
production for most disease groups. The problem of
underutilization of specialized input is analyzed as one
of inappropriate factor combinations. Shortcomings are
pointed out in the argument that/ given the reflection of
factor disproportionality in the excess of specialized
inputs to hospital beds/ the problem might be overcome by
increasing the number of hospital beds available. An
alternative, a disease-specific approach to hospital
planning in which production efficiency is sought through
the proportion in which specialized inputs are combined
with hospital beds/ is suggested. The distinctive feature
of the approach is said to be its concern with the demand
and supply of specific types of care within a large
geographical region. Mathematic formulations are
included. (NTIS)
Reference:
Jonathan Metsch and Frank Tilley,
"Planning Integrated, Comprehensive Services,"
fafiSlLLUla* Vol.49, p.63-66, (16 June 1975).
The use of functional programming in planning forGENERAL
CONCEPTS IN PLANNING
Page 23
ambulatory care services at Woodhull Medical Center* New
York City is described. Functional programming is defined
as a systems approach to the planning process whereby the
whole is viewed as greater than the sum of the parts and
individual components are developed in light of a clearly
articulated objective. The Woodhull Center* which will
replace the Greenpoint Hospital as a component of the New
York City Health and Hospitals Corporation* represents a
change in delivery approach from a traditional clinic
system to comprehensive ambulatory care. Functional
programming provides the mechanism for systematizing the
planning of comprehensive services* staff orientation an!
training* and community education at the new facility.
The framework for primary care at Woodhull is described*
and the functions of the primary care team members*
including physicians* registered nurses* and social
workers* are delineated. Subsystems* such as specific
forms needed to facilitate the delivery of comprehensive
primary care* are defined. Guidelines for integrating
emergency services with primary care services are
presented which view emergency services as a mode of
entering the primary care system rather than as an
alternative way of delivering medical services. Plans for
a demonstration project to test the comprehensive systen
before it is implemented in full at the center are
described briefly. (NT1S)GENERAL
CONCEPTS IN PLANNING
Page 21
Reterence:
Richard Sasuly and Paul D. Mard,
"Two Approaches to Health Planning:	The Ideal vs. the
Pragmatic,"
CiCfir Vol.7, No.3, p.235-241, (May-June 1969).
The authors point out that planning is a dynamic
process in which real forces must be understood, and
brought to a point of realization, before abstractly
conceived plans can be made operative. This process is
sometimes political, and is in any case pragmatic. The
ideal approach to planning, which merely balances need
with resources, is likely to be rendered inoperative by
opposing forces in life. The result has been slow
progress for health planners, but progress may be
accelerated by the pragmatic approach. Pragmatism,
however, does not obviate the need for hard data. These
are needed above all for evaluation.
Reference:
Slaiaaiani. an tha Etinaialss taaaifitifiQaijLS ttaalib
Elannina*GENERAL
CONCEPTS IN PLANNING
Page 22
San Francisco:	American Public Health Association* 1967.
A four-page policy statement on the principles of
comprehensive health planning is presented by the
Governing Council of the American Public Health
Association (APHA). The statement reflects concern over
the confusion and competition that is emerging in the area
of health planning on the one hand* and the unuarranted
expectation placed on planning to solve all problems of
the health industry on the other. Comprehensive health
planning is described as an effort to balance total health
resources against total health needs to provide
appropriate guidance to other public efforts with health
implications. The statement defines and distinguishes
among three types of planning activities: agency
administrative or program planning; interagency
categorical planning* and comprehensive planning. In
support of health planning in all its aspects* the APH4
offers eight principles to assist communities and
agencies. (NTIS)GENERAL
PERSPECTIVES AND PROCESS
Page 23
Reference:
Jan Acton/ and Robert Levine/
iteaiiti ttaanaMex LUnuiaai A Efllic* QttatxifiM*
Santa Monica/ Calif.:	Rand Corp./ May 1971.
The Rand Corporation's health care research program
is described/ with emphasis on ways and policies to
increase manpower in the health fields.	An approach to
State health manpower planning is suggested which is based
on planning and manipulating the supply of health
personnel without precise estimates of demand. The key to
such planning involves the recognition of imprecision in
estimates of demand for medical care/ in predictions of
future medical production functions/ and in advance
estimates of policy decision results. As a result of
imprecision/ planning must be flexible enough to meet
uncertainty. Instead of concentrating on existing
manpower supplies to raett long-term demands/ health
manpower planning should design supply systems that cao
respond rapidly to changes in demand or to firmly based
short-term predictions of demand change. Literature on
health manpower location and distirbution is reviewed/ and
its application to the State of Illinois is discussed in
terms of health manpower availability. Four categories of
health manpower are considered:	(1) physiciansGENERAL
PERSPECTIVES AND PROCESS
Page 21
(increasing the number of medical school graduates,
attracting and retaining additional physicians, changing
the length of clinical training, and distribution of
physician services within States); (2) dentists; (3)
nurses; and (4) extended health personnel (referred to as
allied or physician assistant-type personnel). Tabular
data are provided on the distribution of health
professional in Illinois. (NTIS)
Reference:
Nancy C. Anderson,
Campufiliausiya Hfiallti £lannins in the Sialasi A Sludy and
tuilisal Analysis*.
Minneapolis, Minn.:	Institute for Interdisciplinary
Studies, Dec. 1968.
Comprehensive health planning activities in the
States during the 2 years following the enactment of the
Comprehensive Health Planning and Public Health Service
Amendments (P.L.	89-749) in 1966 are reviewed and
assessed in a report directed primarily to health
opens with a description of ths
pianne rs
The
reportGENERAL
PERSPECTIVES AND PROCESS
Page 25
initial efforts of States and territories in implementing
the Congressional mandate for comprehensive health
planning. Designation of State agencies				to carry	out
health	planning/ problems of	hiring	new staff/ selection		
and orientation of volunteer advisors			for	agencies/	and
early	planning activities of	the	State	programs	are
covered	The discussion then	turns	to an	analysis	o £
three	types of planning	approaches:		cooperative/	
managerial/ and regulatory. It is noted that each
approach deals particularly well with a different aspect
of health problems and that each employs different
structures and methods. Based on the review of planning
activities and approaches/ recommendations are offered
concerning the comprehensive health planning program's
purpose/ the type of planning to be pursued/ and planning
priorities. Managerial planning/ in which the planning
endeavor is an adjunct to the administrative capability of
an organization or government (e.g./ an office of planning
in a State health department) is posed as a model for
statewide comprehensive health planning. Areawide and
other federally funded planning programs are advised to
engage in cooperative planning/ characterized by the
primary involvement of providers. (NTIS)GENERAL
PERSPECTIVES AND PROCESS
Page 25
Reference:
Nancy Anderson and Leonard Robins,
"Observations on Potential Contributions of Health
Planning",
lol£LOdiiJ2ual igytoal aL K&allb Z&LxiQZSf voi.6, No. 4,
p.651-666, (1976).
The passage of the National Health Planning and
Resources Development Act in the United States in 1974 is
used to set the context for a new assessment of health
planning as a change agent. In reviewing the record of
health planning the most striking conclusion is that even
its friends have been unable to establish that it has had
any quantifiable impact. The authors suggest, however,
that comprehensive health planning may have stimulated the
belief that changes in medical care organization are
crucial to improving the health care system.
The authors next consider the role of health planning
interred from three widely espoused "models" of the health
care system: professional, central planning, and market.
Although market advocates generally deemphasize health
planning as contrasted to those supporting a centrally
planned system, none of the models is sufficiently
developed to indicate specific roles and functions for
health planning.GENERAL
PERSPECTIVES AND PROCESS
Page 27
Ralph Andreano/ Kenneth Smith and Due Reinhardt/
RlaQains a Maiicoal Haaliti MancaMat Ruliciti A Ctiliaue
acd a Sicaleaxx
Madison:	Wisconsin Univ./ Mar. 1973.
A critical review is offered of the approach being
taken to national health manpower policy planning as of
March 1973/ and an alternative strategy is suggested. The
paper argues that the approach is not a sensible and
meaningful one but rather one which may lead to a public
policy unresponsive to demands likely to confront the
health system. It is further suggested that existing
manpower strategies are likely to lead to undesirable/
socially costly consequences/ e.g./ the use of resources
in ways which perpetuate deficiencies in the system.
Finally/ it is argued that a sensible and rational aproach
is one which (1) confronts explicit national health goals/
financial or qualitative/ toward which national policies
are directed/ and (2) evaluates the likelihood of
realizing a reorganization of the medical delivery system
designed to achieve these goals. Specifically/ it is
observed that manpower policy formulated without a clear
national health policy is futile/ given the complexity of
the interaction between manpower goals and health systems
goals. This theme is illustrated by the futility ofGENERAL
PERSPECTIVES AND PROCESS
Page 29
Baking numerical estimates of health sanpouer requirements
from simplistic assumptions. Indepth discussions are
offered of the following issues: parameters which define
permissible areas of Federal intervention in Manpower
policy determination; the problem of implementing changes
in health manpower uses under existing and contemplated
programs; the dynamics or reorganization and the
implications for health manpower needs; the problem of
lags; and the capital-manpower substitution problem.
(NTIS)
Reference:
A££dMid£ Plaanioa &X La£ilili£2 ini:	Eslidbililaiiiia
Sfi £l£i££Sx
fcashingtori/ D.C.:	Public Health Service/ April 1963.
Fatterns/ problems/ and trends in rehabilitation
facilities and services are examined/ and goals and
techniques for planning and implementing rehabilitation
programs are outlined. Rehabilitation is defined as the
process of restoring a disabled person to optimal
physical/ mental/ social/ vocational/ and economicGENERAL
PERSPECTIVES AND PROCESS
Page 29
usefulness. Five major goals in the planning of
facilities for rehabilitation are enumerated: (1)
establish and maintain rehabilitation services and
facilities at a high level of quality; (2) provide
rehabilitation facilities and services for all types of
need; (3) develop and maintain coordinated rehabilitation
facilities and services at a high level of maximua
effective utilization; and (5) create an awareness of the
value of rehabilitation. Principles for plannning
rehabilitation facilities are delineated. Basic planning
procedures are outlined, and the rehabilitation process is
reviewed. Components of rehabilitation services are noted
as medical, social, psychological, vocational, and
educational services. The administration of
rehabilitation services is explored in educational
institutions, general and mental hospitals, independent
facilities, and State rehabilitation agency facilities.
Financial aspects of rehabilitation are discussed.
Architectural plans of 15 facilities, descriptions of
government and voluntary agencies, and other information
pertaining to rehabilitation and rehabilitation programs
are appended. A list of references and an additional
bibliography are provided. (NTIS)GENERAL
PERSPECTIVES AND PROCESS
Page 30
Reference:
Donald B. Ardell/
"Urban-Planning/Health-Planning Interrelationships"#
Affifinicau Jautnal aL Rublic itealiii/ Voi.59,	1*0.1#
p.2051-2055# (Nov.1969).
The potential utility of close relationships between
urban and health planners has been recognized# and
interest in developing them is growing. This paper
describes and discusses aspects of these relationships?
and offers suggestions for accelerating their development.
Reference:
Edith Pierhorst Back#
"Co-opting the Planners#"
HalifiDz. Vol.220# No.3# p.81-84# (Jan. 197b).
The assurance of adequate health care is discussed in
relation to large expenditures made by the Federal
Government to finance health and health planning.
Statistics on the costs of health care and on fundaGENERAL
PERSPECTIVES AND PROCESS
Page 31
4
allocated at the Federal level for health programs are
presented. It is pointed out that urban areas/ with 73
percent of the U.S. population, have 86 percent of the
physicians; that more than 80 percent of poor people with
medical problems are receiving inadequate care or none at
all; that the amount of medical care delivered in
hospital emergency rooms and outpatient clinics increased
from 10 percent in 1955 to 25 percent in 1970; that the
United States has a significant number of empty hospital
beds because the poor and the uninsured are refused
admission; and that 20 percent of physicians, half of
them partially licensed, are graduates of foreign medical
schools. A lack of adequate health planning in the United
States is emphasized, and it is felt that the public has
received little in return for the significant expenditures
invested in regional medical programs. Weaknesses of
comprehensive health planning agencies are evaluated. The
most important weakness is considered to be the fact that
they react to proposals by others rather than suggesting
alternative ways to meet needs. The enforcement of
comprehensive health planning legislation, based on the
National Health Planning and Development Act, is
discussed. (NTIS)GENERAL
PERSPECTIVES AND PROCESS
Page 32
Reference:
R.M. Battistella and T.P. Weil,
"Comprehensive Health Care Planning - New Effort or
Redirected Energy?"
Itew siaie Jcutaal al	voi.69, p.2350-2370,
(Sept. 1, 1969).
The authors attempt to determine whether the emphasis
now being given to, health planning in the United States
marks a new departure in public policy. On the premise
that understanding of the present and the future may be
improved by a knowledge of the past, the development of
health	planning in the United States was described
briefly, along with selected milestones in such other
areas of planning as housing, transportation, recreation,
and economic and social development.
The popular rhetoric portraying health planning as
revolutionary notwithstanding, when looked at in the light
of the past, health planning does not appear to be
anything new or radical. Rather it emerges as a logical
extension of a gradual evolutionary series of adjustments
to the growing complexities of industrial and urban
development.
GENERAL
PERSPECTIVES AND PROCESS
Page 33
Reference:
Henrik L. B1 uni/
El£DHiH4	tJfiallhi J2£X£l££fl£I)l	AEBliCdlifiD fl£
Sacial Change IheaLix
Berkeley:	California Univ.# 1974.
The application of social change theory to health
planning is examined. The assumption underlying the
creation of health care services is that better health
aill result/ that some improvement in health not otherwise
attainable will result from effectively applied health
services. In addition to the provision and availability
of health care services# other factors are relevant to
health# e.g.# hereditary# environmental and behavioral
factors. Four major aspects to be considered in the
application of social change theory to health planning are
discussed: (1) environment for planning (origins of
social change# multiple purposes of planning# modes or
methodologies of planning# a developmental and multimode
approach to planning# a working definition of health for
planners# the scope of health concerns# comprehensive
planning for health# and needs in health planning); (2)
planning to determine what improvements are wanted
(assessment and a systems approach to the analysis of
goals and problems); (3) achieving improvements definedGENERAL
PERSPECTIVES AND PROCESS
Page 34
as desirable by planning (roles and functions of planning
bodies and planners and the conversion of plans into
policy and operations); and (4) measuring improvements
obtained through planning (evaluation). References
accompany each chapter and information is appended on
health future mapping for a two-county community and on
health indicators. (NTIS)
Reference:
Henrik Blum and Associates,
Csnmnshsflsivfi EldDDiDii Lei iisalltu
San Francisco:	American Public Health Association,
Western Regional Office, 1968.
United States experiences in comprehensive health
planning are summarized, emphasizing elements which must
be considered in goal determination and in implementation,
methods of measurement in gathering data on health
services, health manpower planning,
regional medical programs.
and organization ofGENERAL
PERSPECTIVES AND PROCESS
Page 35
Reference:
Lester Breslow/
"Political Jurisdictions^ Voluntarism/ and Health
PIanning"/
Affi££iciJD diiucnal cX Eublic ttealifcu voi.58/ No.7/
p.1147-1153/ (July 1968).
Health planning has become the order of the day - in
thought/ in discussion/ and in action. Given this
situation/ what roles shall governmental and voluntary
agencies take ? What contributions can and should they
make ? How can these be used most effectively in joint
planning ? These are the questions to which this paper is
addressed/ for the future pattern of health services in
the U.S. will depend on the answers.
Reference:
E.F. Bridgman/
"Integration of the Organization of Medical Care into
Health and Town Planning/"
Vol.3/ No.l/ p.50-53/ (Jan. 1967).
GENERAL
PERSPECTIVES AND PROCESS
Page 36
The author emphasizes hou important it is tor
town-planners and those responsible for national planning
to obtain the opinions of public health administrators and
to take account of the public health plan so that it may
be integrated into development projects. Just as public
health administrators must have some knowledge of
demographic prospects and of future population-group
distribution, so must urban development planners pay some
attention to health organization schemes. Statistical
methods oi analyzing medical-care consumption, hospital
utilization and distribution of patients are being studied
and will be tried out in pilot areas. The public health
plan can and must have a scientific basis. Consequently,
it must be an integral part of economic and social
planning.
Reference:
John Eryant,
h££llb banna*££ Claiming in ihe Changing 2c£n£ af iba
New York:	School of Public Health, Columbia Univ., 1973.GENERAL
PERSPECTIVES AND PROCESS
Page 37
The discussion focuses on principal issues of health
nanpower planning such as monitoring supply, determining
present and future requirements, controlling production
and distribution of health personnel to meet requirements
of the system, and determining how these issues
interrelate with planning and management practices in the
U.S. Conclusions indicated there is a slowly increasing
capability to deal effectively with technical aspects of
health manpower planning. The capability for monitoring
the supply of manpower is improving. Although forecasting
future supply requirements is complex, useful projections
can be developed. However, the determination of manpower
requirements for the evolving health care system does not
have adequate technical capability. (NTI5)
Reference:
Karen Butler and Cynthia Skidmore,
Perspective fia tifidlill ££fifl£am LUnaiaa*
Atlanta:	Comprehensive Health Planning Agency, Georgia
Dept. of Human Resources, Mar. 1974.
A perspective on the use and importance of goals andGENERAL
PERSPECTIVES AND PROCESS
Page 38
objectives in the health program planning process is
provided, and examples of progression in plan development
are presented. The key factor in any health planning
process is the logical progression from the general to tne
specific — from broad health goals to specific plans o£
action. Review of numerous program proposals reveals the
common practice of omitting the developing of goals and
program objectives and beginning with specific strategy
objectives. This does not allow for the development of
guidelines to measure program outcome. Two charts detail
the health program planning progression. One example
pertains to a health status problem, disability and
disease from alcoholism and alcohol abuse, while the other
example pertains to a health systems problem, inadequate
access to alcoholism and alcohol abuse services. The
health goal sets the parameters for the health needs
assessment and, thereby, for the entire planning process.
The needs assessment provides the material and analysis
for development of health program objectives and
alternative strategies. The strategy goal and objective
and the plan for action express proposed methods for
determining attainment of the program objective and,
ultimately, the program goal. A bibliography is included.
(NT1S)GENERAL
PERSPECTIVES AND PROCESS
Page 39
Reference:
Robert Chapman/ Richard Coffey and Kenneth Peltzie/
••A Generic Process for Planning Health Services"/
AlB££:i£dD tlQULQdl fit	ElaQIlillS/ vol.2, No.2, p.39-44,
(Oct. 1977).
In June of 1975 Chi Systems Inc. of Ann Arbor and
Stone/ Marraccini and Patterson of San Francisco were
awarded a contract by the Department of Health/ Education
and Welfare to study the planning of health services and
the planning/ design, building and evaluation of health
i
facilties. A series of documents have been produced to
assist planners at agencies and institutions, governing
boards and participating community representatives in the
process of planning.
The first, a "State of the Art" document recommended
a planning process which is termed "generic" because the
same sequential steps are involved at the state. Health
Systems Agency and institutional levels. The following
six steps in the planning process form the basis of all
the documents: (1) policy and planning framework; (2)
service area characteristics; (3) health status and
needs; (4) services and resources; (5) plan development;
and (6) project development and review.GENERAL
PERSPECTIVES ‘AND PROCESS
Page 10
Reference:
A. Stephen Coburn,
"Regional Approach May Be Voluntary System's Last Chance,"
fifiseiial £Cfl.flJ:£SS* Vol.56, No.6, p.48-51, (June 1975).
The regionalization of health resources is a major
implication of the National Health Planning and Resources
Development Act of 1974 (P.L.93-641). Provisions of the
act emphasize a regional approach, focused on the propec
distribution of health services, the minimization of
duplication, and cost containment. It is envisioned that
comprehensive health planning agencies, regional medical
programs, and Hill-Burton agencies Hill be absorbed into
the new regional structure. Three basic principles in the
regionalization of health resources are prescribed by the
act: (1) planning must be performed by organizations
representing and incorporating the interests of consumers
of health service, providers of health services, and
concerned public and private organizations? (2) health
care planning must be adequately financed; and (J)
emphasis in effective health care planning must be placed
on implementation, with implementation requiring that
planning agencies have sufficient authority to taK€
positive actions. Under the regional structure for health
resources, four new bodies are to be created: healthGENERAL
PERSPECTIVES AND PROCESS
Page 41
systems agencies (HSAs) at the regional level, State
health planning and development agencies and advisory
groups, statewide health coordinating councils, and a
natinal council on health planning and development.
Responsibilities of each of these bodies are delineated.
The impact of the regionalization of health resources on
hospitals is assessed. (NTIS)
Reference:
M. Colburne,
ELanoinii Eat ttealibz.
London:	Oxford University Press, 1963.
The author examines the health problems of developing
African nations with a focus on the formulation and
implementation of health plans. He raises questions as to
the need for estsablishing health priorities and suggest
better ways of organizing health facilities to meet these
priorties. The dependence of effective health care
delivery on meaningful planning and implementation of such
efforts is stressed.GENERAL
PERSPECTIVES AND PROCESS
Page 42
Reference:
Avery Colt,
"Elements of Comprehensive Planning",
^annual al Eublit tiaaliii/ voi.60, No. 7,
p.1194-1204, (July 1970).
The establishment of mechanisms for comprehensive
health planning involves problems and issues that are not
immediately apparent. The following paper offers some
thoughts on this topic, but recognizes that it is not
possible to present a diagnostic prescription. The
discussion serves as an aid to diagnosis.
Reference:
Ralph Conant,
Eclilics qL QamuDi&x Msaliiu
Washington, D.C.:	Public Affairs Press, 1968.
The political aspects of community health are
addressed in a report prepared by the National Commission
on Community Health Services, a temporary nonprofitGENERAL
PERSPECTIVES AND PROCESS
Page 43
organization set up to collect and study facts concerning
community health needs, attitudes, resources, and
practices, and to encourage the use of this information to
bring about effective health services. The stud/
addresses the following questions: (1) to what extent is
the metropolitan or regional community an appropriate
territorial area for the administration of health policy
and coordinated services; (2) is metropolitan and
regional health planning politically feasible; (3) what
are the constraints on metropolitan and regional health
planning and how have these constraints been handled in
some communities; (4) to what extent are the lessons of
effective health planing transferable; and (5) does
effective communication exist among interest groups in the
health field and between health interests and other
regional planning groups. Five case studies were chosen
in cooperation with a panel of nationally known leaders to
assist in answering these questions. The areas selected
(San Mateo, California,; Rochester, New York;
Cincinnati, Ohio; Lincoln, Nebraska; and Maryland)
allowed a balance of experiences representing local,
regional, State, and interstate planning, and
governmental, private, and professional sponsorei
Planning. (NTIS)GENERAL
PERSPECTIVES AND PROCESS
Page 44
Reference:
Gerald Connor,
"State Government Financing of Health Planning",
Am£i:i£dD OautDal iifialih Elaonina* vol.i. No.2, p.48-51,
(Oct. 1976).
The planning movement in the United States springs
from two basic impulses. First, planning began with a
pursuit of the "public" interest. It was to be the
process by which individual investment decisions would be
coordinated to create the city beautiful or, by extension,
the efficient health system. The second impulse was a
reaction to the venal politics in turn-of-the-century
American cities. The reformers of that age were certain
that urban political bosses - whatever else they were
were not the best guardians of the public interest. These
two impulses have combined throughout the history of the
movement to creat contradictory and ambiguous planning
"theories" which result in sometimes peculiar structural
arrangements.
Health planning, in its relatively short history, has
not been immune from these contradictions and ambiguities.
The planning system suggested by the National Health
Planning and Resources Development Act of 1974 (P.L.
93-641) is replete with ambiguous theory and
structura LGENERAL
PERSPECTIVES AND PROCESS
Page 45
seen as essential to fair enforcement. Because of
limitations of authority already imposed by Congress on
health planning agencies, health planners must be good
politicians to perform well, including in the planning
process a broad grassroots participation to ensure
solutions that are agreeable to all.	Public
accountability is another area of concern to the health
planner, as are relatively new functions of review of
application for grants and loan guarantees. The problems
of privileged information must be considered, especially
in the lignt of possible libel litigation. The politics
of group dynamics must become the politics of health
i
planners, and the concept of certificate of need, and tne
coupling of reimbursement with planning are now considered
I
the most effective enforcement mechanisms within the
health planning field. (NTIS)
Ref erence:
Morton Creditor,
lifiallb Caie Elarming ansi Dfiitalaaaflaii 4 Manual lac
Managing Ebanas*
Chicago:	Illinois Regional Medical Program, 1974.GENERAL
PERSPECTIVES AND PROCESS
Page 45
recommendations. Unless some of the ambiguity is removed/
the question of who will pay for health planning cannot be
finally resolved. This paper examines major ambiguities
and implications of the contradictions for the future
financing of health planning.
Reference:
Robert Corbett/
"Health Planning:	Some Legal and Political Implications
of Comprehensive Health Planning/"
Affisritai] sJflUiDal al itealtfa Elauninaz Vol.64/ No.2/
p.136-139/ (Feb. 1974).
Problems of enforcement of health planning
legislation are considered in this article covering some
minor court decisions that have impact on the health
planning field. As yet/ no important landmark cases in
the area of health planning have been decided. Questions
relating to the delegation of legal enforcement to a
health planning agency by a State legislature were
considered in the California District Court/ and the
decision was 'yes.' The review and appeal mechanism isGENERAL
PERSPECTIVES AND PROCESS
Page 47
Guidelines for managing change in the context of
health care planning and development are presented in a
manual based on the planning process that guided tne
development of the Illinois Regional Medical Program. The
approach is one of management by objectives and was
influenced by the techniques of key factor analysis.
Following discussion of the background of health planning
management/ the operators in the management for change
process are identified, and their activities are discussed
relative to perceiving the need for change, proposing
programs for change, deciding to make change, implementing
change, evaluating the effects of change, and generating
new information which broadens the boundaries of
possibility .for change. Two categories of system
operators are identified: (1) the planner, responsible
for strategic planning, decisionmaking, and evaluation;
and (2) the provider, responsible for program proposal,
implementation, and evaluation. Techniques available to
operators in the management for change system are
described relative to setting human goals and objectives,
setting progfaramatic goals, creating programs, and
developing success indicators. Mays in which the two
kinds of operators might use the techniques are discussed
in general. A partial and theoretic example of the
results of the process described is provided in tne
appendix. A list of references is included. (NTIS)GENERAL
PERSPECTIVES AND PROCESS
Page 48
Reference:
fislEfci SumaiaLV. - ttsaliti Elanoina fiaixiaLSx.
Madison:	Dept. of Industral Engineering, Wisconsin
Univ., 1973.
The results of a Delphi study on barriers to health
care planning for CHP (comprehensive health planning) an!
RMP (regional medical program) agencies are presented.
Thirty-eight barriers to effective health planning are
listed in order of decreasing importance, and comments on
each barrier are provided. The 10 most frequently cited
barriers are: (1) patterns of crisis intervention rather
than long-term or preventive planning? (2) financial
insecurity with respect to ongoing projects; (3)
reluctance to change since vested interests may be
adversely affected; (4) inadequate measurements of need?
(5) lack of qualified staff and overworked staff; (6)
ineffective or insufficient community involvement in
planning; (7) lack of coordination among agencies; (8)
insufficient time to coordinate planning and explore
further directions for planning; (9) the determination of
budget size and type of project by powerful interests
ratehr than such determinations being based on the needs
of people? and (10) the reactive rather than proactive
nature of Federal and State government funding. (NTIS)GENERAL
PERSPECTIVES AND PROCESS
Page 49
Reference:
Brian Donald,
"Planning and Health Care - The Approach in a Reorganized
NHS (National Health Service),"
LftDfl Rauflfi. Elannina*. Vol.7, No.6, p.33-42, (Dec. 1974).
The 1974 reorganization of the National Healtti
Service (NHS) in England is discussed. The reorganization
was undertaken to meet rising aspirations for medical care
from limited budgets despite increasing costs) encourage
more effective depldyment of manpower;	remove
administrative barriers to the integration of family,
community, and hospital care; facilitate planning so that
individual and collective needs can be met adequately
within resource constraints; and synchronize changes in
the NHS with the reform of local government and so effect
the transfer of personal health services. Independent
branches dealing with family practitioners, community
services, and hospitals were integrated during the
reorganization period into a single service. England's
NHS is examined in relation to healtn services planning,
effectiveness and efficiency of the system, and health
indexes. Details on the planning process in the
reorganized NHS are presented. The interim planning
system resulting from the reorganization is described.GENERAL
PERSPECTIVES AND PROCESS
Page 53
This system has five broad functions: (l) improve
priority and resource allocations through firm links
between plans and budgets; (2) facilitate collaboration
with matched local authority services; (3) facilitate
community and professional participation in planning; (4)
enable genuine delegation and accountability to ba
achieved between authorities on one level and the next an!
between them and their officials; and (5) insure that,
while the NHS responds to the initiatives of England's
Secretary of State, it remains sensitive to developments
at all levels in the system. (NTIS)
Reference:
Merline K. Duval,
iteaiih Cate ELatmius sad flualilx Cans*
Washington, D.C.:	Uffice of the Assistant Secretary for
Health and Scientific Affairs, 1972.
Basic ingredients
care are addressed,
adequate manpower fac
proper patient care.
in health care planning
Proper planning can
ilities are available
Thus, one of the
and quality
assure that
to insure
most basic
4GENERAL
PERSPECTIVES AND PROCESS
Page 51
ingredients in quality health care is continual planning.
Under proposed Federal legislation, the Secretary of
Health, Education, and Welfare (HEW) will be authorized to
■ake grants which qualifying states can use to coordinata
their human services. With this legislation. States will
no longer have to shape their human services in the imags
of fragmented Federal programs. It is noted that HE* has
more than 30 categorical grant programs which support
health services. All States and territories and 170 local
jurisdictions have comprehensive health planning agencies
which serve about 70 percent of the nation's population.
However, these agencies serve primarily as advisory groups
and often lack trained professional planners, sufficient
resources and meaningful authority. HEW's efforts to
unify health service programs are noted, with particular
emphasis on reorganization steps that have been taken.
The Social Security amendments now pending in the Senate
and revenue sharing are also noted. It is concluded that
linking financial reimbursement to compliance with more
stringent health care standards is the only realistic
method for upgrading the quality of service and that
outcome measurements are the final test of the success of
the health care delivery system. (NTIS)GENERAL
PERSPECTIVES AND PROCESS
Page 5^
Reference:
Ray H. Elling,
"Health Planning in International Perspective,"
Madinal Cat&t Vol.9, No.3, p.214-234, (May-June 1971).
A conceptual review is presented of the contexts,
goals, structures, processes and evaluation of health
planning efforts throughout the world, followed by an
examination of questions of strategy and method in healtn
planning research. The distinction is drawn between
research involving the design, implementation, and
evaluation of new departures in health and research
concerned with systematic, cross-national studies of
exisiting planning efforts. The limitations of
multinational studies attempting to employ comparable
definitions and standardized data-gathering techniques are
pointed out in view of the complexity and uniqueness of
the historical, cultural, and political circumstances
affecting health planning in each country. It is still
suggested that a more promising style of research, still
in the tradition of observing and recording, would be 3
series of historically oriented, national case studies
focused on health planning. Such systemwide studies
should keep in view the following: the character of the
environment; the breadth and character of health goals,GENERAL
PERSPECTIVES AND PROCESS
Page 53
their perceived interrelations with society/ and the
specificity and character of objectives; the structure/
coaposition/ and placement of the health planning
endeavor; processes of communication and involvement of
consumers and others in decisionmaking; and information
systems and evaluation. The objective of such studies
should be to develop indepth understanding of the problem
of health planning in different sociocultural
environments. In regard to research efforts Involving
"doing and recording' as opposed to 'observing and
recording/' it is suggested that the general strategy of
community or consumer involvement may be most worthy of
exploration and demonstration. (NTIS)
Reference:
Kenneth M. Endicott/
Islands. a Ealicy isil iiaalib tiaasaian Elaauiua*.
Rockville/ Md.:	Office of the Administrator/ Health
Resources Administration/ 1976.
Barriers to effective health manpower planning in th2
United States are reviewed/ and efforts at the FederalGENERAL
PERSPECTIVES AND PROCESS
Page 54
level to overcome these barriers are described by the
administrator of the Health Resources Administration/
DHEW. One barrier is found in the limitations placed on
health manpower planners in helping to shape the outcomes
of the educational process. The isolation within which
the medical specialty boards that do shape these outcomes
operate is pointed out. Another barrier stems froi
instituitional response to the restraints of planning in
view of perceived infringements on academic freedom. It
is further noted that the concept of health manpower
planning as a tool for assuring universal access to
competent medical care has not noticeably altered tne
perspectives of State medical licensing boards. Th*
contributions to health manpower planning from several.
DHEW divisions are noted. Problems that continue to limit
health planners are identified relative to the formative
status of basic techniques for planning and for gathering
statistics; the unpredictibility of the economy; the
conflicts between consumer demands and objectively
assessed needs; and uncertainty about the future of the
health care system in general and of the medical
specialties in particular. Local-level problems likely to
be encountered by health systems agencies in their
analysis and planning activities are discussed. The nee!
for an integrative planning effort exploiting th»
strengths and compensating for the weaknesses of eaciGENERAL
PERSPECTIVES AND PROCESS
Page 55
level of governaent Is pointed out* Supporting
documentation is included. (NTIS)
Reference:
A. Engel/
E££&&££lix£2 IQ tisallii Elanniiis/
London:	Athlone Press/ 1968.
This book is a compilation of lecture series
delivered by the author upon his retirement as
Director-General of Swedish National Board of Health. He
discusses the role of national health planning in aodern
society/ and stresses the necessity for accurate vital
statistics and asymptomatic disease screening as public
health methods. He concludes with a description of
function/ growth/ and transition of the Swedish
regionalized hospital and health system to exemplify
effective operation with minimal organizational
requirementsGENERAL
PERSPECTIVES AND PROCESS
Page 56
Reference:
£tLVi£fiUfli£Dldl ttealih AsR££i£ fli Metropolitan Planning aa j
J2£X£lfi£lB£Illx.
Geneva:	World Health Organization/ 1965.
Various aspects ol environmental health
considerations in urban planning and development are
discussed. Following a general discussion of the need for
planning for environmental health and of the magnitude of
the problem of environmental health in urban populations,
the need for a broad multipurpose approach to the problems
of environmental health and planning is noted. Problems
in metropolitan planning and development are outlined in
general, and the planning of new towns in the USSR is
cited as an example of methods of dealing with health
problems. The following specific areas of environmental
health are then considered: water supply/ sanitary waste
disposal, drainage/ solid wastes and land pollution, air
pollution, ionizing radiation hazards, housing and open
space, problems involved in the planning of public health
establishments, vector control, and noise and vibration.
Administrative considerations in metropolitan planning,
particularly as they relate to coordination of public
health activities, are discussed. Hesearch and training
needs with regard to the environmental health aspects ofGENERAL
PERSPECTIVES AND PROCESS
Page 57
i
urban planning are noted. Recommendations concerning
urban planning, primarily from the national perspective,
are offered. (NTIS)
Reference:
James Falick, David Burdick, and Henry Winkelman,
"Planning Can't Replace Money But...,"
Care# Vol.5, No.4, p.53-55, (April 1976).
The process of planning health care institutions in
order to make effective use of the available money is
discussed in relation to an organization chart that takes
the planning firm out of the direct decisionmaking line.
The medical facilities planning review committee is
considered the innovative part of this approach. It is
composed oi 4	to	10 members of	the medical,
administrative, and nursing staffs, each member designate!
as liaison to one departmental committee. The department
committee is responsible for analyzing the needs and for
developing the design recommendations for its area. These
*
recommendations	are	then considered by the review
committee. This allows the staff to see a clear structureGENERAL
PERSPECTIVES AND PROCESS
Page 50
for participation# yet ensures that the board and tha
adainistration do not feel a loss of control. Two
organization charts are provided. The first places the
planning consultant directly between the departments and
the administration/ this causes resentment by hospital
workers feeling disenfranchised. The second chart shows
the departments reporting through their committees to the
review committee which in turn reports to the
administration; the administration deals directly with
the board. In this chart the planning consultant is
connected with the departmental committees/ the review
committee# the administration# and the board; it is no
longer in the direct decisionmaking line. In addition# a
game designed to teach planning clients about physical
planning is described. A workbook developed for the
review of successful and unsuccessful ideas and decisions
in planning is delineated. No references are provided.
(NT IS)
Reference:
Bernard Frieden and James Peters#
"Urban Planning and Health Services:	Opportunities for
Cooperation#"GENERAL
PFRSPFCTIVES AND PROCESS
Page 59
Jamml fil 1h& Aasiican Insiiiuls at Elannsts* Voi.36,
No.2, p.82-95, (Mar. 1970).
Findings of a state of the art survey of areawide
health planning, undertaken to explore possible
interactions of health planning with urban planning, are
discussed. The survey does not claim statistical
validity, but certain elements of planning philosophy and
method were repeated often enough in the 33 published
plans studied to suggest several generalizations. The
following characteristics of areawide health planning,
gleaned from the survey, are outlined:	the scope of
documents included under the general term 'plan' (e.g.,
plans for planning , special studies, surveys of health
services, health service system plans); types of agencies
and organizations most commonly functioning in a planning
capacity; health plan goals and objectives; the kinds of
health information collected by health planning agencies
(prevalence, utilization, resources, and ecological
information); ways in which health information is used
(projections of future bed needs, definitions of health
facility service areas, studies of housing conditions);
implementation; recommendations; and planning for system
*
alternatives. The survey indicates that few health plans
have moved toward proposing future health
syster*GENERAL
PERSPECTIVES AND PROCESS
Page 60
alternatives. Another survey of over 200 city planning
agencies is cited which indicates that very weak
relationships exist between health planners and city
planners. It is suggested that urban inforaation and
■ethods can contribute to proposals for alternative health
service agencies. (NTIS)
Reference:
Oscar Gish/
•'Alternative Approaches to Health Planning/"
Assignment Children* Vol.33/ p.32-51/ (Jan.-Mar. 1976).
Various health planning strategies are detailed/ with
particular attention given to the context for health
planning/ the combining of preventive and curative health
activities/ health planning for rural areas/ and the
preparation of a 5 year health plan. Differences between
health care services in less developed countries and
services in the industrialized world are noted. The
assumption is made that health planning will be
appropriate only to the extent it considers the entire
population of a country/ region/ or district. It is feltGENERAL
PERSPECTIVES AND PROCESS
Page 61
that preventive health planning aust be accoaplished in
conjunction with effective planning for rural areas. The
problem of obtaining adequate resources for health care in
rural areas is addressed. Steps in the preparation of a
five year health plan are outlined: (1) calculate
catchment areas for health facilities; (2) develop a
budget; (3) plan for health manpower; and (4) choose an
appropriate staff mix (for example/ 1 physician or 30
rural medical aides). The importance of consumer
involvement in the health planning process is stressed.
The need for the development of national health planning
policies is also emphasized. An example is provided to
illustrate how a population can be effectively covered by
a network of small facilities as opposed to one largo
hospital. The role of hospitals in health planning is
discussed/ and the functions of local units of government
in the provision of health care are considered. (NTIS)
Reference:
Quite Lq ££jD£££b£Q2iX£ ii££lib Elaimiaa 12L
Eoston:	Health Planning Council for Greater Boston/
Inc./1970.
>GENERAL
PERSPECTIVES AND PROCESS
Page 62
Guidelines are presented to aid comprehensive healtn
planning within hospitals in the Greater Boston
(Massachusetts) area. The document opens with discussion
of the key concepts of comprehensive health planning*
followed by comments on the need for comprehensive
planning in hospitals.' Relevant excerpts are presented
from the American Hospital Association statement on
planning. The purpose* composition* and responsibilities
of the hospital long-range planning committee are then
discussed* and the activities to be undertaken by such
committees (defining the hospital's service area*
evaluating the success of implemented projects and
programs* setting goals* analyzing new proposals) are
reviewed. Emphasis is placed on the inclusion of
representatives of the community in the hospital's
planning activities* and approaches for assuring community
representation are suggested. An outline is offered of
the planning process* including the following stages:
self-analysis; community analysis; establishment of the
hospital's long-range mission; appraisal of the
hospital's role in meeting community needs; consideration
of problems in achieving the long-range mission;
establishment of priorities; coordination;
implementation; and evaluation. Planning principles
approved by the area's health planning council and adopted
by the area's hospital council are appended*
as areGENERAL
PERSPECTIVES AND PROCESS
Page 63
examples of programs included in a comprehensive health
care system. (NTIS)
Reference:
"Health Challenges for 1978-83"#
Miffl £tLCflnl£lfi/ Vol.31, p. 123-126# (1977).
The challenges facing health administrators will vary
from one country to another depending on its level of
development. In general# however# man's health has come
to be regarded as a prequisite for optimum socioeconomic
development as well as one of the most important goals of
such development. Public health services are no longer
considered merely as a complex of solely medical measures.
They are being increasingly recognized as an important
component of socioeconomic systems# combining all tno
economic# social# political# preventive# therapeutic and
other measures on which human society# in any country and
at any stage in its development# is based. Recognizing
the close links between health planning and socioeconomic
planning# WHO has in recent years done a great deal to
bridge the gulf separating the two. But for the years
tGENERAL
PERSPECTIVES AND PROCESS
Page 64
immediately ahead of us* what challenges are there for
health planners and health workers ? The article proposes
an answer.
Reference:
"Health Manpower Planning in the Americas*"
Miifl £h£flni£i£* Vol.29* No.3* p.85-90, (Mar. 1975).
Proceedings of the First Pan American Conference on
Health Manpower Planning* held in Ottawa in September
1973* are summarized. The conference was attended by
representatives of the 29 member countries of the Pan
American Health Organization and by delegates from the 10
provinces of Canada. During the conference* issues and
goals of health manpower planning in the Americas were
identified* tools and methodologies were reviewed* and
action priorities were proposed. Working groups met oh
health manpower supply* distribution* utilization* and
requirements* and on the new health occupations and the
health manpower planning process. Presentations
summarized include: a discussion on implications of the
health field concept for manpower planning* which focused
<GENERAL
PERSPECTIVES AND PROCESS
Page 65
attention on prevention through changing lifestyles/
■oderating the environment/ and extending knowledge of
human biology; a review of the rural strategy promulgated
in the Ten-Year Health Plan for the Americas/ which is
based on active and informed community participation in
all health-related activities; and an outline of health
manpower planning problems in Latin America/ such as
separation of manpower decisions from general health
planning/ mutual isolation of occupational groups/ lack of
information/ bias in career selection/ resistance to
transfer of functions/ vagueness of policies and
underestimation of sociocultural aspects/ absence of
health manpower planning units/ and others. Conference
recommendations relative to healtn manpower planning in
the Americas are presented. (NTIS)
Reference:
"Health Planning/"
EllfcliC Efifllltl ES2.2LIS*. Vol.91/ special issue, (Jan.-Feb.
1976).
The National Health Planning
and
ResourcesGENERAL
PERSPECTIVES AND PROCESS
Page 65
Development Act of 1974 is given comprehensive coverage in
this issue of the official journal of the Public Health
Service. Articles focus on implementation of the act,
designation of health service areas, the National Health
Planning Information Center, the regulatory and revie*
functions of agencies created by the act, organization and
administration of a state certificate-of-need program,
linkages between health systems agencies and professional
standards review organizations, and training of planning
personnel and of board members for health planning
agencies. Several of the contributors are with the Bureau
of Health Planning and Resources Development in the Health
Resources Administration, which is responsible for
implementing the act.
Reference:
H.E. hilleboe,
"Health Planning on a Community Basis",
apical	Vol.6, No.3, p. 203-214,, ( 1968).
The meaning of health planning on a community basis
is explained in the broad concepts of personal andGENERAL
PERSPECTIVES AND PROCESS
Page 67
environnental health. Recent developments in methodology
reported in the literature are indicated.
The relation	of health	planning	to other community
planning brought	out the	role of	health	in social and
economic development and the importance of a central
planning unit in the community. Fragmentation is the
single most prominent characteristic of the health
industry today, with specialization of services and
agencies running a close second.	Reorganization	of
community health	programs	appears	to be	the key to
improvement in the years ahead,	with changes	in
geographical boundaries of agencies the first order of
business. P.L.	89-749 should stimulate	and hasten
beneficial changes in administrative organization and
management of health services. Health planning for the
future means systematic projections for the next 15 to 20
years, not for just one or two years.
The crisis in health manpower threatens the whole
fabric of planning and implementation.
Health agencies need to employ more full-time
planners and, equally important, health administrators
need to oecome more expert in the planning process.GENERAL
PERSPECTIVES AND PROCESS
Page 68
Reference:
William Hiscock,
"Urban and Regional Foundations for Health Planning,"
£ublic lifiallh Beportg, Vol.85, No.3,	p.267-275, (Mar.
1970).
Theoretical and policy aspects of health planning at
the urban (community) and regional level are discussed,
with reference to the experiences of the Regional Planning
Council of Baltimore, Maryland. The history of the trend
toward urbanization is traced, and the impact of that
trend on health planning policy is considered. The
'social system' of planning is discussed, and factors in
efforts to improve the health care system are cited. The
role of the Citizens Advisory Council in the Baltimore
region health planning structure is described briefly. It
is observed that areawide health planning agencies, uith a
mandate from an involved advisory council of consumers,
local governments, health services professionals, and
providers, 'can and must' become a vehicle for
synthesizing health issues and resources and for achieving
'community responsibility' in health affairs. These
agencies, it is suggested, should, serve as 'catalysts*
stimulators, and encouragers' in developing health goals,
policies, and strategies. (NTiS)GENERAL
PERSPECTIVES AND PROCESS
Page 6**
Reference:
J.C. Honey/
El^QDiufl and Hi£ Eiixale Sscicl*
New Vork:	Dunellen Publishing Company/ Inc*/ 1970.
The author develops the role of the private sector in
government planning efforts within developing countries.
He examines alternative modes of participation in various
national procedures/e.g./ consultative relationships/
collaboration in detailed central planning efforts/ and
macroeconomic planning arrangements. Financial/
technical/ and professional inducements to private sector
performance are cited in accordance with established
government plans.
Ref erence:
P. Hornby/ A.Mejia/ D. Ray/ and L. Simeonov/
"Trends in Planning for Health Manpower/"
£hiflDi£l£<. Vol. 30/ No.11/ p.447-454/ (Nov. 1976).
International developments in health
manpowerGENERAL
PERSPECTIVES AND PROCESS
Page 70
analysis and planning are reviewed. The discussion opens
with the description of a simplified framework within
which the planner can develop year-by-year comparisons
between the demand for manpower and the likely supply. I
review of the development of manpower planning throughout
the world reveals two basic types of studies relevant to
health manpower problems. The first type - the manpower
study - seeks to improve the quality of information about
manpower and is usually carried out on a large scale. The
second type - the study of the manpower planning process -
uses available information to improve analytical and
decisionmaking processes in health service management.
The information-oriented study became popular in the
1960's and was carried out in several World Health
Organization member states. Manpower studies and studies
of the manpower planning process usually are conducted
exclusively of each other/ particularly in developing
countries. The differences between the two approaches are
illustrated in descriptions of a mnapower study carried
out in Sri Lanka and of a process-oriented study of rural
water supply and sanitation personnel. Lessons to be
gained from experience in manpower planning are
summarized/ including the complex/ country-specific nature
of manpower problems and the need for a multidisciplinary
approach to manpower planning. (NTIS)GENERAL
PERSPECTIVES AND PROCESS
Page 71
Reference:
Everett Johnson/
"Puzzlement for Hospital Planners/"
Hospital and Health Satvlcfis AdaiQisItalian^ Vol.21. No.2/
p.64-72/ (Spring 1976).
The complexities involved in assessing the impact of
duplicated hospital services are examined in a discussion
prompted by concern over health planners* perceptions of
hospital operations. The concept of preventing the
duplication of institutional services usually refers to
halting the development and operation of a hospital
service or department in hospital when it appears that a
less expensive alternative is to use an existing service
to its maximum capacity or potential expansion. Cobalt
therapy, open-heart units, and obstetrical services
frequently come under consideration in this respect. It
is suggested that generally accepted planning processes,
though well thought out, do not reflect all of the issues
with which hospital administrators are concerned. Seven
major concerns to be considered by hospitals when deciding
whether to start, phase out, or expand any program are
identified; the operating cost of the service; capital
investment requirements;	the technological and
organizational processes involved; the time perspective;GENERAL
PERSPECTIVES AND PROCESS
Page 72
human behavior/ particularly that of the physician; and
the acceptability of a new service in the marketplace.
Determining when duplicated hospital services should be
prevented or allowed is a complex judgment in terms of
these elements. No standardized/ general formula is
possible. It is suggested that government masks its goals
of controlling organized by using a tangential approach/
i.e./ by developing mechanisms for controlling hospitals
that will in turn impinge on physicians/ a tactic that
creates conflict in hospitals. (NTIS)
Reference:
Herbert Kaufman, Basil Mott, Eugene Feinyold, and Robert
Binstock,
•’The Politics of Health Planning", A Symposium.
AmfiiLitan Jcutaal oi Eiiklic iiaaliti/ Voi.59, No.5,
p.795-813, (Hay 1969).
The four papers presented in the symposium are:	(1)
"The Politics of Health Planning," by Herbert Kaufman;
(2)	"The Myth of Planning Without Politics," by Basil Mott;
(3)	"The Changing Political Character of Health Planning,"GENERAL
PERSPECTIVES AND PROCESS
Page 71
by Eugene Feingold; and (4) "Effective Planning Through
Political Influence," by Robert Binstock. Political
factors which influence health planning are discussed id
an attempt to prove that planners are powerless unless
they are capable of acting in a political environment.
While theoretical planners disdain politics and
politicians, the consequence of attempting to separate
policy planning from the political process is isolation
from the means of shaping public policy. Political
scientists conclude that policy planners should be aware
of how the political system works and how to operate in 3
political environment. Actions of planning agencies to
get the community to accept change are political
struggles. Tn this sense, politics is an inescapable
aspect of health planning and of the decisionmaking
process. Consequently, successful planning lies in the
ability of the planners to make the most of the little
power they possess. Two models of community health
planning - the rational decision model and the community
action model - are discussed. The rational decision
model, which begins with a problem or unmet need and moves
to a course of action, is politically naive because it
fails to recognize that the setting of objectives is a
subjective process in the political world. The community
action model stresses that planning cannot be accomplished
unless planning decisions are acceptable to those affectedGENERAL
PERSPECTIVES AND PROCESS
Page 74
by then. However, it does not recognize the liaits of
consensus as a Beans of getting action. (NTIS)
Reference:
Herbert E. Klarraan,
"National Policies and Local Planning	for Health
Services",
UilkaDk	Eund fluaitsiJU# voi.54, No.i, p.i-2a,
(Winter 1976).
The primary reason for health planning in the U.S.
is the numerous instances in whicn the interests of the
individual, health-care institution and those of the
community may diverge, as in the case of hospital staff
appointments for physicians.
From a technical standpoint, it is	much more
difficult to plan for health services at the local level
than nationally. Notwithstanding, health services are
mostly provided at the local level, and health planning
should be geared to the solution of local problems. In
performing health planning, the local area can benefit
from outside assistance.GENERAL
PERSPECTIVES AND PROCESS
Page 75
In the past decade, local health planning has been
hampered by unstable federal funding* The absence of
national policies and guidelines has led to a constant
quest for new ideas. In the absence of substantive
concerns, requirements for consumer representation have
led to a preoccupation with structure and organization.
bhat is required, in addition to steadier funding, is
a fostering of local capabilities for health planning.
Health planning organizations will require a good deal of
%
technical assistance in the form of concrete ideas on ways
to enhance the flexibility and versitility of health
facilities and personnel, monitoring natural experiments
and learning their lessons, and elucidating the public
policy implications of empirical research findings and
even of apposite propositions from theory.
In specified circumstances the federal government is
expected to serve as the superceding decision maker.
Reference:
R. Llewelyn-Davies and H. Macaulay,
Hfisniial EldcoiDfl and AdaiDisiiaiiaux
London, England:	Bartlett School of Architecture, 1966.GENERAL
PERSPECTIVES AND PROCESS
Page 7S
Basic information on the problems related to hospital
planning and administration is presented in this aonograpi
prepared for the World Health Organization- In order to
stress the concept of an integrated and coordinated
hospital service/ the first section is devoted to planning
on a national and regional scale. Directed mainly to the
attention of health authorities/ it deals particularly
with legislative/ financial/ statistical/ and overall
aspects of hospital organization. The second section
0
provides guidance on the planning of a general hospital/
which applies to many different types of institutions/
ranging from the rural hospital with a feu dozen beds to
the huge/ highly specialized institutions with many beds
and facilities for scientific research and medical
education. The main emphasis is on a standard general
hospital with several hundred beds/ comprising a number of
medical/ surgical/ and special departments/ and meeting
the needs of a population of from 50/000 to more than
several hundred thousand. Section three is an analysis of
the requisites of the principal departments within 3
comprehensive general hospital. These include generals
special/ and technical medical services/ as well as
psychiatric services/ and nonraedical services and
facilities. An annotated bibliography is provided/ as
well as a list of reviewers to whom the preliminary draft,
was submitted for comment. (NTIS)GENERAL
PERSPECTIVES AND PROCESS
Page 77
Reference:
Robert Makowski,
"Hospital Planning:	Synthesis and Restatement/"
Hospital P£QiiL££&*. Vol.54, No.4/ p.24/26-28/	(28 April
1973).
Principles of hospital planning are reviewed in the
light of recent (circa 1973) planning experience.
Comprehensive/ full-cycle hospital planning/ it is
suggested, should possess the following characteristics:
(1) it should give long-range purpose and establish
long-range (10-year) objectives toward which hospital
activities should be directed; (2) in the near term, it
should provide for implementing timely long-range
objectives, speak in action-oriented terms, and give
guidance for achieving specific and tangible goals for a
period of one year; (3) it should personalize
responsib1ity and provide for individual accountability;
and (4) it should provide for appropriate feedback and
control information, so that all aspects of planning can
be monitored and restated as required. The constituent
elements of the planning process are discussed separately,
including:	the master plan; the annual plan of action;
accountability management; and the planning cycle, i.e.,
the plan for planning. It is concluded that planning canGENERAL
PERSPECTIVES AND PROCESS
Page 7d
provide the management process with unity, direction,
structure, and purpose, thereby becoming 'a working tool
rather than a theoretical abstraction.' (NTIS)
Reference:
J. Joel May,
Jteallh Elanuinai Lis Eas.1 and Efllsaiials*.
Chicago:	Center for Health Administration Studies,
Chicago Univ., 1967.
An historical review of areawide health facility
planning in the United States is presented. During the
years 1920-1945, two approaches are evidenced: (1)
activity in the evaluation and interrelationship of
hospitals and hospital beds; and (2) developments in the
public sector	dealing with	the	role	of the 1
government in	the provision	of	health	services
period from 1946 through 1958 is noted for the passage of
the Hill-Burton legislation, and the Hospital Survey and
Construction Act of 1946 (P.L.79-725). Under this
legislation, emphasis is placed on the survey of hospitals
and the development of a comprehensive plan setting forthGENERAL
PERSPECTIVES AND PROCESS
Page 79
the States' lost pressing needs. In 1958/ four regional
conferences Here held to develop 'principles for planning
the future hospital system.' The Joint Committee of the
American Hospital Association and the U.S. Public Health
Service and the Pennsylvania Economy League identified
three major types of structures for planning or fund
raising: a hospital council/ a hospital planning
association/ and an integrated coordinating and planning
council of professional representatives and a citizens
committee. By 1961 the report of the Joint Committee wa5
accepted/ and Federal money helped increase the number of
planning agencies from 14 in 1961 to 80 in 1966. A method
of agency evaluation is appended/ and a bibliography is
provided. (NT1S)
Reference:
Joseph H. McCarthy/
"Planning Process for Rural Health Care/"
LfllUlIU. Vol.19/ No.13/ p.7/8/22/ (Aug. 1976).
A planning process is proposed to help rural
hospitals identify fundamental problems/ determineGENFRAL
PERSPECTIVES AND PROCESS
Page 90
realistic alternatives, and implement the best
alternative. A uell-developed plan provides a frameuorfc
for dealing with three major problems confronting rural
hospitals: organization, physician recruitment, and
financing. Five major steps compose the planning process
for rural hospitals: (1) analysis of hospital
characteristics and trends; (2) analysis of the area
served by the hospital; (3) definition of the future
role, programs, and services; (4) evaluation of resource
requirements; and (5) development of a plan of action.
Emphasis must be placed on the patterns of practice of
each individual physician of the medical staff, community
attitudes, disease incidence, and health care utilization
patterns. Consideration must be given to the fact that
the elements of the health care delivery system are more
directly dependent upon one another in a rural setting*
Specific examples of issues encountered in a study of a
rural hospital are noted. It is concluded that community
organizational ability and commitment are essential, and
implementation of a planning process must be carefully
thought through. (NTIS)
Ref erenceGENERAL
PERSPECTIVES AND PROCESS
Page 81
Regina McNamara and Karen Shanor,
1q1Xu£ii££ aL tuliuial EaclilES an the. itealih Eiinning
East Orange, N.J.:	Center for Hunan Resources Planning
and Development/ Inc./ 1976.
The Center for Human Resources Planning and
Development/ Inc./ a private nonprofit corporation based
in New Jersey/ is developing planning and educational
tools for culturally sensitive health services. The
center asserts that cultural patterns in society can
affect the process of health planning and for research
purposes/ defines culture as patterns of behavior/ not
simply a random collection of elements. The development
efforts have taken essentially three forms:	research into
the nature of cultural barriers interfering with quality
health care? group discussions within health institution®
about cultural lactors that influence care? and meetings
and workshops to influence policy/ planning/ and education
of health care personnel/ and the implementation of
services. Research reported here involved an intensive
literature search which resulted in 500 relevant articles
focusing on Negroes/ Puerto Ricans/ Asian Americans/
Chicanos/ and Native Americans. The center's research
documents the implications of cultural values in theGENERAL
PERSPECTIVES AND PROCESS
Page 92
perception of need/ use of preventive services/ patient
compliance/ continuity of care/ and consumer education.
Effective health planning acknowledges and utilizes these
cultural components toward a goal of improved national
health status. (NTIS)
Reference:
Sam Muszynski/
"Mental Health Care and Treatment:	Jill Health Planning
Make a Difference ?"
ftfiSEiisil	Camaiuaiii:	EawLhialL**. voi.27/ No. 6,
p.398-400, (June 1976).
The National Health Planning and Resources
Development Act of 1974 establishes a five-tiered syste»
for health planning that begins with the Secretary of
Health/ Education/ and Welfare and reaches the local level
through areawide health systems agencies. The author
describes the implications of the law for mental health
services/ focusing particularly on its impact at the local
level. He describes the functions of the health syste.nS
agencies/ points out limitations in their authority/ andlGENERAL
PERSPECTIVES AND PROCESS
Page 31
emphasizes that cooperation of community organizations and
agencies is essential if they are to be effective irt
improving health and mental health care and treatment.
Reference:
Charles Pierce,
"Partnerships in Planning:	Getting Everyone into the
Act,"
ijflSILitalSx Vol.50, No.12, p.113, 114,116, (16 June 1976).
0
Interfaces among hospitals, Health Systems Agencies
(HSA's), health associations, and State agencies for long
range planning are discussed. State planning requirements
in New Jersey illustrate how institutional and areauide
planning can be interrelated. Institutional long range
planning in New Jersey was seen as a management process
that would encourage institutions to analyze their
existing and future roles in health care systems in their
areas. These institutional plans became public documents
when submitted to the State, and the availability of these
documents to planning agencies and other providers
stimulates communication between institutions and planningGENERAL
PERSPECTIVES AND PROCESS
Page 84
agencies. A long range planning regulation was drawn up
describing a goal-oriented or systems approach to planning
which is compatible with P.L. 93-641/ which outlines what
HSA's and State planning agencies must do in reviewing
institutional requests for Federal funds. Two possible
methods of interface are explored: data collection and
dissemination and statements of policy. An interface
sequence for the development and selection of alternative
courses of action is suggested. (NTIS)
Reference:
Steven Portnoy/
"Planning Must Exist at All Levels of System/"
Hospitals/ Vol.50/ No.12/ p.65-67/ (16 June 1976).
The health planning process is examined at all
institutional levels in this overview of a special issue
of HfiSEllals which focuses on institutional planning.
Definition of the hospital's community and determination
of need for health services in that community are
discussed as the earliest steps in the health plannning
process. This involves gathering and analyzingGENEPAL
PERSPECTIVES AND PROCESS
Page 35
statistical data and assessing internal and external
political, socials and economic characteristics.
Techniques for determination of need are noteds as are
differences in approaches to planning between large and
smalls teaching and communitys and public and private
institutions. Operational interrelationships among
institutions to facilitate health care delivery and
support are considered. The impact of Federal legislation
and regulations on health care delivery is assessed. The
interface between institutional and areawide planning and
activities underway by States metropolitans and national
hospital associations to promote institutional and
areawide planning are discussed. (NTIS)
Reference:
Joel Richman and Thomas Saraph,
Eublic Accfiuniafciliijii issuss and lattmianss	itealih
£dl£ El3QQiQ3<.
Syracuse, N.Y.:	MULTUS Corp., Dec. 1975.
Issues and techniques surrounding public
accountability in health care are examined. ObjectivesGENERAL
PERSPECTIVES AND PROCESS
Page 86
and accountability issues in Public Law 93-641
(Comprehensive Health Planning and Services Act) are
outlined, and background information leading to the
development and enactment of this legislation is
presented. Public accountability is defined/ and
integrated components of public accountability are
described. Accountability in health care planning centers
around evaluating the degree to which health systems
agencies (HSAs) discharge their responsibilities. Issues/
concerns/ and problems of HSA governing bodies are
addressed to the need to achieve accountability. Issues
of the construction of bylaws place emphasis on how HSAS
can increase their accountability. Alternative methods
for establishing public accountability are presented.
Included is a discussion on the direct impact of
developing and implementing survey methods to achieve
accountable procedures for staff and board functioning.
Evaluation is considered as a means to establish and
enhance public accountability/ and suggestions are made
for evaluation procedures for HSAs. The education of HSA
board members and staff is considered as specific
knowledge and attitudes so that public accountability can
be increased. Appendices contain an annotated
bibliography and an HSA checklist developed to organize
primary issues in public accountability and to permit HSAs
to monitor their progress toward the establishment ofGENERAL
PERSPECTIVES AND PROCESS
Page 37
accountable organizations. (NTIS)
Reference:
Cyril Roseman,
"Problems and Prospects for Comprehensive Health
Planning",
American sLeytaal fit ElikllC Health, Vo 1.62, No.l, p.16-19,
(Jan.1972).
Immediate past and future principal problems and
challenges confronting those involved in comprehensive
health planning are identified and discussed. Prospects
for survival of comprehensive health planning and its
likely role in innovation are discussed.
Reference:
Anthony Rourke,
"Hospital Planning,"
Hfialih tflLfi SlSlfilE CflllSllliflniSz Vol.4, No. 2,
iGENERAL
PERSPECTIVES AND PROCESS
Page 89
p.1-4/ (Feb. 1975).
Cost containment and areawide planning aspects of
hospital organization are considered. Federal and State
legislation related to hospital planning is noted/ as well
as accreditation requirements. The Social Security
Amendments of 1972 (P.L.92-603) establish requirements for
ongoing planning:	annual review and update of a
hospital's long-term plann/ the creation of short-tern
plans/ a projected 3-year capital expenditures budget/ and
a projected 1-year operational budget. The provision of
high quality health care requires that a hospital have an
organizational design which permits systematic planning/
analyzes its own industry/ engages in self-analysis/ and
develops a marketing strategy. A graphical illustration
is provided to depict the traditional long-term planninQ
approach. Steps in a continuous planning process for
hospitals are outlined. The first step involves the
formation of a planning committee. The role and functions
of a planning committee are detailed. Ongoing or
continuous planning encompasses the organization of
several components/ including hospital administrators/ thi
medical staff/ the board of trustees/ department
personnel/ consumer agencies/ and consultants. Thi
significance of each of these components in the planning
iGENERAL
PERSPECTIVES AND PROCESS
Page 3)
process is discussed. The developaent of a hospital
profile is addressed. This profile is related to hospital
programs/ services/ activities/ utilization/ Manpower/ and
facilities. National trends in the use of hospitals are
illustrated for the period between 1968 and 1975. (NTIS)
Reference:
Ben Saltzman/
"Comprehensive Health Planning for Rural Areas/"
Journal fiX ltl£ l£DH£££££ U£di££l A££0£.i£li£IU Vo 1.62/
No.7, p.622-626/ (July 1969).
The significance of the Comprehensive Health Planninj
and Public Health Service Amendments of 1966 (P.L.
89-749) for rural involvement in community health planninj
is discussed by a member of the American Medical
Association Council on Rural Health in a presentation
before a March/ 1969 meeting of State medical
associations' rural health committee chairman. The
provisions of the law are outlined/ and factors in th*
increased emphasis on comprehensive health planning are
identified.	Arguments for and against greater
1GENERAL
PERSPECTIVES AND PROCESS
Page 93
governmental involvement in solving health care problems
are pointed out. The Partnership for Health idea is
described as a means for providing health benefits at both
the public and private level. The Regional Medical
Program is also described briefly, and it is suggested
that this program has made more headway than comprehensive
health planning because the former's scope is limited to
the ideas and initiative of people involved in the health
professions, while the latter has involved both health
personnel and the consumer of health care. Meeting
participants are urged to encourage physicians to take the
leadership role for the planning activities within their
communities. The importance of effective 'grass roots'
development in forming a basis for regional and State
plans is emphasized. Further, it is suggested that the
consumer 'knows that he knows very little about health,'
and therefore looks to the physician for leadership.
Comprehensive health planning in rural areas where
maldistribution of health manpower is a primary problem is
viewed as a top priority; from the models developed at
this level, comprehensive planning can grow. (NTIS)
Reference:
iGENERAL
PERSPECTIVES AND PROCESS
Page 91
Frank Schofield,
"Health Planning in Developing Countries",
IflfiACi fii SclfiDCfi flD 2££i£l£s	Vol.25, No.3, p.181-257,
(July/Sept. 1975).
Health planning is a management tool uith which the
politicians and civil servants who administer health
services can be helped to obtain and organize resources
for the purposes they consider as having highest priority.
Health plans are most likely to be successfully
implemented when these purposes are made explicit. The
political, economic, social and institutional purposes
which underlie decisions made in the health sector are as
important as those affecting health. Health planning has
particular advantages for developing countries, but there
are special problems for these countries, too, in the
formulation and implementation of their health plans.
Reference:
Richard H. Seder,
"Planning and Politics in the Allocation of Health
Resources,"GENERAL
PERSPECTIVES AND PROCESS
Page 92
Amfititan JanmaL &i Eufclic Health, voi.63, No.9,
p.774-777/ (Sept. 1973).
The roles of politicians and planners and the
of conflict between them in the allocation of
resources are examined. Responsibility and init
alternates between planners and politicians a
decisionmaking process goes forward/ and a succ
program can be claimed only when a method for treati
problem has been selected/ resources appropriated/
principles set/ and implementation criteria spec
Some of the common problems of planning and the pol
process are identified as:	disproportionate inf
over public resource allocation by those pri
possessing substantial resources; a preoccupatio
personal interests; a disproportionate attention t
powerful; and objective analysis and planning onl
such activities are perceived to support the positi
the powerful. Some cures for
suggested/ including substitution of
of adversary activities of planners
participation of experts in
planning process/ a focus
the legislative branches of
more access to planning/
areas
health
iativg
s th§
essfu l
ng the
design
ified.
itica 1
luenc e
vately
n with
o the
y when
on of
these ailments are
systematic analysis
and politicians/ the
several disciplines in the
on general principles/ giving
Federal and State governments
anu finally a clarification ofGENERAL
PERSPECTIVES AND PROCESS
Page 93
the roles and responsibilities of politicians and
planners. (NT1S)
Reference:
William Shonick,
Ll£m£Q.i£ cl Elannina Lql AnfiarJiide Eatssmal E&alld
a&ULiQ&S*.
St. Louis/ Ho.:	C.V. Mosby Company/ 1976.
Components of planning for an areawide personal
health service system are outlined/ and techniques and
disciplines used or proposed for health planning are
described. A comprehensive system for providing personal
health care is viewed as consisting of five elements: (1)
services for acute/ short-term inpatient facilities; (2)
services in ambulatory facilities; (3) services in tne
homes of patients and at sites of life threatening
occurrences; (4) long term Inpatient chronic ani
rehabilitation care; and (5) an areawide system that
coordinates all personal health care system elements into
a total system for maintaining personal health. Component
steps in planning for areawide health care include tha
»GENERAL
PERSPECTIVES AND PROCESS
Page 91
establishment of an overall goal and subgoals#
consideration of alternative ways to meet goals#
determination of the geographic allocation of total
utilization reguirments for service centers# estimation of
the quantity and kinds of personal health care required by
a population# evaluation of resources required at each
center to produce the agreed upon desirable utilization#
adoption of a plan# evaluation of the operation# and
adjustment of the operation in response to feedback.
Consideration is given to issues and problems in health
planning# planning for hospital inpatient resources#
planning for physician visits# examples of planning for
personal health care# and areawide planing instruments and
related legislation. A list of references is provided.
(NTIS)
Reference:
Robert Sigraond#
"Health Planninq"#
UfilUcal Cax£/ Vol.5# No.3# p.117-128# (May-June 1967).
Planning is no easy answer to the U.S.'s healthGENERAL
PERSPECTIVES AND PROCESS
Page 95
problems. Planning is hard work/ and involves inevitable
tensions as conflicting goals and aspirations are
resolved. Improved planning will necessarily evolve
slowly. Concrete results in terms of improved health for
people will take even longer. Attempts to short-cut the
process^ to develop simplistic "master planning" which
assigns pre-cast roles to autonomous operational units/
will almost inevitably interfere with effectiveness/
innovation/ and morale. What is needed is a clear
understanding of effective planning processes/ of
obstacles to achieving effective planning/ and of
necessary steps to overcome these obstacles. Special
attention to comraraunity-oriented redefinition of goals
throughout the entire health system is the necessary first
step.
Reference:
Albert Snoke and Parnie Snoke/
"Linking Private/ Public Energies in Health and Welfare
Planning/"
Hggpitals# Vol.50/ No.16/ p.53-58/ (16 Aug. 1976).
tGENERAL
PERSPECTIVES AND PROCESS
Page 95
The expanding involvement and authority of federal
and state governments in health activities in the United
States present potentials for serious erosion of the
responsibility and the ability of the voluntary health
sector to provide high-quality health services. Tne
authors suggest that an effective counterbalance to these
forces might be provided by the voluntary sector if it
were to develop a voluntary/ comprehensive organization in
each state that could work in partnership with government
in promoting improved health and welfare.
Reference:
Anne Somers/
"Goals into Reality:	The Challenges of Health Planning/
hpspjtals/ Vol.43/ Part 1/ p.41-47, (1 August 1969).
The author suggests four guiding principles to helo
establish planning as a viable/ integral part of the
health care system/ and discusses the role of the hospital
as the place where meaningful community health planninj
starts. The hospital must not not just be an institution
but an organized arrangement of all medical resource;
1
tGENERAL
PERSPECTIVES AND PROCESS
Page 97
necessary to bring patients into contact with the skills
of physicians and other members of the health care team.
Reference:
David Stewart/
"Planning as an Integral and Essential Part of a National
Health Program”/
H£jdi£2l Cfll£/ Vol • 6/ No. 6/ p.439-453/ ( Nov.-Dec. 1968 ).
This article discusses the nature of planning/ the
role of politics and government fiscal policy in planning/
and the organizational aspects of planning. The planning
process is outlined: collecting data and analyzing it/
establishing priorities and selecting objectives and
selecting among alternative methods to achieve these
objectives/ drafting the plan/ and implementing and
evaluating the plan. Conceptual difficulties associated
with the various steps in the planning process and the
problems of personnel/ resources and budgeting are alsoGENERAL
PERSPECTIVES AND PROCESS
Page 98
Reference:
P. Strauss and R.D. Finney,
•'Health Planner Involvement for Improving Mental Health
services in Long-Term Care Setting",
ilaiiinal fll Lana lata Carp Administration, Vol.4, No. 2,
p.47-55, (Spring 1976).
A number of factors make it necessary for the long
term care administrator to develop high quality mental
health services. A health planning process is presented
in the article as a tool for the long term care
administrator to use in designing the needed high quality
mental health services. The authors conclude that the
challenge of providing such services is twofold. First,
there must be a willingness to accept the available
planning and mental health technologies with help fron
professionals in those areas. Second, this acceptance
must be institutionalized so that planning for high
quality mental health services becomes an ongoing function
in the long-term care setting.
Reference:
Louis Tannen,
GENERAL
PERSPECTIVES AND PROCESS
Page 99
"Health Planning:	A Critical Analysis/"
and &£di£ia£x BUD Eacit&l Hr
New York:	Health-PAC, 1978,p.1-21.
In this article, the author is highly critical of
health planning and describes it as one of the several
vehicles corporations and the Federal governoent are using
to reform the health system to limit their future
expenditures. While there is much to fear from a powerful
planning system directly or indirectly "controlled" by tha
corporate class (in terms of what health conditions are
treated as well as who is treated), planning can be a
progressive tool when controlled by progressive community
interests. Democratically controlled planning can
mobilize people to identify community health needs and
target programs at those problems. They can be the means
for popular discussion and control of the future of tha
health system.
This dual potentiality of planning, being both
progressive and regressive, underscores the point that all
planning activities reflect the ideological bias of those
that control the planning process. This includes the
obvious direct control such as a voting majority on the
planning board, or indirect control such as defining the
power and jurisdiction of the agency. Only byGENERAL
PERSPECTIVES AND PROCESS
Page 103
understanding and exposing the current bias of planning
efforts can one effectively and efficiently take up health
planning issues.
Reference:
Sharon Warren and J. Williams/
"What Pole is There for Municipal Government in Health
Regionalization ?"
£auadiaD ilQurnal ai £uklic Haaliiu voi.67/ p.io5-10 3/
(March-April 1976).
The pros and cons of active municipal government
involvement in planning and coordinating health services
for the Canadian provinces are discussed. Active local
government involvement, may improve medical care delivery
and democratize hospital organization. However/ the
present structure of local government would make its
active involvement difficult/ and the medical profession
might not approve.GENERAL
PERSPECTIVES AND PROCESS
Page 101
Reference:
William Jospeh Waters,
Etfi££££	2L £2m&££tl£Q£iV.£ il££llU Elaimillfl. tfce
Sl£t£ L£¥£lx
Columbus:	Ohio State Univ., 1975.
A set of evaluative criteria is developed to assess
the comprehensive planning process, and the extent to
which comprehensive health planning (CHP) agencies are in
compliance with these criteria is measured. A conceptual
statement on the process of comprehensive health planning
is derived from a review of literature. In this
statement, the five fundamental steps in the planning
process are identified as: task design, system
investigation, ends establishment, means selection, and
intervention evaluation. The conceptual statement of the
planning process is compared with the practice of
comprehensive health planning at the State level. A
questionnaire was mailed to all 50 State CHP agencies to
determine organizational and institutional
characteristics. In addition, a case study of one State
CHP was conducted to compliment the survey. It was found
that the concept of the comprehensive health planning
process described above is arbitrary, and continued
refinement of the concept is necessary. A review andGENERAL
PERSPECTIVES AND PROCESS
Page 102
comparison of survey and case study results indicate a
number of common problems: State CHP agencies do not
appear to be engaged in technical analysis to any great
extent; CHP agency activities lack precision; and the
State agencies are not setting overall goals. Both the
survey and the case study indicate that State CHPs take a
categorical or patchwork approach to planning activities.
The survey instrument is included. (NTIS)
Ref erence:
William J. Waters,
Ih£ £lJDJamcni^l	fil ££mEI£il£DSill£ Mfidllh £i£DDiog
isi££s 2i ttealiti Ulanninal*.
Columbus:	Dept. of Preventive Medicine, Ohio State
Univ., Aug. 1974.
The report presents a normative definition of the
process or steps involved in state planning for health
comprehensively, including system investigation, ends
establishment, means selection, and intervention
evaluation. The normative definition is based on an
extensive review of the professional health planningGENERAL
PERSPECTIVES AND PROCESS
Page 10)
literature. (NT1S)
Reference:
Alfred Yankauer,
"National Planning and the Construction of Maternal and
Child Hygiene Norms in Latin America",
AiD£Li£dQ Mutual at Eublia Esallli/ voi.57, No.5, p.7bi-6i,
(May 1967).
The need to recons
and tactics of maternal
America within the cont
provides the point o
Although specifically
conditions, the mode
applicable as well to c
a time when health p
this exposition is high
ider the philosophy, objectives,
and child health services in Latin
ext of national health planning
f departure for this blueprint,
related to Latin American
of approach to health planning is
onditions in the United States. At
lanning assumes central importance,
ly relevant to current problems.GENERAL
PERSPECTIVES AND PROCESS
Page 101
Reference:
Dieter K. Zschock/
"Health Planning in Latin America:	Review and
Evaluation/"
Lalin Aai££i£an E£S£2££h tLSltiSMz. Vol.5, No.3, (Fall 1970).
The present review focuses on health planning and the
economic aspects of health conditions in the region. It
describes the period during the sixties in which the
Alliance for Progress began to stimulate the inclusion of
health as one goal of development. These health goals of
the Charter of Punta del Este were arrived at rather
arbitrarily/ since the data on health conditions as well
as analytical experience available at the time were
insufficient for health planning purposes. The role of
the Pan American Health Organization (PAHO) in health
planning and the PAHO "health planning method" are
discussed. The author believes that it should be possible
to begin supporting health planning with economic analysis
with data from the national health studies in Peru/
Colombia/ Argentina and Chile/ complemented by available
economic/ demographic/ and vital statistics.
Three economic approaches are compared - the first
two are variations of cost-benefit analysis and the thir<$
is oriented toward calculation of health manpowerGENERAL
PERSPECTIVES AND PROCESS
Page 105
requirements. None of the approaches attempt to isolate
the effects on health of health services from those of
other environmental factors.
The article concludes that health planning in Latin
America/ though buttressed as in Peru and Colombia and in
the region's major urban centers by extensive new health
survey data/ has not so far involved extensive economic
analysis. While plagued by ambiguities in the area of
health, economic analysis can nevertheless contribute to
conceptual clarification of alternative approaches to the
improveaient of health conditions and the delivery of
medical care.GENERAL
CASE STUDIES - SPECIFIC
Page 106
Reference:
Mildred Barry and Cecil Sheps,
"A New Model for Community Health Planning"/
A£L££i£d£ JfllitMl fil EllfeliC tUalliU Vol.59, No. 2/
p.226-236/ (Feb. 1969).
A description of the process by which the Cleveland
metropolitan community developed a health goals plan is
presented. The three basic elements that made up the
framework of this project were a concept of health/
involvement/ and utilization of knowledge.
Re ference:
Harry Brickman/
"Federal Versus Local Community Mental Health Planning:	A
Plea For Conflict Resolution"/
Affl££i£an Jautnal qI EuLILsl itedlliw voi.60,	No.12/
p.2251-2256/ (Dec. 1970).
Undesirable effects of the federal Community Mental
Health Center programs on community planning and programsGENERAL
CASE STUDIES - SPECIFIC
Page 107
are presented in terms oi Los Angeles County- Suggestions
for resolving conflicts and problems are offered.
Reference:
Montague Broun,
1q&££1 qL ChaoaiQa l£i£L££a£Qiiaiiflaal Efilalians an Ibe
Efilicy SlLiiGtuce aL a Eaaaiiaii An iUs.ULic.al Casa Sludy
ai a HaaUl ElanQiag OLsanizalian and a itosniial iUsieffl/
Chapel Hill:	Dept, of Health Administration, University
of North Carolina, 1972.
An exploratory, historical case study is used to
examine the way in which changes in the environment of the
Greenville Hospital System in Greenville County, South
Carolina influence its internal policy structure. The
study focuses upon the impact of the South Carolina
Appalachian Region Health Policy and Planning Council's
operation and development on the leverage of hospital
policy participants (trustees, physicians, and
administrators).	Three historical periods	of the
Greenville Hospital System are reviewed:	1947-1964, prior
to introduction	of the health	planning	council;GENERAL
CASE STUDIES - SPECIFIC
Page 103
1965-1967# during the council's formative stages; and
1968-1971# after establishment of the council's and the
Greenville County Health Planning Council. The research
design of the study is derived from a behavioral model of
organizational theory and disjointed incrementalist models
of policy processes and uses a leverage point method.
Leverage dimensions include issue relevance# subphase
resources# and personal efficacy# with leverage defined as
the capacity to substantially influence outcomes.
Theoretical issues in the study include pluralism versus
elitism# rational models versus behavioral models# and the
extension of related theory to the study of
interorganization change. Study findings suggest that
attention should be directed toward an increased number of
jointly sponsored health planning programs# use of
multiple finding sources for planning projects# more
specific target problems for health planning agencies to
explore# greater citizen iraputs to program policy and
planning# and greater health professional interaction with
professional planners. Appendices address research
techniques of the study# and a bibliography is provided.
(NTIS)GENERAL
CASE STUDIES
SPECIFIC
Page 10q
Reference:
££i££lali£i} o.L Rutal iLesilti EtiaiJ.ii£s nilti Ilnkaa aaalib
Eriflxliifis io ih& ElaDflioa Etacsss ai the. East laaafiaaas
iteallh ElanniDa Cfluncilx IqCxx Juli lx 1224=A£iil Hz
1225*
Knoxville:	East Tennessee Health Planning Council, Inc.,
1975.
The purpose of this study is to determine to what
degree urban and rural health priorities are encompassed
in the health planning process of the author council. To
do this, three topic areas are addressed:	(1)
establishment of urban and rural nealth priorities in
terras of long-term facilities, community-controlled
facilities, emergency medical facilities, need for
physicians and dentists, and mental health; (2) the
direction of the planning process; and (3) adjustments
needed to direct planning to the goals. The results show
a need for improvement of the planning process.
Recommendations include greater flexibility toward both
rural and urban priorities. Establishment of a system of
rural input and participation in the process are also
suggested. Follow-up of programs are also found lacking.
The recommendations are presented as action-oriented
measures that will facilitate solutions to the healthGENERAL
CASE STUDIES - SPECIFIC
Page 110
problems of the East Tennessee area. Appendices provide
lists of consultants and experts employed in the study,
outlines of the study design, and a summary of the health
planning process employed by the Health Planning Council.
(NTIS)
Reterence:
John Cumming, Donald Coates, and Peter Bunton,
•'Community Care Services in Vancouver:	Initial Planning
and Implementation,"
CaDa da's filial Health, Vol.24, No.l, p. 19-23, (Mar.
1976).
The planning of community mental health facilities in
Vancouver began in the context of a crisis and a
comparative service vacuum with intense implementation and
development compressed into a short tiflie span. This paper
describes the background situation, planning features and
%
the beginnings of implementation. Included are some
suggestions in the planning process which take into
account the concerted attempts by government to make
services more local and more available. Presented in 1973GENERAL
CASE STUDIES - SPECIFIC
Page 111
the paper reflects initial optimism but a note on the
present situation tempers this with a comment on the
reality of effecting such a program.
Reference:
Robert Daniels/ James Wagner/ and Morton Creditor/
"An Example of Sub-Regional Health Planning/"
Inquiry/ Vol.7/ No.4/ p.25-33/ (Dec. 1970).
Many technicians agree that health planning is an
important process. However/ many disagreements exist as
to the methods and who shall participate. This report
reviews the preliminary steps used to create a health
planning structure in which the legislative guidelines
have been followed. A not-for-profit corporation for
health planning has been created/ the Mid-South side
Health Planning Organization in Chicago. It consists of 3
mixture of community organizations/ professional healtl)
societies, and health care institutions. Community
responsibility and control are clearly established, going
well beyond the typical legal definition. The community
is not advisory but rather assumes its place on the BoardGENERAL
CASE STUDIES - SPECIFIC
Page 112
of Directors along with professional and institutional
representatives. The process of organization has been
completed. This group will now enter phases which
emphasize building a health system in an area where
complicated social, racial, and economic problems exist.
However, unless city, state, and Federal agencies and
others concerned with health service planning and delivery
recognize its potential and involve it in health planning
it may not survive.
Reference:
Herbert Harvey Hyman,
Egliiics Ql flfialiti Cats! fjiD£ Siudifis fll immxalixe
Elanoiog in Nsi!
New York City:	Praeger Publishers, 1973.
The involvement of hospitals, medical schools,
citizens, health unions, real estate interests, and
investors in the conversion of Federal dollars into health
programs, planning, and service in New York City i3
explored in order to find some common, basic
characteristics to permit a comparative analysis ofGENERAL
CASE STUDIES
SPECIFIC
Page 113
dynamics. The answers to three primary questions are
sought: (1) Who were the decisionmakers involved in
determining the nature of the issues. (2) What objectives
were sought by these decisionmakers for what target
populations. (3) What happended to these objectives when
opposition developed and how did the decisionmakers cope.
Each of nine researchers was assigned to a set of data
collection procedures to be applied to nine health
programs: The Ghetto Medicine Act of 1968: Medicaid;
family planning — raultifunded and multidirected;
abortion legislation and implementation; the
extermination of rats in the neighborhoods; the control
of the municipal health systems of New York ny the Health
and Hospitals Corporation: ambulatory health care;
Regional Medical Programs established by P.L. 89-239 in
1965; and the Comprehensive Health Planning Act of 1966.
Data and bibliographic references are provided. (NTIS)
Re ference:
Jesus M. De Miguel/
"The Spanish Health Planning Experience:	1964- 1975"/
Sci£D££ And fcfidifiillfi/
Vol.9/ p.451-459/ (1975)GENERAL
CASE STUDIES - SPECIFIC
Page 111
This is a study ol health planning processes in an
authoritarian system, analyzing the three first Spanish
Health Plans (1964-67, 1968-71, and 1972-75) as published
by the Comisaria del Plan de Desarrollo Economico y Social
de la Presidencia del Gobierno and officially approved b/
Las Cortes. The author examines the balance between
economic and social development in such plans; the
objectives and peculiarities of each of these three
governmental ’’white papers”; and the relationships
between yearly projections and results; and the
ideologies implicit in the Health Plans.
Reference:
Irene Easling,
££££££} ifit QuJk£2Ql£2 ~ A Stydy Ql £2Hmi£b£Q2iy£ tt££llb
EJLanBiim Asliviliss Id Dalla Sfiunix* l£*a5*
Houston:	School of Public Health, Texas Univ. Health
Science Center at Houston, 12 June 1976.
The purpose of this study was to examine an areawide
comprehensive health planning agency in terms of its
effectiveness. In addition, the research attempted toGENERAL
CASE STUDIES - SPECIFIC
Page 115
explore possible indicators and to develop hypotheses for
future research. The subject of the research was the
North Central Texas Council of Governments. Emphasis was
on those agency activities concerned with control of
capital expenditures in Dallas County. To accomplish the
research objectives, interviews were conducted with
representatives of the Regional Health Council, the Dallas
Health Planning Council, and hospital administrators who
had not participated in health planning activities. Among
the findings were that the agency was thought to be most
effective in the areas of community involvraent and
education. It was thought to be less effective in
carrying out such functions as preventing construction of
unneeded hospital beds and duplication of equipment.
Other findings were that the agency's project revie*
process was workable; that the agency had not had a great
deal of influence on cost containment measures (although
it had made some recommendations); and that the voluntary
nature of the review process was related to le fact that
the county is overbedded. Suggestions for future research
deal with such areas as the development and use of
standards and criteria for distribution of health
services, and cost containment measures. When hospital
data were studied to determine their usefulness in
evaluating the agency effectiveness it was found that
rates, lengths of stay, and cost per patient day
occupancyGENERAL
CASE STUDIES - SPECIFIC
were not particularly valuable; lengths of
specific diagnoses and charges for specific
might/ however, be useful. References are
(NTiS)
Reference:
Arlene Fonaroff,
"Identifying and Developing Health Services in a New
Town",
AuLeiisLau Jflutaal qL tuhlic. frsalila, voi.60, No.5, p.821-27,
(May 1970).
Identifying and developing health services in a New
Town is an unbelievably difficult, complex proposition.
Diagnosing what people know, think, and do as it effects
action for community health planning requires non
specific profesional attention that it has been given in
the past. One must also come to grips with the fact that
to involve people in planning - professional and consumer
requires asking and answering questions; for example,
planning for whom and for what, and who shall hold the
power, authority, and representativeness to provide
Page 116
stay for
services
included.
theGENERAL
CASE STUDIES - SPECIFIC
Page 117
answers ?
Implications oi the author's experience in Reston,
Virginia are that increased emphasis should be placed on
methods which Cl) define range of power, authority and
representativeness of participants (consumer and
professional) lor purposes of evaluating their influence
on decision-making; (2) expedite communication within and
between the professional institution, consumer planning
group and community; and (3) expedite consumer education
to facilitate enlightened decision-making on alternative
health care systems.
Reference:
D.S. Grimes and T. E. Chester,
"Medical Manpower Planning:	The British Experience",
•Iflil'i MasaitalS/ vol. 12, No.4, p.229-33, (1976).
The article presents an analysis at the way in which
medical manpower planning has been attempted in Great
Britain, and the lessons that might have been learned fron
this experience. Four key problems are distinguished:
(1) the total number of doctors reguirea, especially inGENERAL
CASE STUDIES - SPECIFIC
Page 118
the long term? (2) the need for them to practice in the
right location; (3) how to get them into the specialties
most needed by the population; and (4) in times of major
scientific and technological advances together with
rapidly changing morbidity patterns, how to get the
medical profession to adapt to changing needs.
Reference:
Thomas L. Hall,
’’Planning For Health In Peru - New Approaches To An Old
Problem",
Amsuicaii Jaiitaal QI Eublic a&aliii/ voi.56. No. a,
p.1296-1307, (Aug.1966).
The problem of plann
current interest. Whil
same everywhere, speci
countries require raodif
contribution to the ov
indicating how needs in a
ing for he
e certain
fic cond
icat ions.
er-all p
specific
alth is one
essentials
itions in
This paper
roblem of
country are
of great
may be the
dif f eren t
is a useful
pla nning,
handled.GENERAL
CASE STUDIES - SPECIFIC
Page 119
Reference:
Thomas Hall/
Mfiflilh Han2i2M£L in Eficui A Cass Sludx io ElaDni&a*
Baltimore:	John Hopkins Press* 1969.
This monograph examines the organization of medical
care* distribution of resources* and the organization of
the planning function in health services. The author
describes study methods employed to estimate costs of
health care* comparing economic feasibility of alternative
manpower targets and contrasts methods used to measure and
predict future manpower needs.	He analyzes the
characteristics of current health personnel* including
geographic distribution and employment conditions. The
implications of the study in determining manpower policies
and the role of the planning function are reviewed.
Reference:
A.S. Haro and T. Purola*
"Planning And Health Policy In Finland"*
InifilLiltiflDal JaULUal 21 iieall.i}	Vol.2* No. 1 *
p.23-34* (1972).
IGENERAL
CASE STUDIES - SPECIFIC
Page 120
The health service system in Finland is analyzed froii
the point of view of planning-oriented activities.
Society has traditionally been tne main provider of
services in this country, and executive responsibilities
of local autonomous authorities are balanced with the
centralized control carried out by legislative measures
and subsidies. An organized information system is a
prerequisite to planning (this is especially true in a
country with Finland's type of organizational structure).
The Finnish system is based on problem-oriented data
banks. Health interview surveys which link social
background data with health-related information have a key
role in this system; these surveys are well suited to
before and after comparisons. Information is capable of
producing action only if it is properly analyzed and
timed. In order to obtain information about actual goal
expectations of the decision-makers, the special-purpose
planning departments are located at a high level of
government in Finland. Typical methods of implementation,
such as financial subsidies, are described in this paper,
and economic estimates and long-term budgeting are given
as examples of guides for the central authorities. The
use of before and after studies to measure the effect of
the policies is described, and some observations on the
weaknesses in the present system are presented.GENERAL
CASE STUDIES - SPECIFIC
Page 121
Reference:
M.J. Hartgerink,
"Health Surveillance And Planning For Health In The
Netherlands"/
iDl££0alifiI}2l JfiU£D£l Q1 fiEldfifflifllflay/ Vo 1.5/	No-1/
p.87-91/ (1976).
This
backgroun
Netherlan
and major
is noted,
governmen
de 1 ivered
organizat
with the
governmen
attempts
inforraati
rudiments
exist an
system on
paper begins by describing the historical
d to health surveillance and planning in the
ds from their beginnings in the late Middle Ages,
legislation on health care between 1804 and 1970
Under the guidance and supervision of the
t of the Netherlands/ health care in 1976 is
by a	significant	number of different
ions and by private physicians who must comply
rules and tariffs negotiated by relevant
t agencies. It goes on to discuss the recent
to obtain more reliable and comprehensive
on on which to base health care planning. The
of a general health information system already
d a feasibility study for establishing such a
a regional basis has been proposed.
lGENERAL
CASE STUDIES - SPECIFIC
Page 122
Reference:
P.J. Heath/
“Health Care Planning And Computing In Sweden"/
Elitilic Health/ Vol.89, No.6, p.297-303/ (Sept.1975).
This	article	outlines the	organization of	medica1	
care in	Sweden	and its relationship to their		system oE	
governmen	t and	their economy.	A description	of	the
Stockholm	County	Medical Information System then		follows,	
together	with a	discussion	of planning	and	its
relationship to the British planning machinery.
Reference:
A. Idriss/ P. Lolik, R. Khan, and A. Benyoussef,
JSflild Health QtaaniiaiiflD Hulleiiu/ Voi.53, p.461-471,
(1976).
As a follow-up to the national
process developed in 1975 in Sudan, a
program for the whole country was
assistance from WHO. In this article
health programming
primary health care
formulated with
the methods used inGENERAL
CASE STUDIES - SPECIFIC
Page 123
the programming and formulation are described and
discussed. These methods ensured an intersectoral
approach on which technical, cultural, socioeconomic,
financial, and political considerations were based. Areas
in the field of health and rural development requiring
government and community action during the period 1977/70
-1983/64 are identified. Details on the strategies for
population coverage of rural and nomadic communities with
primary health care are given. Fundamental to these
strategies is community participation in the development
of primary health care within community development as a
whole.
The guiding principles of these strategies are their
technical, political, social and financial feasiblity.
The social relevance of the primary health care prograa
for the community and the developmental sectors is
emphasized.
Reference:
Irving Leveson, and Jeffrey H. Weiss,
Analysis. al lithaa health Eiohlemsi Casa Studies team the
health SetYiaes AdaiaistLaiiaQ at the £itx at hew lath/
New York:	Halsted Press, 1976.GENERAL
CASE STUDIES - SPECIFIC
Page 124
Urban health problems are analyzed by the Health
Services Administration (HSA) in New York for the period
between May 1970 and January 1974. The experience of
HSA's analysis staff provides an opportunity for those
interested in policy analysis/ urban problems/ and health
services to gain a deeper understanding of urban issues.
The book is specifically designed for use by officials of
State and local health departments/ comprehensive health
planning agencies/ hospital review and planning councils/
city planning departments/ budget bureaus/ city
administrators/ and practitioners in program design and
administration. Topics considered in the book relate to:
system monitoring of hospital utilization; program/
agency/ and process evaluation; analysis methodology and
quantitative relationships; policy development an 1
analysis; and program development and implementation
planning. Programs and activities carried out by the New
York City HSA are reviewed. (NTIS)
Reference:
Emmanuel Margolis/
"National Health Planning and the 'Medical Model':	Th®
Case of Israel,"GENERAL
CASE STUDIES - SPECIFIC
Page 125
&££lal &£i£Q££2 And MsdltlDS/ Vol.ll* p.181-186* (1977).
In 1968-1969 a special committee elected by the
Israeli Medical Association prepared and submitted a
report on the organization of health services in Israel.
The committee recommended a broader definition of health
and a comprehensive health-care approach for its
implementation. In spite of the expectations of its
compilers the report proved to be ineffective policy-wise
and did not create even a forum of discussion.
The report suffered from some fundamental
inconsistencies. The committee chose a comprehensive
concept of health but abstained from examining the
relationship between health* health services and
socio-economic development. Isolating the health delivery
system from the major system - the Israeli society - and
proposing the solution to the crisis in the Israeli health
system wihtout specific discussion of the latter* the
report inevitably created the impression that what was
wrong in the health-care system was wrong within the
health-care system itself* and not a reflection of the
social milieu in which the health services function. fly
trying to be objective and strictly professional the
committee adopted a neutral "medical model"; the result
was that instead of generating change* the status quo was
i
fGFNERAL
CASE STUDIES - SPECIFIC
Page 126
secured.
The recommendations of the committee, if accepted,
would have affected first of all the network of primary
health care which has always been the domain of the Sick
Fund (Kupat Holim) of the Labor Federation (HistadrutK
dominated by the Labor Party. Introducing comprehensive
health care would have meant replacing the solo Kupat
Holim physician with a health team, giving to welfare and
other agencies, represented in the team, a share of rights
and duties. For such partition of power Kupat Holim was
not ready. Reflecting the actual location of power, the
medical profession lost its battle for redefinition of
health and health services.
The	Mann	Committee	recommendations		exemplify an	
attempt	at	innovation.	The	manner	in	which its
conclus ions		were formulated		and later		"shelved”
illustrates the way that many attempts, not only in the
health field, were dealt with. The case of the committee
report indicates that significant changes in the health
field cannot be expected without radical changes in
Israeli society itself.
ReferenceGENFRAL
CASE STUDIES - SPECIFIC
Page 127
Peter D. Mott/ Anthony T. Mott/ Jonathan M. Rudolph/
Eduard R. Lane/ and Robert L. Berg/
"Difficult Issues in Health Planning/ Development/ and
Review"/
*
km&Llzan Jaucoal al itedllb Elauninji/ Voi.66, No. 3/
p.743-747/ (Aug.1976).
To give an overview of the kinds of issues expected
to be encountered by the new Health Systems Agencies being
established in comformity with Public Law 93-641/ the
authors draw from the experiences of the Comprehensive
Health Planning Agency and Regional Medical Program of an
Upstate New York area. Problems faced together in the
years 1972 to 1975 in health planning/ development/
review/ and public policy are described. The unusual
geographic and working relationship of these agencies
makes them/ together/ a useful prototype of the HSA to
examine.
Reference:
V. Navarro/
Health Services/ and Health Planning in Cuba"/
"Health/GENERAL
CASE STUDIES - SPECIFIC
Page 128
Inl£Laalianal Jnumal a1 Haalih SeiiticfiS/ voi.2, No.3,
p.397-432/ (1972).
The profound changes which have occurred in the Cuban
health services since 1958 are described and appraised in
this article.	The first		part treats	the	main
socioeconomic	policies.	particularly the		urban	and
agrarian reforms	, that have	had	an equalizing	effect	on
the distribution of resources (including health resources)
between regions and social classes. These socioeconomic
developments have determined changes in mortality and
morbidity patterns, particularly in the control of
waterborne diseases, in the reduction of the level of
malnutrition, and in the increasing prevalence of chronic
conditions. The second part describes the main
characteristics of the health services development in the
last decade: centralization of inpatient facilities;
decentralization of ambulatory ones; and the training of
large numoers of physicians, paramedical personnel, and
especially, auxiliary personnel. The nealth services arc
structured according to a regional model that aims at the
integration of preventive with curative services, personal
with	env ironmenta1	f	and	medical	with social	services.
Within	this model,	gr	eat	priority	is given to	pr imar/
care,	especi al1y	in	r ui	ral areas,	where the	greatest
GENERAL
CASE STUDIES - SPECIFIC
Page 129
benefits of the restructuring of the system have been
realized. The education and training of human resources,
particularly of physicians, in response to the
requirements of the system and the flight of nearly half
the medical manpower after the revolution, are also
discussed in this section. The third part of the article
describes the process of decision-making and planning in
Cuba today, with special emphasis on the health sector.
This process is highly centralized in plan preparation but
highly decentralized in plan implementation. The medical
profession has a definitive and decisive influence in the
preparation of the plans, through the very powerful
advisory planning task forces. The advantages and
disadvantages of this active participation are discussed.
Plan implementation is accomplished with massive
participation by the population and its organs, the mass
organizations,	whi ch	partly explains	the	great
achievements	of the	public health	programs.	The
relationships	between decision-makers and		planners,	no t
always an easy	one, are	also analyzed.		
Reference:
Vincente Navarro,GENERAL
CASE STUDIES - SPECIFIC
Page 130
tfaiianal and Beaipna1 itealiti Eianiiiiia in SMeden/
Baltimore:	John Hopkins Univ./ 1974.
This monograph details the health delivery system in
Sweden. The elements of government are discussed/ with
the locus on administrative relationships at both the
national and local levels. The Swedish social security
health insurance and health service systems are examined.
The report also covers the national and regional planning
processes and long-term planning and budgeting for the
health sector at the regional level/ as well as the
planning roles of the Cabinet and Parliament/ of
regulators and controllers/ of data collectors/ and of
data analyzers. The final part of the report deals with
points that emphasize the relationship between the health
insurance system and health care delivery and the
infrastructure required for the process of national health
planning. Tables and schematic representations accompany
the text. (NT IS)
Reference:
Ite* 0i££clipD5 let ttsallh Elaanina in iiatiti CacaliuaGENERAL
CASE STUDIES - SPECIFIC
Page 131
Chapel Hill:	Health Services Research Center/ University
of North Carolina, 1975.
Issues involved in health planning for the State of
North Carolina are analyzed, based on a study conducted by
the Health Services Research Center at the University of
North Carolina. New directions for health planning an!
the National Health Planning and Resource Development Act
ol 1974 (Public Law 93-641), and issues involved in the
implementation of this Act in North Carolina are
discussed. Consideration is given in the issue analysis
study to planning for health care, State impact and
constraints on health planning, historical perspective on
health planning, designation of agencies to assume
responsibility for Statewide and areawide health planning,
efforts to provide comprehensive health planning agencies
with limited regulatory authority, studies on past
activities in health planning, designation of health
service areas, issues associated with health systeaiS
agency designatiion, and enabling authority to plan and
implement new health care programs. Particular emphasis
is placed on requirements and procedures involved in t|he
delineation of health service areas. (NTIS)GENERAL
CASE STUDIES - SPECIFIC
Page 132
Reference:
A. Pizam, and ¥. Neumann,
"Planning of Medical Manpower,"
JcutnaJL cl Lana Eanas Elanaiiisx Voi.9, no.i, p.44-52,
(Feb. 1976).
A project concerned with the forecasted demand for
physicians in Israel in 1982 is detailed. The objective
of the project was to estimate the demand of the Israeli
economy for physicians in 1982 and to compare this witn
the supply expected for that year. The problem of demanj
for physicians was distinguished from the demand for
medical services. The demand for medical services was
divided into two categories:	(1) hospitalization ;and (2)
outpatient services. Two factors, the quantity of medical
services in the future and the optimum productivity or
work output per physician needed to supply these services,
were used to determine the required number of physicians
for 1982. A mathematical estimation procedure was devisei
that incorporated a number of socio-economic variables.
Data were obtained on outpatient visits over a 24-year
period, along with socioeconomic data and data on
hospitalization in Israel. Regression analysis wa»
conducted to test the accuracy of physician estimates.
Medical services were translated into the number ofGENERAL
CASE STUDIES - SPECIFIC
Page 133
required physicians with regard to hospitalization/
specialized fields/ and outpatient services. (NTIS)
Reference:
Lewis Polk,
"Areawide Comprehensive Health Planning:	The Philadelphia
Story",
-JautDdl ml Eutilic itealili/ voi.59. No. 5,
p.760-764, (May 1969).
This paper offers a case study
encountered and handled in the
comprehensive health planning from in
Not all problems have been solved,
have been taken to develop a structure
Philadelphia metropolitan region.
of some problems
course of turning
tent into reality,
but the first steps
for planning in the
Reference:
B. Popovic, M
Skribic, and R. Kohn,GENERAL
CASE STUDIES - SPECIFIC
Page 131
"Yugoslavia's Autonomous Health Institutions:	Their Role
within The Constitutional And Sociopolitical Framework Irt
The Republic T)i Croatia"/
Iniscnaiiaual Jautual Qi Jtealib. Satiicas/ voi.3/ No.2/
P.213-222, (Spring 1973).
Heal
partnersh
authoriti
sociopo1i
associ a t i
of healt
health po
high d
inst itut i
general
Self-mana
autonomy
other age
high le
departmen
c l ass ica1
instituti
respondin
health ma
th care in Yugoslavia is provided through a
ip of federal/ republic/ and local health
es in collaboration with health insurance funds/
tical and work associations/ as well as other
ons which represent either the providers or users
h services/ or those who shape the development of
1 icy.	The	concept of	cooperation culminates in a	
egree	of	autonomy	for	individual health
ons/	with	self-management		characterizing the
pattern of Yugoslav health care delivery,
gement entails legal/ administrative/ and fiscal
of the institution/ both in its relations with
ncies and within the institution itself/ with
vels of self-management within individual
ts and sections. Given this diminished role of
hierarchical organization/ the health
on operates with a minimum of legal restraints in
g to the special social interests concerned with
tters. To deal with the institution's externalGENERAL
CASE STUDIES - SPECIFIC
Page 135
role on the one hand, and its internal cohesion on tne
other, two organs have been created to serve these
respective functions: the council and the aanagement
board. Self-management requires planning for several
distinct levels: the individual health institution, the
local community, and the entire republic. Health services
development planning requires cooperation of all pertinent
organizations in achieving a ’’social agreement" on the
objectives and priorities of the health services, the
resources required, and the specific plans for
construction and renovation of health facilities. The
principles of the "social agreement" encourage the
interest as well as the broad support of citizens and
their representatives in the development, implementation,
and financing of health protection plans.
Reference:
J.E. Powell,
A HfiJt Laaii ai Hadiaias and Ealiiias,
London:	Pitman Medical Publishing Company, Ltd., 19bb.
This book is a description of tne British system ofGENERAL
CASE STUDIES - SPECIFIC
Page 136
health care delivery in terms of authority, power, and
administration. It discusses the organization of the
Ministry of Health and of the National Health Service,
noting public and private responsibilities in financing
the service, and comments on problems in centralization of
health-related activities, as well as in determining the
supply and demand of health resources within the existing
system. Finally, modifications and alternatives to the
existing 3ritish health services system are discussed.
Reference:
John J. Reid and Dulcie G. Gooding,
"Health Service Planning in a British New Town",
LDiS-LDdliflCdl JfiUtDdl 21 ESdlli) SfiOACfiS/ Vo 1.5, No.3,
p.429-439, (1975).
The initial development of new towns in Britain tooW
place at a time when the present British National Health
Service was in its infancy, and few attempts were made to
integrate health service planning into the overall
planning process. The more recent new towns have been the
object of better social planning and at the same time, theGENERAL
CASE STUDIES - SPECIFIC
Page 137
National Health Service has been substantially unified/ at
first functionally and/ in 1974/ administratively. In
consequence/ attempts have been made to use the
opportunities which such towns present for planning health
services in a comprehensive and integrated manner. The
evolution of a planning and implementation structure for
health services in Milton Keynes/ a new town with a target
population of 250/000/ is described/ together with some of
the implications for the administratively unified National
Health Service which came into being in 1974.
Reference:
Anne Somers/
"An American City and Its Health Problems:	A Case Study
in Comprehensive Planning"/
id£di£3l	Vol.5/ No.3, p.129-141, (May-June 1967).
This article outlines the health problems and the
need for health planning in the city of Trenton/ New
Jersey. The author believes that for developing effective
planning for health services: (1) some statutory
authority will have to be granted; (2) the planningGENERAL
CASE STUDIES - SPECIFIC
Page 133
authorities must really represent the total community;
and (3) planners must become involved in positive planning
rather than negative nay-saying. It is pointed out that
the building blocks for a meaningful planning mechanism
already exist in a community like Trenton but that its
serious gaps and deficiencies are the reason that a new
overall effort is badly needed.
Reference:
C.E. Taylor, R. Dirican, and K.W. Deusche,
"aElaanina in
Baltimore:	John Hopkins Press, 1968.
This monograph contributes to the methodology of
health manpower research on the basis of experience in the
Turkish health manpower planning project. It presents
examples of planning methodology, data collection, and
alternative analysis designs. Also it discusses problems
of supply and distribution of health personnel,
appropriate economic analyses, as well as methods of
measuring demand and manpower needs.GENERAL
CASE STUDIES - SPECIFIC
Page 139
Reference:
Donald C. Wegmiller, and Carl N. Platou,
"Looking Backward, Planning Forward",
Hospitals* Vol.49, No.5, p.57-59, (Mar 1975).
Planning activities leading to the development of the
Ridges Community Health Center to serve a rapidly growing
suburban area of Minneapolis, Minnesota, are described.
Planning was initiated approximately five years before
construction of the project was begun. During that
period, study of the community and its health care need*
and program development were undertaken by FairvieJ
Community Hospitals, a multi-hospital organization which
operates three hospitals and provides contract management
services to eight others in Minnesota and Wisconsin. The
planning was conducted under the discipline of an overall
development theory, rather than as another community plan
to provide health care services. The needs assessment and
planning efforts were conceived and directed by a health
care provider organization, rather than by a government
agency, private commercial developer, or health cara
planning department. The plan was developed to meet needs
over a long period, and in phases related to the needs as
the community and the experts defined them.
Responsibility and accountability to plan and provideGENERAL
CASE STUDIES - SPECIFIC
Page 140
health care services for a growing area proved difficult/
but an orderly# progressive development was encouraged.
It is suggested that the discipline represented by not
immediately responding to a perceived need with the
solution of an expensive inpatient facility is of
importance to health care planning agencies. (NTIS)
Reference:
Charles K. rthite, and Leona J. Short#
tteBlth	£lannina in Lbs Anaslss SfluciYi Lcakleauz
E£sau££££* Bad Eacammandaliaua#.
Oakland# Ca.:	Health Systems Management Corp.# 1976.
Intended as a resource document for the Los Angeles
Health System Agency (HSA), this document focuses on
problems and recommendations for health manpower planning#
continuing education# minority recruitment and retention#
and consumer education. Changes in the patterns of health
care delivery are noted# including the increasing
incidence of group practice and prepaid health plans.
Educational institutions that train health manpower are
described, and trends are indicated. A major lack ofGENERAL
CASE STUDIES - SPECIFIC
Page 141
health manpower planning coordination is cited/ as is the
maldistribution of the existing supply of health manpower.
Recommendations are made for general planning/ for data
collection and coordination/ for educational coordination/
and for use of midlevel practitioners. An overview of
continuing education calls attention to the lack of
coordination and planning and the resulting problems of
availability of offerings/ accessibility/ expense/
clinical placement/ academic recognition/ and duplication.
Recommendations concern data coordination/ educational
coordination/ organizational considerations/ and funding
considerations. Problems in the minority recruitment and
retention relate to staffing patterns. The employment
characteristics of specific minority groups in Los Angeles
are given and barriers to minority recruitment are
described. Affirmative action is recommended and steps
toward that end are outlined. Consumer education problems
are described in terms of barriers — transportation/
educational/ language, cultural, organizational, and
financial. Steps to assure consumer participation in
planning and delivery of health care are detailed.
Histories of the Manpower Education Consortia are
appended. (NT1S)GENERAL
CASE STUDIES - SPECIFIC
Page 142
Reference:
A.P. Zhuk,
Euhlic Heal Hi £1 aiming in lim Il*S*.S«.Bxx
Bethesda, Md.: Fogarty International Center for Advanced
Study in the Health Sciences, National Institutes of
Health, 1976.
The translation of a Russian document is part of an
effort on the part of the United States to review on a
continuing basis the national health activities of other
countries. An analysis of these foreign health-related
activities and programs may provide U.S. Government
health administrators with new insights in solving some of
the complex problems relating to the improvement of health
in the United	States. The	theory.	methodology	and
organization of	public health planning		discussed in	the
volume assumes	that public	health	planning is	an
inseparable part	of planning the	national economy.		The
book contains nine chapters dealing with several aspects
of health planning - the organization of work to prepare
and implement a plan; methods of analyzing the data which
are to be part of the plan; care standards for urban and
rural populations; and staff standards and personnel
support for the public health network. Because the most
important problem in public health planning is toGENERAL
CASE STUDIES - SPECIFIC
Page 143
implement measures directed toward lowering morbidity and
eradicating mass-scale infections, one chapter deals with
the present status of this
several important diseases,
helminthiasis, and cancer,
citations lists mostly Soviet
problem with reference to
particularly, tuberculosis,
The bibliography of 198
works. (NTIS)GENERAL
CASE STUDIES - COMPARATIVE
Page 141
Reference:
Christa A1tenstetter/
"Planning for Health Facilities in the United States and
in West Germany,"
HiliLank Mamfitial £uud fluaulfiLly*- voi.51, No.i,
p.41-71,(Winter 1973).
The intent of this article is to present an intensive
comparison of one area of health planning, viz., planning
for health facilities in the United States and in Germany-
In both countries federal legislation increasingly has
atttempted to achieve comprehensive policies through
planning. Most attempts have been markedly influenced b/
various levels of authority which exist apart from the
federal level. In the United States the notion of
comprehensive health planning seems to be an indirect
outcome of several isolated decisions. In Germany, on the
other hand, state and local governments have long accepted
health as a public responsibility and have been involved
in hospital-related matters within certain limitations,
ie., hospitals have not been directly influenced by
centralized decision making. While the German health
bureaucracy remains the principal vehicle for hospital
decision making, consumer advocacy planning in the
American sense does not exist. Health planning in theGENERAL
CASE STUDIES
COMPARATIVE
Page 145
United States under the Regional Medical Program and
Comprehensive Health Planning provides an example of the
interaction and interrelatedness of many political factors
which influence health planning. Paradoxically# the
American health planning process lacks a clear mandate
from the consuming public in terms of developing fiscal#
political# and legal powers over the subjects to be
planned# including hospitals.
Reference:
0.1«. Anderson#
"Styles of Planning Health Services:	The United States#
Sweden# and England#"
International Journal fli ilfiOlltl J££vi££5# Vo 1.1# No.2#
p.106-120, (1971).
Conscious planning of health services is being
regarded as a necessity in western countries in order to
contain costs# provide rational delivery systems# and
assure equal access. Brief case studies of styles of
planning for health services in the United States# Sweden#
and Great Britain are presented in this paper. It isGENERAL
CASE STUDIES - COMPARATIVE
Page 146
contended that since there are very feu scientifically
verified criteria regarding adequacy of personnel and
facilities, proper volume of use of services, and hou much
health services should cost, conscious plannning becomes
at best arbitrary. Types of personnel and facilities are
quite uniform in all countries determined by technologic
imperatives. There are, however, differences in health
services organizations and systems, sources and amount of
funding, ratio of personnel and facilities to population,
and use of services. It is, therefore, suggested that
varying organizations, structures, and use result from
differing social	and	political	con	texts.	both historical	
and current. The	health services		of	each	country are	a
reflection of	their	problem	-so	Iving	styles.	The
open-ended nature	of	health	se	rvices	precludes	a
standardized health		services	sys	tem f	rout country	to
country, analogous to airports.
Reference:
Ralph Conant,
'•Politics of Health Planning,"
HflSEilal Elfl£I£S5c Vol.50, No.l, p.51-56, (Jan. 1969).GENERAL
CASE STUDIES - COMPARATIVE
Page 147
A study on the politics of community health planning
in five urban communities across the nation is reported.
It is noted that community healt planning objectives have
been opposed by many. It is also noted that the Federal
government entered the health field when it became clear:
(1) that population growth would outdistance the capacity
ana will of local and State governments to solve their
problems; (2) that local and State governments would
respond only to the demands of strong constituencies; and
(3) that the deprived and alienated constituted too large
and threatening a minority to ignore. Although
parochialism in the narrow inhibiting sense is giving way
to cosmopolitanism, the uniquesness and diversity of local
communities remains the central problem confronting the
Federal government in its efforts to create viable
territorial constituencies through which Federal policies
and programs can be implemented on a nationwide scale. A
future is foreseen in which the United States, through a
feaerally dominated program of social and economic
development largely implemented at the metropolitan
regional level, will make great strides. Unless care is
taken, one of the high costs of such a nationally
initiated, regionally implemented social and economic
development policy could be the continued exclusion of
urban minorities, especially blacks, from the experience
of local self-government. (NT1S)GENERAL
CASE STUDIES - CUMPARATIVE
Page 149
Reference:
Jose Maria Pacheco de Souza/ Dagmar Raczynski, George B.
Patino, Anthony T. Ribeiro/ and Emilio Feliu,
"Notes on Health Care Planning in Latin America and the
Caribbean,*'
EUiuL&la Sands RuUlisa/ voi.n, p.279-83, (1977).
Attention is called to the fact that efforts to
improve health of populations in Latin America have
generally failed. The inequality in the distribution of
ill-health is great. The authors accept the fact that
lack of resources available to the health sector may be a
restriction towards the improvement of the situation, but
they argue that a much more important issue is the misuse
of such resources and their maldistribution within the
health sector. The lack of integration and coordination
between the health services, the conflict of public and
private health systems, the under-utilization of existing
services and	the gap between	planning and real
implementation are discussed.
ReferenceGENERAL
CASE STUDIES - COMPARATIVE
Page 149
Chester Douglass*
Ufiiiliii S££i£i££s Elanoina in iiin IliJian Sheila
Cfiisnntalixje Analysis ai Eiabi Harisl Silies Encatajiax
Ann Arbor:	Michigan Univ., 1971.
An analysis of the results of the community health
services planning process is provided in the examination
of eight Michigan Model Cities Program first year action
plans. Limitations to the identification of the three
basic synoptic stages of the planning process (problem
definition, generation of alternative solutions, and
choice of one alternative) are documented. A more
generalized model of planning is developed, incorporating
the concerns of participant selection and representation
patterns, influence relationships among participants, and
the consumer or provider orientation of the plan. Similar
problems are shown to have been cited by each of the model
cities; the marked variations in the program outcomes are
analyzed through an examination of selected
characteristics of the planning process. Related planning
literature is reviewed and a bibliography is appended.
(NTIS)GENERAL
CASE STUDIES - COMPARATIVE
Page ISO
Reference:
Richard DuFour, David Thompson/ Richard Grimes/ Catherine
Allen/ and Ted Sparling/
"Three Case Studies in Planning/"
flaaliti	Raaaatilit voi.9, No.i/ p.62-78/ (1974).
These three articles are concerned with case studies
in health facilties planning. The first case cites a
project by a Michigan hospital to determine the minimum
number of beds that would alleviate problems of crowding
and surgical waiting lists without creating excess
capacity. The study applies an analysis of fluctuations
in hospital census identifying characteristics that would
allow predictions of fluctuations. This method shows that
a far smaller expansion than originally planned is
sufficient to meet bed needs. The second case study
concerns development of a financial simulation for a
health maintenance organization that would allow
reasonable planning. Variables include monthly growth
rates for each plan/ operating expenses/ and the share of
administrative revenue. The model allows for management
to determine financial trade-ofls of delivery decisions
such as	premium levels	for health care			services.	The
final	case study involves		a	framework	used by	the
Houston'	-Galveston Area	Counc i1	to	evaluate	the impact	ofGENERAL
CASE STUDIES - COMPARATIVE
Page 151
setting a limit on the number of short term generaL
hospital beds on a regional basis. Four different
extrapolations of past utilization rates are applied in a
decision matrix showing the possible consequences of each
decision if the assumptions turned out to be incorrect.
(NTIS)
Reference:
Paul Grigorieff, Nancy Lombardo and Lorrie Stuart/
Eiiaati aa	SLudias zl	SfiQmishfiQSiis
Elaiminax
Cambridge/ Mass.:	ABT Associates/ Inc., 1972.
Case studies describing the way in which statewide
comprehensive health planning (CH?) A-agencies achieve
successful outcomes are presented. Four CHP agencies in
Maine, Minnesota, Tennessee, and Washington were selected
for study. A flexible case study method was employed to
gather information. The issues investigated in two case
studies dealt with the CHP agency role in influencing the
passage of statewide legislation affecting health status
or services. In Washington, the legislation dealt with
<GENERAL
CASE STUDIES - COMPARATIVE
Page 15J
certificate of need for health facilities and services.
In Tennessee, the legislation applied to solid waste
disposal. The issue in Minnesota involved the development
of statewide policies and procedures for residential care
of the bahaviorally disabled. Three issues were studied
in Maine, all of which involved the CUP agency in program
development in the areas of health manpower education,
home health care, and emergency medical services. In an
assessment of CMP agency, CHP advisory council, and staff
involvement in these issues and strategies employed by C3?
agencies to deal with the issues, it was found that CM?
agencies in all four States played a highly innovative
role. Strategies employed by CHP agencies to address the
issues included financing, study and analysis,
implementation through 3-agencies, contracting out, joint
staffing between other agencies and A-agencies, public
information, lobbying, and serving as a convener of
already interested parties. (NTIS)
Reference:
Richard Llewelyn-Davies,
"Planning Health Facilities in Developing Countries
Case Studies and Their Lessons,"GENERAL
CASE STUDIES
COMPARATIVE
Page 153
jiAEld JiflS2XUlS,f. Vol.12, No- 3 , p.159-163, (1976).
The author first discusses the context within which
hospital planning takes place in the developing world and
second, describes two projects in Thailand and Bahrain
with which he was personally involved that illustrate i
different aspect of the subject. The first is a
description of the management of the planning process in a
particular project. The second is an account of how the
planning of a major new hospital was related to the
economic, technical and manpower limitations in an area of
scattered population.
Reference:
Edmund Ricci, Pat Sands, Don Benson, and Lois Whaley,
£t£a_t£iiies in SLfiiMUIliiZ Eliannioa i0£
Pittsburgh:	Univ. of Pittsburgh, 1974.GENERAL
CASE STUDIES - COMPARATIVE
Page 15 1
Case studies on emergency care planning in three
communitites are reported with emphasis on the geographic
and demographic characteristics of the communities, the
status of emergency care programs in the 1960"s, emergency
care planning activities, and a description of each
community's emergency care system and potential for
improvement. In the first community, one of the 10
largest population centers in the United States,
statistics for 26 voluntary hospitals during the
mid-196C's show that emergency rooms handled over 250,003
patient visits annually. In 1963, approximately 13,000
medical emergency calls were handled by police. Ambulance
service was also available, although the ambulances were
unequipped and staffed with untrained personnel. The
second community involves 30 political subdivisions over a
50-square-mile area. A significant increase in the use of
hospital emergency rooms was observed in this communit/
during the period from 1967 to 1973. Emergency care was
provided to community residents by hospital emergency
departments, physicians in their offices, and 16 ambuianci
services. In the third community, over 75 percent of the
residents live in urban centers. Ambulance care in the
miu-1960's was provided in this community by a volunteer
fire department and funeral homes. No specializej
training in. emergency care was required for hospital
emergency room nurses and physicians. The reportGENERAL
CASE STUDIES
COMPARATIVE
Page 155
concludes that health planning methods can have a dramatic

‘impact on the less cosmopolitan areas, and elements for
success are prescribed. (NTIS)
Reference:
S. Richard Sauber,
“State Planning of Mental Health Services,"
Amaiicim JsuLaal qI C&affluniii	voi.4, no.i,
p.35-45, (March 1976).
4
The findings of a study of 14 State departments of
ited. The following State;
Lrizona, California, Colorado,
Massachusetts, Pennsylvania,
itributing data to the stud/
uded Florida, Kentucky, New
Virginia. Interviews were
als from 12 States, excluding
lation obtained in the course
:he State department of mental
ia1 policies such as revenue
k
mental		health	are	pr ese
par ticipa		ted in	the study:	
111inoi	S/	Indiana, Maryland		
and Rho	de	Isi and	. Stat	es co
on an	i	nformal	basis	inc
Hampshi	re	, N a w	York,	and
conduct	ed	w i th	State	off ic
New V.or	k	and Flo	rida.	Inf or
of int	er	views	related	t 0
health;		the imp	act of	natio
sharing		on Sta	te planning	
vGENERAL
CASE STUDIES - COMPARATIVE
Page 156
factors affecting the planning, organization, and delivery
of mental health services? and major issues and trends,
including administrative practices, service delivery
systems, manpower developaient, and prevention- Most State
officials were concerned with and committed to
intervention strategies and service delivery systems.
Most States classified their programs as somewhere between
clinical psychiatric and public mental health
organizational models. There was a significant trend in
focus from the level of a single organization to that of a
network of organizations. Interdepartmental changes
within the States are examined. The organizational
structure for mental health service delivery in the 11
States is discussed, and planning issues are delineated.
(NT IS)
)HLIH/HLTH SYSTEM CHARACTERISTICS RELATED TO PLNG Page 157
Reference:
Donald S. Ardell*
’’From Omnibus Tinkering to High-Level Wellness:	The
Movement Toward Holistic Health Planning”*
laiS£l£jJD Jfluinal si iisalih Elannina/ vol.i, No.2* p. 15-34*
(Oct.1976).
This article outlines the growing emergence of 3
’’wellness” or ’’holistic health” movement* recognizes tns
Canadian Government's important contribution to the
wellness literature, provides a conceptual framework for
the principal elements of wellness* notes a set of
assumptions regarding wellness and health planning* and
identifies aspects of P.L. 93-641 which enable healtn
planners to pursue new kinds of health-promotive
initiatives. The relationship of lifestyle an 3
environment to well-being is emphasized* and a set of
wellness activities is set forth as illustrative of
wellness programs amenable to health systems agency (HSA)
functions. Finally, certain implications of the wellness
movement for individual health planners are noted.HLTH/ULTH SYSTEM CHARACTERISTICS RELATED TO PL.'JG Page 158
Relerence:
W. L. Blockstein,
"Current Concerns in Health and
Planning Process"/
American Journal al Ehannazir
(Mar-April 1977).
Their Relationship to the
Vol.149, No. 2,	p.37-44,
The paper treats some of the current concerns in
health and sickness care and the author offers comments
based on his personal experience or readings and study.
In drawing conclusions/ a prescription for continued
study/ exploration, and experimentation, is presented, a*
well as a strong suggestion how planning can play its part
in dealing with very large and quite expensive social
matters that are, at the same time, terribly personal
issues. These issues revolve around health and health
education, illness and sick care, health manpower
education, provision for health facilities, and health
manpower distribution.
Reference:
Henr ik L.	31u:n,
iHLTH/HLTK SYSTEM CHARACTERISTICS RELATED TO PLN'G Page 159
"From a Concept of Health to a national Health Policy",
Aasiican Jauinal al ilsjlih £laanin.S/ Vol.i, No.i, p.3-22,
(June 1976).
The author rev
diminish populatio
basic health prob
inequitable access
costs of care) and
financing and organ
in the way we selac
the priorities s
interrelationships
importance of int
prob 1 eios.
A general syst
health, the evide
summarized, and a n
multiple "Health
Centers" is outline
lews the forces which contribute
n health levels. He identifies
lems (unacceptable health s
to medical services, and the esca
suggests major changes in mod
izing the delivery of medical ser
t and train medical manpower, a
et in health-related research,
of each area are emphasized, as i
erconnected strategies to addre
ems the
nee of
ational
Care D
ory is pres
impact	f
health	po
elivery	Sys
ented in rel
or specific
licy focuse
terns" and "«
ati
for
d
ell
d.
to oc
three
ta tus,
fating
es of
vices,
nd in
The
s the
ss the
on to
ces is
around
-Being
Reference:
i
IHLTH/HLTH SYSTEM CHARACTERISTICS RELATED TO PLUG Page 160
David Cardus and Robert M. Thrall,
“Overview:	Health and the Planning of Health Care
Systems",
Preventive Yed;cipeYol-6, uo.l, p.134-142, (March 1977).
Implicit functions of a health care system which are
omitted or improperly emphasized are the study and
promotion of individual health. This situation stems from
the fact that health care systems are primarily based on
the concept of disease, while the attributes of health
(positive health) have not been investigated and
objectively defined. However, an operational definition
of the elusive concept of health appears possible today
and is discussed in this paper. If the hypotheses that
health can be improved and deterioration due to age can be
retarded are accepted, then the consequences of these
possibilities must he analyzed in relation to the planninj
of health care systems and to the planning of national
health care programs. Thus, any attempt to describe the
natural history of the health process must include the
effects of intervention aimed at the promotion of health
in the absence of disease. These effects must be defined
so that quantitative criteria, which would serve as the
basis for predictive medicine, can be established.
Quantitative predictive medicine is necessary in order tj
I
kHLTH/HL7H SYSTEM CHARACTSRISTICS RELATED TO PLNG Page 15L
evaluate the elfectiveness of preventive measures. While
it is widely recognized that the prevention of disease is
one of the major goals of a health care delivery system/
the methods presently used to evaluate alternative courses
of action are notoriously limited.
Reference:
Rick J. Carlson/
"Planners and the End of Medicine"/
AafitisLaa Jamaal al hsaLtb. LLaaaiaa/ Vol.i/ tfo.i, p.32-37,
(July 1376).
There is a growing belief that a new medicine is
emerging. The reasons tor its emergence are many/ but
central among them are the dramatic rise in medical care
costs; the mounting evidence regarding the "limits" o£
medical care to produce health; and the promise of man/
alternative approaches to achieving health/ more
"holistic" in nature than modern medical care.
Yet for ail the enthusiasm/ the political/ economic/
anu social carriers to the transformation of medicine are
formidable/ even though there are many promising signs of
iHLTH/HLTH SYSTEM CHARACTERISTICS RELATED TO PLNG Page 162
change. These barriers can and should be overcome, but
the task will be hard, and all the more difficult if tha
’’politics" of change are not squarely faced.
Reference:
Donald L. Fink,
"Holistic Health:	Implications for Health Planning",
Aa-axlcaa JmixDal Hftalili ElanciiiSr Vol.i, Ho. l, p.23-31,
(July 1976).
Holistic Health is a term being used currently to
decribe concepts and practices in health care that
transcend or radically alter current health cara
practices. Included under this rubric are concepts of
humanistic medicine, alternative health care, pre-primary
care, and altered provider-patient relationships. The
content and linkage of these concepts and practices have
profound implications for the U.S. health system and for
the health planner. Despite the primitive state of many
of these techniques, increasing public attention to
holistic health can be expected because of the promise it
offers of reduced costs, more efficient utilization of
4
4HLTH/HLTH SYSTEM CHARACTERISTICS RELATED TC PLNG Page 163
limited resources/ and better results.
Reference:
Arnold D. Kaluzny and James E. Veney,
"Types of Change and Hospital Planning Strategies"/
Aaetitjm iIoutuaL Q.I iLaaltti Eldanlna/ voi. i, No. 3/
P«13-19, (Jan. 1977).
A major purpose of health planning agencies is to
promote constructive changes among health institutions
that are in the public interest. The approaches to
promoting such changes in hospitals are examined in this
article. The focus is on three types of change/ the
relationship of change to the environment/ and three kinds
of control mechanisms.
Reference:
Philip p. Lee./
"A New Perspective on Health/
Health Planning/ and HealthHLTH/HLTH SYSTEM CHARACTERISTICS RELATED TD PLNG Page lo1
Policy",
Jgucnal al Allied health, Vol.6, Mo.l, p.8-15, (Winter
1977).
The article	proposes an	approach	to	health	policy
that can lead	to a more	rationa 1	use	of the	U.S.'s
resources to meet the nation's health needs.
This new approach to health policy can be translated
into action by the Federal government's pursuit of two
goals. The first is to improve the health of the people
by attacking the changing causes of ueath and disability
in the United States and by restoring the concept of
individual responsibility for healtn. The second goal is
to complete the task of making it possible for all
Americans to have access to adequate health care, to 03
able to pay for necessary care, and at the same time, to
reform the system of providing and paying for care so that
its costs will not continue to overwhelm other national
priorities.
Reference:
Philip Lee,HLTH/HLTH SYSTEM CHARACTERISTICS RELATED TO PLUG Page
l55
"Frontiers of Health Planning,"
American JsuLnal si Haallti Pianaiiiai Vol.i, no.ii, p-1"0'
(Oct. 1976).
The potential of health planning to deal with
questions of lifestyle, the environment, ana a changing
concept of illness is discussed in relation to P-L*
93-641. a broader view of health planning than has been
traditionally accepted includes a health care system whose
goal is health, not just the relief of pain and treatment
of disease. Such an' approach must deal with both
individuals and populations. The Canadian health fieii
concept considers the problems of health and disease frou
a policy and planning perspective. The nature of illness
in the United States is shifting from infectious disease
to chronic disease. Although improvements in medicine
combine to contribute to declining mortality, lifestyle
and environment remain important factors in health status.
The application of these ideas to planning requires s
greater understanding of the impact of both environmental
and medical factors on health status. No matter what
framework is adopted, the obstacles of shifting from a
health care strategy to a health-promoting strategy are
formidable. it is concluded that a new conceptualization
of health policy and health planning should emerge, basedHLTH/HLTH SYSTEM CHARACTERISTICS RELATED TO PLNG Page 155
on a broader base of research. (NTIS)
Reference:
Nancy Milio,
"An Ecological Approach to Health Planning for Illness
Prevention"/
American Jim-tnal cl itealili Siaxminnx Voi.2, No.2,	p.7-ii/
(Oct.1977).
Myriad recent articles	and	reports	have analyzed		the
sources of growing concern		about	current	planning	
approaches to health care.	The	brief	overview	of	the
nature of modern illness which follows will help reveal
why traditional planning strategies are limited in their
potential impact on the health of modern populations.
From this will be derived some possibilities for
developing new/ more effective strategies for dealing with
contemporary illness patterns by health systems agencies.HLTK/HLTH SYSTEM CHARACTERESTICS RELATED TO PLNG Page 157
Reference:
Charlotte Muller/
"Health at What Price! Some Motes tor Comprehensive
Health Planners/"
AT etic an Journal 2l ElifcliS Hfialliix Vol.59, No. 4,
p.651-656/ (April 1969).
The relationship between the pricing of health
services and the structure of the system for their
provision and delivery is discussed as it pertains to
hospitals and related facilities. The effects of price
movements w	i thin	the health	field	on nonhealth
expendi tures	are	identified as follows:		(1) if certain
health items	have	suostitutes at	a lower cost/ some	
portion of	the	consuming public	will	seek out the
substitutes; (2) if such substitutions are not feasible
or are not acceptable to the patient/ health care may
either be consumed in lesser amounts at a given income
level or else draw away from spending on food/ housing/
clothing/ and education; (3) the cost of health care may
compete in the family budget with saving a portion of
disposable income; and (4) if the patient accepts the
designation of medical indigency/ he will apply under
public programs and leave the private market far care/ but
only in the sense that the financial concern isHLTK/HLTH SYSTEM CHARACTERISTICS RELATED TO PLUS Page 168
r,<rfprred Prom individuals to the public sector. The
transiei •. -
health services pricing structure reflects a variety of
organizational configurations and is subject to great
changes in the sources and flow of health care financing.
Specific	influences	on the pricing structures	of
physicians and of hospitals are pointed out, and proven
and potential effects of changing pricing structures on
the framework within which these providers deliver health
care are	discussed. Current	demands	on hospitals	to
improve efficeincy in the production of health care are
discussed, and ways of meetings these demands are noted.
(NT IS)PLANNING LEGISLATION
Page 169
Reference:
Arthur A. Atkisson, and Richard M. Grimes,
"Health Planning in the United States:	An Old Idea with 3
New Significance",
UauxuiU. iLsalib Ealiiicsx EaliiYx and Lasr vol.i, No.3,
p.295-318, (Fall 1976).
This paper examines major features of the U.S.
National Health Planning and Resources Development Act of
1974 (P.L.	93-641), a piece of legislation that would
radically restructure the health planning system of the
United States. The Act combines several, previously
uncoordinated, health planning and health resources
development agencies into one coordinated program. The
program is to consist of a statutorily restricted federal
agency which will generally oversee the operation of the
program, a state program directed by a consumer-dominated
board and a series of locally based, generally private,
nonprofit, consumer-dominated corporations ("Health
Systems Agencies") which will carry the bulk of tn»
planning functions.
The resource development portion of the act grants
funds for a variety of programs. These include both
grants and loans (at very favorable interest rates) for
medical facilities. In addition there are funds availablePLANNING LEGISLATION
Page 170
lor innovative projects which hold the prospect of
improving health services and environmental conditions
within the community.
The act also provides the states and local
organizations with substantial power over a large portion
of the allocations made under the Public Health Act and
specifies the process by which health planning must be
carried out. Each local planning agency must design a
long range health plan for its community and prepare 3
one-year plan for carrying out portions of the health
system plan. These two documents then are used to create
State Health plans, plans for construction, modernization
or conversion of health facilities and criteria for
judging the appropriateness of health services offered in
the local areas and in each state.
The act seems to create a mechanism whereby th2
health industry could be quickly converted into a heavily
regulated industry. This regulatory process could be
implemented in conjunction with national health insurance
or by itself.
Reference:
Roger Battistella,PLANNING LEGISLATION
Page 171
"The Course of Regional Health Plannniny:	Review and
Assessment of Recent Federal Legislation",
Medica1 £ax£/ Vol-5, No-3, p.149-159, (May-June 1967).
Recent legislation in response to mounting pressures
in the provision of health care points to an expanded and
more vigorous role for the principle of regionalization in
the planning, organization, and delivery of services,
fohich of two major paths this development will follow is,
however, somewhat unclear.
On the one hand, there is the revolutionary path
suggested by the Heart Disease, Cancer, and Stroke Act in
which traditional state and local governmental channels
and political boundaries can be bypassed for the sake of
administrative units based on more functional criteria.
The second path followed by the Comprehensive Health
Planning Act is more orthodox and involves the use of
traditional state and local health administrative channels
and boundaries.
The merit of either approach notwithstanding, this
article concludes that the major thrust of development, at
least in the short run, will, because it is less radical
and more likely to gain the support of the state and
established health power structure, follow the second
course. Attention was drawn to ongoing regional healthPLANNING LEGISLATION
Page 172
progress in New York State as a possible pattern to be
followed by states in meeting the leadership opportunities
handed them by the Comprehensive Health Planning Act.
Reference:
T. J. Brooks/
’’Regional Health Planning:	What To Look For”,
Journal q! Mississippi Siais Mfidical Asspsiaiipos Voi.17,
No.9, p.271-274, (Sept.1976).
P.L.	93-641 seeks to establish the basis for
developing regional systems of care with emphasis oh
primary care services. This is to be accomplished by way
of a regional-influence Health Systems Agency with
planning and implementation responsibilities. Heretofore,
there have existed at the state, regional and local levels
planning bodies with authority and dimension insufficient
for coming to terms with a multidirectional health care
apparatus. In financing, the notions of achieving better
and more health care will continue to imply community and
community/governmental responsibilities beyond simple
cost/sharing.PLANNING LEGISLATION
Page 173
Probably all modern substantive issues in health care
will be decided by providers in concert with a more active
and inquisitive consumer and elected constituency.
Hopefully, P.L. 93-641 will provide the avenue for
expanded cooperation between these groups.
Reference:
William Curran,
'•Present at the Creation:	Health Planning and the
Inevitable Reorganization,"
flaaliti £at£ HdQaaamaiilx. vol.i, no.i, p.33-43, (1976).
A critical review is offered of comprehensive
planning under the Comprehensive Health Plannin
Public Health Service Amendments of 1966	(P.L.	8
and the National Health Planning and Resources Devel
Act of 1974 (P.L.	93-641) by a former member of th
England Regional Advisory Committee for Compreh
Health Planning. Criticisms of the earlier years
to problems of the scope of the initial compreh
health planning effort, the design of the basic str
for State planning bodies,
health
g and
9-749)
opmen t
e Maw
ensive
relate
ensive
uc ture
and the methods used toPLANNING LEGISLATION
Page 174
establish areawide planning agencies. The competitive
grant mechanism is said to have produced an uneven and
inequitable distribution of areawide agencies across the
nation. Other	criticisms	relate to the Federal
orientation of	the local	agencies and to the
representation	requirraents	of comprehensive healta
planning boards. P.L. 93-641 attempts to deal with many
of the most serious problems of the earlier legislation.
It is suggested that the most serious and legal problems
in reorganization under P.L. 93-641 may be associated
with its overexpansive scope/ coupled with inadequate
fiscal/	managerial/ and legal means to achieve the
widespread goals of the legislation. It is observed that
the history of government and law in the United States is
largely contrary to cooperative/ step-by-step planning to
accomplish national goals - except in war. Despite
improvements over earlier legislation/ P.L. 93-641 is
seen as containing the seeds of bureaucratic confusion/ as
well as provisions for the Federal	Government to
'leapfrog' the States to regulate local agencies. It is
concluded that considerable sophistication and common
*
sense at the regulatory level will be needed to make the
law work
(NTIS)PLANNING LEGISLATION
Page 175
Reference:
R.B. Greenberg,
"Federal Health Planning, Part 1:	Legislative
Background",
Aa.sxix.an JxiiiMl si iissniial EJiaxaaxY/ voi.33, no.io,
p.1049-1051, (Oct.1976).
The author discusses O.S. federal health planning
legislation and describes the effectiveness of the early
legislative initiatives in health planning — the
Hill-Burton, Comprehensive Health Planning and Regional
Medical Programs.
Reference:
R.3. Greenberg,
"Health Planning, Part 2:	The National Health Planning
and Resources Act of 1974",
A&sxican iLsnxnal al iics2ii.al EhaxaaxYv voi.33, mo.ii,
p.1211-1214, (Nov.1976).
The author discusses the National Health Planning andPLANNING LEGISLATION
Page 176
Resources Development Act of 1974, with particular
reference to national guidelines. Health Systems Agencies,
state planning and development, technical assistance from
H.E.W., and the purpose, plan and state approval of Health
Resources Development. He concludes that the Act attempts
to eliminate the problems experienced in earlier federal
health planning efforts through a variety of methods.
Specific funding and staffing requirements are designed to
assure uniform and effective operational capabilities by
planning agencies. Detailed minimum standards,
responsibilities and functions also will attempt to focus
upon specific national planning needs and provide
direction to planning agencies now functioning as part of
a national system. Coordination of all planning, both
upward and downward, may bring order and rationality to
what had heretofore been an underfunded, undermanned,
dislocated and chaotic effort at health planning.
Reference:
"Health Planning — Unresolved Questions",
Hulletin	AaaLic^n Calleqe o£ EhysisianS/ Voi.17, No.10,
p.18-20, (Get.1976).PLANNING LEGISLATION
Page 17 1
The article discusses U.S. P.L. 93-641 and
describes a number of problems which must be addressed
before the organizational and philosophical framework
envisioned by Congress is actualized. Problems discussed
include (1) the health system and annual implementation
plans; (2) HSA/PSRO data sharing and cooperation; and
(3) certificate of need review.
Reference;
M&allli Sislaas ElaaoiBai An lDiL2du£to£Y Guide iat Eudiis
Lea 22=641 EetiiciueniSx
Providence:	Rhode Island Dept, of Health/ Jan. 1976.
Health systems planning is discussed in relation to
the National Health Planning and Resources Development Act
of 1974 (P.L.	93-641). One important feature of this Act
is that it reduces the amount of fragmentation/ conflict,
duplication/ and overlap which previously existed in U.S.
health planning.	P.L. 93-641 combines the following
health	planning	activities;	Hospital	Survey and
Construction Act (Hill-Burton); Heart/ Cancer/ and Stroke
Amendments (Regional Medical Program); and ComprehensivoPLANNING LEGISLATION
Page 179
Health Planning and Public Health Service Amendments
(Partnership for Health). The law also calls for a health
planning process which will result in the production of
specific health plans at the Federal, State, and local
level. The purpose of planning, it is noted, is the
improvement of decision-making. The health systea
planning process is examined. It is recommended that both
health status and health service goals be established in
such planning, and the relationship between goals and
problems in the planning process is illustrated. 1
four-step planning methodology is identified which
involves system investigation, ends establishment, means
selection, and intervention evaluation. It is noted that
P.L. 93-641 calls for the coordinated implementation of
three functions: health systems planning, resource
development, and regulation. (NTIS)
Reference:
Arthur Jacobs and Richard Froh,
"Significance of Public Law 89-749 and Comprehensive
Planning",
Nfiw LngJUnd jiautnai al ‘dediaias/ voi.279, no.24,
p•1314-1318, (12 Dec.1968).planning legislation
Page 179
The actual operational impact of Public La* 89-749
will not be clearly visible for some time. Regardless of
how the law is implemented/ it brings forth new approaches
for the health system such as planning for the functional
system/ the addition of planners to the health team/
regionalization/ consumer involvement in the
administration of health services/ federal funds for broad
areas of human need rather than for narrow categories and
delegation of decision making from the federal to the
state and local level. There are both advantages and
disadvantages in planning for a pluralistic society but
Public Law 89-749 - Comprehensive Health Planning - should
provide a catalyst so that the variety of special interest
groups that comprise the health system can change their
behavior. Behavior can be changed in the light of an
understanding gained by study of the functional system aj
opposed to study of its component parts. The social
significance of Public Law 89-749 is that it attempts ta
impose order and produce change in the health system while
avoiding the lack of responsiveness to local needs and the
inertia to change inherent in a health system with
centralized decision making.PLANNING LEGISLATION
Page 130
Reference:
E.J. Krill/
"A Critical Assesment of P.L. 93-641”/
Hqgpital EiaatssS/ Vol.57, No.3/ p.66-70/96/(March 1976).
The impact of P.L. 93-641 yill be cumulative/ with
apparently inconsequential early decisions and actions
forming the basis for later substantial regulatory moves.
The law's requirements include health systems/ annual
implementation/ and appropriateness review plans/ the
latter of which has significant enforcement potential.
Because the law provides a basis for complete federal
regulation of health care/ administrators should develop a
strategy for dealing most effectively with its provisions.
Reference:
R.E. Macstravic/
"Planning System/Hospital Relations:	Phases and
Fallacies"/
tiosailal PxaaLSSSr Vol.57, No.3/ p.53-8/65/ (Mar.1976).PLANNING LEGISLATION
Page 191
The relationship between public health planning
councils and individual hospitals in the U.S. has entered
a fourth phase. Each prior phase has been characterized
by logical fallacies/ some of whose effects have been more
harmful than others. P.L. 93-641 offers the opportunity
for a new relationship between planning agencies and
hospitals/ one in which planners propose and hospitals
dispose instead of vice versa.
Reference:
baking Hie laiifliml lifidilh Elanaiaa UaM	Ihs. 3-laia
Perspective - A R£afi£l qL ths Mtipual Ilealth Planning
Cfla-sarliunu
Washington/ D.C.:	National Governor's Conference/ Feb.
1977.
The implementation of State policies pertaining to
! }
health planning are considered in relation to the passage
l
of the National Health Planning and Resources Development
Act of 1974	(P.L.	93-641). In 1975/ the Committee on
Human Resources of the National Governors' Conference
established a consortium of 22 states to advise governorsPLANNING LEGISLATION
Page 182
on the implementation of P.L. 93-641. Through committees
of the consortium/ 23 problem areas in the implementation
of P.L. 93-641 were identified and 91 recommendations
were made. Issues related to the review of institutional
health services mandated by the Federal law are examined.
Recommendations are made regarding certificate of need,
the separate review of institutional health services/ the
coordination of functions assigned by P.L. 93-641 to
various agencies and advisory bodies/ the relationship
between the State health planning and development agency
and health systems agencies (HSAs) in States with only one
such agency/ coordination among States in an interstate
health service area and among HSAs in a multiple agency
interstate metropolitan area/ planning and financing of
hospital construction and modernization under title XVI/
data sources and needs for health planning/
appropriateness of health services/ projects supported by
area health services development funds/ and rainimua
funding levels for health planning agencies. Appendices
list the consortium participants/ provide a comparison of
regulatory provisions relating to State activities under
P.L. 93-641/ and include a glossary and an index of
issues by consortium committee. (NTIS)PLANNING LEGISLATION
Page 183
Reference:
J.J. May,
"Will Third Generation Planning Succeed ?"/
Hospital £xiiirs5§/ Vol.57/ No.3/ p.61-5/ (Mar.1976).
The
legislati
structure
program
po al
the law
leadersh i
with ad
legislati
chance.
U.S.'s third generation of health planning
on/ P.L.	93-641/ promises/ at least
lly/ to be the most adequate and effective
he -tofore. But difficult technological/
/ and physiological problems are likely tz plague
regardless of its structure. Only sound
p at the local/ state and federal level/ coupled
equate funding from multiple sources and
ve patience/ could give the law a fighting
/
Reference:
John T. O'Connor/
"Comprehensive Health Planning:
Memorial Earna i)iia£ifiiiy,
Dreams and Realities"/
Vol.52/ No.4/ p.391-413r
(Fall 1974).PLANNING LEGISLATION
Page 134
Comprehensive Health Planning legislation was signed
into law by President Johnson on November 3, 1966. Since
that time frequent attacks have been made on CHP agencies
for an alleged lack of significant accomplishment. This
article considers such criticisms in the light of the
objectives of CHP legislation, the dimensions of tna
problems involved in effecting change in the American
medical care system, and the provisions of the legislation
itself. The role which planning for health care is likely
to perform in the future is also examined.
Reference:
L.M. Perez,
"The iNational Health Planning and Research Development Act
- PL. 93-641",
jJLqU£U21 Lhz El^£jda Jifidic^i £sS££.Uti2Q, Vo 1.63, No. 5,
p.429-31, (June 1976).
The author criticizes P.L. 93-641 as vague and as
having hidden political implications. He believes that if
one follows the history of U.S. federal intervention in
the health delivery system, the final result will be anPLANNING LEGISLATION
Page 135
all-powerful National Health Organization with absolute
control over the whole system.
Reference:
Leonard S. Rosenfield and Irene Rosanfield,
’•National Health Planning in the United States:	Prospects
and Portents"/
iDljexuaiiimal dmiiaal o£ Ihs. Isalli] Ssmisss/ v01.5, no. 3,
p.441-453/ (1975).
The National Health Planning and Resources
Development Act of 1974 in the United States demonstrates
a growing determination in Congress to motivate the system
of health services toward greater efficiency in
utilization of resources. The Act was designed ta
overcome some of the weaknesses in earlier planning
legislation. More complete coverage and more functional
local jurisdiction should result. The Act provides better
financial support/ and more effective incentives and
inducements to assure adherence to plans. Concern is
expressed about aspects of the legislation which the
authors feel may deserve consideration. The principle ofPLANNING LEGISLATION
Page 135
delegating responsibility to voluntary agencies for
disbursement of public funds is questioned, and the
authors suggest that local public health authorities apply
for designation as planning agencies. Reservation is
expressed about the adequacy of regional organization as
provided by the Act to accomplish its purposes, and the
authors recommend demonstrations of regional
administrative agencies to implement plans developed by
Health Systems Agencies. Failure to incorporate the
provision of the House planning bill to set up a national
health policy council in the Act is considered
unfortunate. Persistence in pursuing the course outlined
in the Act is urged.
Reference:
E.J. Rubel,
"Implementing the National Health Planning and Resources
Development Act of 1974",
Public Hea 1 th fiapQL.LS/' Vol.91, No.l, p.24-28, (Jan-Feb.
1976).
The author summarizes the U.S
National HealthPLANNING LEGISLATION
Page 137
Planning and Resources Act of 1974 (P.L. 93-641) and the
initial problems and regulations in establishing the
framework and organization for its implementation.
Reference:
Steven Sieverts,
BiaDDiua Lsauas and Euiilic. Laa llzMlz.
Chicago:	American Hospital Association, 1977.
Indepth issues of the National Health Planning and
Resources Development Act of 1974	(P.L.	93-641) are
explored in a text directed to those charged with the
responsibility to make the law work. The health systems
agencies (HSA's)	are compared with	the	areawide
comprehensive health planning agencies (Clip's) and the
similarity of the HSA to the CHP should enable HSA's to
build on the pragmatic experience of the CHP's.
Governance of HSA's are described in terms of members, and
advisory committees. Statutory restrictions on public
agencies becoming HSA's are detailed,	and	possible
conflicting interests and accountability aspects are
noted. The functions of HSA's in plan development arePLANNING LEGISLATION
Page 133
characterized as development of areawide plans, promotion
of institutional planning, participation in resource
allocation, and advocacy of health and health systems.
The functions of HSA's in review of Federal grants are set
forth in relation to the Office of Management and Budget
Memo A-95 and to the States, and exemptions are noted. In
detailing the functions of the HSA's in providing
assistance in planning, it is suggested that HSA's may
significantly affect local entities. The area health
services development fund (AiJDF) is discussed and use of
these funds is described. Statutory requirements and
delegation of functions of State Health Planning and
development agencies are noted. Reasons for certificate
of need (CON), and the purpose, function, and working of
CON are treated. provisions for periodic review of
institutional health services, interstate HSA's, statewide
HSA's, and the size of HSA's are covered. (NTIS)
Reference:
Steven Sieverts,
"Putting P.L. 93-641 into Proper Perspective,"
liSiisiliglSz. p«125, 12b/ 128, 130, (16 June 1976)PLANNING LEGISLATION
Page 189
Planning perspectives associated with the
implementation of P.L. 93-641 are discussed. The
statement is made that future Federal initiatives will
increasingly focus on the use of public controls to effect
changes in the health system. It is felt that the
National Health Planning and Resources Development Act
(P.L. 93-641) failed to achieve comprehensive health
planning on a national scale. Historical aspects in the
development of health legislation and P.L. 93-641 are
reviewed. Major criticisms of comprehensive health
planning are identified, based on the belief that the
major problem in such planning is the result of a
fundamental misconception of institutional decisionmaking
dynamics in the health system. Certification of need and
health systems agency (HSA) components of P.L. 93-641 are
detailed. It is envisioned that there will be continual
increases in the extent of public regulations on the
health system. Some increases will move in the direction
of federally mandated activities by State governments an!
by essentially nongovernmental bodies such as professional
accreditation and certification bodies. Other increases
will represent attempts at stricter direct controls over
the spending of Federal funds for health, and still other
increases will continue to be State activity without
significant Federal direction. A chronology of majoc
Federal health planning legislation is presented. (NT1S)PLANNING LEGISLATION
Page 190
Reference:
Donald Smith/ Thomas Jones, and Elizabeth Downs,
"National Health Planning Act:	Significance for Mental
Health Agencies,'1
Hospital and Cnimiinii^ EaYchiaioi* Voi.27, No. 6,
p.393-397, (June 1976).
The significance of the National Health Planning and
Resources Development Act of 1974 (P.L.	93-641) for those
who plan, administer, and deliver mental health services
is discussed, and steps that can be taken by mental health
administrators to maintain responsibility for planning
their programs while ensuring coordination with general
health planning activities are suggested. Nine areas are
identified in which P.L. 93-641 has particular meaning
for mental health programs:	planning boundaries; data
base requirements; State and local planning requirements?
approval of use of Federal funds; institutional
reporting? institutional health services review; capital
expenditures review; area health services development
funds; and medical facilities construction. Mental
health administrators are urged to take the following
steps:	build a strong central office planning capability:
reexamine existing regional boundaries;	contact
counterparts in health planning to determine their status
<PLANNING LEGISLATION
Page 191
in health systems agencies and State administrative
programs; develop and document Planning relationships?
join or organize a staff team to explore methods of
establishing and updating a common set of data; direct
the team to adopt a uniform method for mental health
planning; reexamine insitutional cost control and
reporting systems? brief planning staffs on plans for
improving institutional services; assist in drafting
legislation to bring certificate-of-need programs into
conformity with national standards; determine ways of
using area health services development funds effectively?
and involve general health planners in developing plans
under the Community Mental Health Centers Amendments in
1975. (NTIS)
Reference:
S. Stiles and K. Johnson/
“Regulatory and Review Functions oi Agencies Created by
the Act"/
Eyblic ilsaliil &SE.QJC1S/ Vol.91, No.l, p.24-28/ (Jan.-Feb./
1976).
iPLANNING LEGISLATION
Page 192
The authors describe the major regulatory and review
functions of the agencies created by the U.S. National
Health Planning and Resources Development Act of 1974.
These include: (1) review of new institutional health
services; (2) review of existing institutional health
services; (3) regulation of rates for provision of health
care; and (4) review of proposed uses of funds provided
by federal programs. They conclude that planning agencies
will increasingly focus their regulatory and review
functions on (1) promoting alternative methods of health
care and (2) discouraging the growth of health care
facilities where it will unnessarily increase the cost of
health care.
Reference:
Stanley Berlin, Alexandra isalcott and Michael Joroff/
"Implementing Formative Health PLanning Under P.L.
93-641",
liJLM	ilQUIDal 0.L	Vol.295,	No.13,
p.698-703, (23 Sept. 1976).
The National	Health	Planning and Resources
PLANNING LEGISLATION
Page 193
Development Act of 1974 (P.L. 93-641) melds the
Hill-Burton program. Regional Medical Program and
Comprehensive Health Planning into a new network for
health planning and resources development- Health systems
agencies will possess broader powers than predecessor
agencies, particularly in the areas of regulation, control
of federal funds, resources development and
implementation. P.L. 93-641 thus offers the possibility
of transforming the basic concept of health planning from
reactive to "proactive". Successful legislative
implementation will require each health systems agency to
build local legitimacy, ensure constructive
consumer/provider dialogue, and respond to state and
national managerial requirements- Many questions about
planning implementation, the role of subarea councils,
agency co-ordination and local governance remain
unresolved. The new health-planning network has the
potential to assume the function of active system
transformation, but will be critically dependent on
adequate program budgeting to fulfill this promise.
i
PLANNING GROUPS
GENERAL
Page 191
Reference:
As.s£5£JB£Di al Ra&LassnXalian and Ratlin Xat MSA aaj
SMEMs* lalama U
Silver Spring, Md.:	Orkand Corp., 12 May 1977-
Volume I represents Phase I of a study to assess
minority representation among heaLth systems agencies
(HSAs) and State health planning and development agencies
(SHPDAs) boards and staffs and to develop criteria foe
assessing HSA performance and impact relative to the needs
of minority/disadvantaged populations which they serve.
The assessment of representation in HSAs and SHPDAs
involved the analysis of data collected by 8HPRD in 1975
on the number of individuals on HSA Governing Boards,
Executive Committees, and Professional and Support staffs,
as well as SHPDA Professional and Support staffs. Two
major concpets were utilized:	representativeness and
parity. Representativeness requires a comparison between
the	number of agency members who possess a given
characteristic and the total number of agency members.
Parity relates to the level of agency representation to
the characteristics of the local population. The report
presents an analysis of HSA and SHPDA representation and
parity and a data collection system capaole of monitoring,
on	a periodic or ongoing	regular basis, the
i
\PLANNING GROUPS
GENERAL
Page 195
representational characteristics of HSAs. (NTIS)
Reference:
and iiali Camaiisiliim of. Esalili Elanoliia Aa&n£.i££x.
Hyattsville, Ma. :	Office of Health Resources Opportunity,
Health Resources Administration, 1977.
A project sponsored by the Office of Health Resources
Opportunity, the Bureau of Health Planning and Resources
Development, and the Alcohol, Drug Abuse, and Mental
Health Administration focused on the composition of the
board and staff composition of health systems agencies
CHSA's) and State health planning and development agencies
(SHPDA's). The study assessed the composition of these
agencies relative to the provisions of the National Health
Planning and Resources Development Act of 1974. In
addition, an attempt was made to assess staff composition
relative to title VII of the 1964 Civil Rights Act on
Equal Employment Opportunity. Data were collected in June
1976 (134 HSA governing boards) and November 1976 (139 HSA
staffs and 47 SHPDA staffs). One finding was that
consumers on the average constituted 52.8 percent of thePLANNING GROUPS
GENERAL
Page 196
governing boards. Most of the HSA's Here uithin the 51-60
percent range prescribed by law; however, a feu had a
smaller or greater percentage. aiomen and lower-status
occupational groups tended to be underrepresented on
governing boards. Minority groups were generally
overrepresented on boards and executive committees,
although they were underrepresented in some HSA's. This
document reports on the following areas: HSA governing
boards and executive committees (overall composition,
consumer members, providers)? HSA staffs (overall
characteristics, expertise, racial and ethnic minorities,
women, age, salary, previous employment); and SHPDA
staffs (same topics as those covered under HSA staffs).
(NTIS)
Reference:
Joseph Holtzman,
R&aienal Elaanina aad CaaLdiaaliDfl 2tnusLiutas in Health
£aie - A Sacialaaical .Sledy*
Ann Arbor, Mich.:	University Microfilms International,-
1975PLANNING GROUPS
GENERAL
Page 191
Attempts over a 10—year period to create a regional
health care planning organization in central Connecticut
are examined in a study of decisionmaking loci and
mechanisms in regional health care systems. The study
focuses on the emergence of health care planning in the
29-town Capitol Region surrounding and including Hartford.
Data were gathered from documents and media reports and
through interviews and direct observation. Interest
groups are identified/ their goals explored/ and their
bases of power assessed. Particular attention is directed
to the roles of economic and political leaders as
proponents and opponents of regional planning and to the
participation or lack of participation in planning by
economic and political leaders/ medical school
representatives/ hospitals/ and other interests. The
analysis reveals a gradual shift in the status of the
players who interact in the health care sector/ a decrease
in the importance of certain power resources and an
increase in the importance- of others/ and a gradual
replacement of the local community by the region as the
most important sphere of interaction. Whereas the local
business community was once the major source of capital
funds as well as the center of control/ the emergence of
regional planning has marked the increasing importance of
Federal and State governments as centers of control.
Supporting documentation and a bibliography arePLANNING GROUPS
GENERAL
Page 198
provided.(NT IS)
Reference:
W.B. Howie,
"Problems of Area Planning,"
Hsaliil aulisliflr Vol.34, p.145-150, (May 1976).
Planning problems facing the area health boards
established under the 1974 reorganization of Great
Britain's National Health Service are examined. The
problems fall within two general categories:	external
influences that limit the power of tne boards to act; and
difficulties that arise in attempting to execute planned
policies. General influences on the planning freedom of
the health boards include the national planning policy
handed down to the boards, the allocation of funds to the
boards, the need to seek departmental approval for
proposed actions, and the influence of pressure groups.
Problems that arise in the process of planning are related
to the logic of planning (how to plan and what to plan
for); to finding resources; to making choices; and to
retrenchment,i.e., assessing services and terminatingPLANNING GROUPS
GENERAL
Page 199
those found to be inefficient or uneconomic. Other
planning problems center on the question of whether
rational planning can be achieved without violating
clinical freedom. It is noted that the area health boards
are faced with severe financial limitations and manpower
shortages. The boards must realize the constraints placed
upon them and work to devise effective planning processes
for dealing with their most immediate problems. (NTIS)
Ref erence:
Mark Secord,
"Damn the Planners - Full Speed Ahead,"
Hqspital Forusi/ Vol.19, No.l, p.8,9, 22 (June 19976).
Sources of antagonism between health planners and
hospital administrators are examined, and approaches to
bridging the gap between health systems planning and
hospital administrators suggested. It is observed that
the typical hospital administrator believes that, on the
whole, the existing system of health care serves the
public well, lie knows that changes are necessary, but
believes they should be gradual. Furthermore, thePLANNING GROUPS
GENERAL
Page 200
administrator tends to view steadily increasing regulation
of health care as a threat to the integrity of the system.
The planner^ on the other hand, sees the health care
industry as an unplanned nonsystem that does not serve the
public well. He tends to believe that radical change is
called for and that stronger government planning and
controls are required. It is suggested that there always
will be and should be 'healthy tension and disagreement'
between the two groups. However/ bridges should be built
between the functions of health systems planning and
hospital administration so that each group of
professionals can take advantage of the other's
perspective. Part of the antagonism is attributed to the
gradual manner in which planners have been handed the
responsibility for health industry regulation. The rise
of consumerism and the alignment of the health systems
planners with the consumer movement are identified as
another source of antagonism. The resulting gap creates a
situation in which health agency planners tend to become
out of touch with the services they are planning for.
Hospital administrators/ because of the demands of
managing a complex organization/ tend to focus on
implementation and often do not look beyond their
institutions to the larger health care system. It is
suggested that hospital administrators begin bridging the
gap by working with/ rather than in spite of planners.PLANNING GROUPS
GENERAL
Page 201
This means an open exchange of information and ideas
between the two groups. Administrators should also make
sure that the administration/planning gap has been bridged
within their own institutions. Planning efforts sponsored
by groups of hospitals should be encouraged/ and health
systems planners should incorporate financial and
organizational analysis into the plans they develop.
Efforts should be made for cross-pollination of planning
and administration at the personal level. (NTIS)
Reference:
fcayne Clark/
ELacskc fit Eutfi - Stale find Lfi&ai HfiJlih Elanuiaa Aa£H£i£5
Id lii£ Sfiylhz.
Atlanta/ Ga.:	Southern Regional Council/ Inc./ 1977.
The Southern Governmental Monitoring Project reviews
the legislative history/ background/ structure/ and
functions of 28 health system agencies (HSA's) in 11
southern States in this report. The main purpose in
evaluating the HSA's was to determine what problems the
agencies were encountering early in their development andPLANNING GROUPS
GENERAL
Page 202
to establish a base for evaluating the effectiveness of
the HSA program. In the summer of 1976 student interns
gathered pertinent information through interviews with HSA
directors, board members, staff members, and other persons
knowledgeable about the workings of the agencies. Tha
report opens with a summary of the legislative history of
the National Health Planning and Resources Development Act
of 1974 (P.L. 93-641), followed by a brief description of
the structure and functions of State and local planning
agencies. The main body of the report discusses the major
issues confronting the southern HSA's in the areas of
consumer representation, provider influence,
accountability to the public, board training, planning
delays, HSA governing boards, pressures by physician board
members, staff influence, and State versus local control.
The regulatory and review functions of the agencies are
discussed, with emphasis on the status of
certificate-of-need legislation in the South. The
activities of statewide health coordinating councils and
state health planning and development agencies are
reviewed. The study offfers recommendations for improving
the agencies" effectiveness in providing comprehensive
health planning and individual profiles of the HSA'S
examined. (NTIS)PLANNING GROUPS
GENERAL
Page 203
Reference:
&£l£££iQ3 USA £2X££ILLim EflilUSx
Fort Washington/ Pa.:	Health Planning Research Services/
Inc./ 1974.
Based on a review of procedures used by comprehensive
health planning 'a' and 'b' agencies for governing body
selection/ guidelines are presented for use by health
systems agencies (HSAs) selecting the membership of the
governing body. Whatever method of selction is used/ the
HSA should first:	(1) decide on the size of its governing
body; (2) specify how many seats will be held by
providers and how many by consumers? (3) make certain
that it is familiar with the requirements of P.L. 93-641
and the regulations regarding membership? (4) acquire a
demographic profile of the region to determine what types
of consumers or	consumer organizations	must be
represented; and (5) prepare a draft list of the types of
organizations or representatives needed to fulfill
requirments. Once the composition of the governing body
has been determined/ the agency must consider how it will
locate and select the members. Selection	processes
include election from total membership/ self-selection/
membership by appointment from outside organizations/
government appointment/ and subarea appointment orPLANNING GROUPS
GENERAL
Page 201
election. Locating is the process by which potential
candidates for membership on the governing body are
identified. Candidates are usually located by a
nominating committee whose task it is to develop a slata
of potential governing body members for further
consideration. Initial election procedures must take into
consideration the need to begin the staggering of terms.
If an agency decides to have a governing body larger than
30 members* it is required by law to have an executive
committee* whose membership may be selected in a number of
ways. In its final chapter* the document outlines tha
activities involved in selecting the HSA governing body.
Information on preparing the governing body section of HS1
bylaws and exercpts from P.L. 93-641 regarding
composition of the HSA governing body are appended.
(NT IS )
Reference:
G.A. Silver*
"Community Particpation and Health Resource Allocation"*"
Inl££D2ii£ual slflULDal fll Healib SsiYisas* voi.3* No.2*
p.117-131* (Spring 1973).PLANNING GROUPS
GENERAL
Page 205
The noticeable trend away from autonomous
professional decision making in official isssues,
including health/ is attributable to diverse factors.
First/ there has been dissatisfaction with professional
decsions/ related in part to growing managerial control
distance of managers from clients/ and in part to
frustration with skewed distribution of products. Second/
there has been growing recognition of the political nature
of decision making/ regardless of profesional input.
Third/ consumer participation has been introduced into
various other models. The writer argues that consumer
participation/ and even control/ will not damage tha
professional's role and may have positive values for tha
planning and implementation of health systems. Consumer
participation at every level can offset the immobility o£
large systems/ racism/ unwieldy bureaucracies/ and class
discrimination.
Reference:
Bruce C. Vladeck/
"Interest-Group Representation and the HSAs:	Health
Planning and Political Theory"/
Affl££i£dD il2il£Ddl Ql Elihlifi Health/ Vol.67/ No.l/ p.23-2 9/PLANNING GROUPS	Page 205
GENERAL
(Jan- 1977).
Examination of the provisions of the National Health
Planning and Resources Development Act/ P.L. 93-641/
concerning the composition of Health Systems Systems
Agencies/ which are to be the primary building-blocks of
local health planning/ suggest that expectations of
substantial change may be unrealistic. Specifically/ in
its provisions for representation on the Health Systems
Agencies, Congress appears to have been accepting an
implicit theory of pluralist interest-group representation
that has long been prevalent in other sectors of public
life in the United States, and long subject to significant
criticism. Such forms of representation tend to lead to
bargaining, log-rolling, and collusive competition among
narrowly-defined special interests, with the interests of
the broader general public less well-served. The
application of this theory to health planning in P.L.
93-641 is examined, and predictions drawn about th3
implications of this analysis for health planning and
health policy in the United States in general.PLANNING GROUPS
HIGH LEVEL
Page 207
Reference:
C.C. Eduards,
"Time for a National Health Authority",
Hospitaft E£flfl££S5, Vol.57, No.6, p.6,10,16, (June 1976).
The author proposes that a National Health Authority
be created and erapouered by the U.S. Congress to
establish rate and fee schedules on a regional basis, to
approve or reject regional plans for the allocation of
health resources, to determine health manpower
requirements and see that they are being met, to regulate
all public and private health insurance programs, and to
advise the Congress and the Executive branch on budget and
policy Issues. Being entirely a regulatory body it uould
in no way supplant or reduce the need for the health
activities of the Department of Health, Education and
WelfarePLANNING GROUPS
TECHNICIANS
Page 200
Reference:
C. DuFlorey* J. Wenddell/ and S. Leeder,
"The Epidemiologist's Contribution	to Medical Care
Planning and Evaluation"/
Ausltalian aod Ksm isalaud JcMtaal al Medicine, voi.6.
No.1/ p.74-78, (Feb. 1976).
The authors state that the epidemiologist	can
identify medical problems in the population for which some
aspects of medical care services should be planned. Also
the epidemiologist can assess the relevance to planning of
morbidity and other statistics. The authors believe that
many medical care problems cannot be answered without
special studies	of the community and that	the
epidemiologist's contribution in	this area can be
particularly useful. He can assist in defining both the
problems and the nature of the answer which will be needed
to persuade planners to reconsider the status quo and in
designing studies that have a very good chance of
achieving their objectives.
Reference:PLANNING GROUPS
TECHNICIANS
Page 209
Leonard Duhl,
"The Health Planner:	Planning and Dreaming for Health and
Wellness",
AjLfixiMu iLautnal at Health LLannina* Voi-i, No.2,	p.7-i4r
(Oct.1976).
Can planners create opportunities for health ? This
article presents the case for the affirmative, and deals
uith the relationship of health and medical care,
planners' role in change, and the potentials under P.L.
93-641.
The nature of health and assaults upon it are
discussed. The Peckham Health Center is recalled and
summarized, and the processes of planning and the planners
are analyzed. The article concludes uith a series of
thoughts for action. Examples of real-uorld approaches to
health enhancement are provided.
Reference:
Leland kaiser,
"The Effective Health Planner",
American iicu£Dai cl itealih Elanninn/ vol.i, no.i, p.38-4 8,PLANNING GROUPS
TECHNICIANS
Page 210
(July 1976).
As health planners become concerned with planning for
people's health/ in addition to their traditional
preoccupation with planning for disease/ they will
naturally become involved in assessing their own level of
effectiveness. Failure as a professional health planner
can result from a deficit in any one of the three
overlapping domains (personal qualities/ professional
behaviors/ and technical expertise). This article focuses
on the first domain/ improvement of personal qualties.
Increased personal effectiveness results when the planner
engages in a natural sequence of self-observation/
self-acceptance/ self-awareness/ and self-actualization.
Numerous diagrams illustrate the process of personal
growth. A self assessment guide is attached to facilitate
the growth process. After completion of the first domain
(or concurrently)/ the health planner should begin work in
the other two domains. Increased planner effectiveness as
an extension of the pursuit of health is the predicted
outcome of this effort.PLANNING GROUPS
TECHNICIANS
Page 211
Reference:
George Stuehler,
"Hospital-Based Planner "In His Time Plays Many Parts#'"
itesaiials* Vol.50, No.12# p.75-76, 78-79, (16 June 1976).
The role and responsibilities of the hospital-based
planner are considered in an article concerned with active
participation by hospitals in the comprehensive health
planning process. The hospital-based planner acts as ^
facilitator of the planning process - including plan
development, implementation, ongoing operations, and
evaluation of the planning process. The importance of
involving the persons who will implement the process once
it is programmed by the planner is stressed. Other roles
for the hospital-based planner include: educating the
hospital administrators in the planning process and
generating active participation in the process; guiding
the process, perhaps through preparation of a guidebooK?
coordinating the hospital's planning activities?
participating as an actual contributor to the planning
process; and ensuring continuing evaluation of the
planing process. It is concluded that planning is an
integral part of good management, and that the
hospital-based planner is an important member of the.
hospital management team. Desirable qualities in aPLANNING GROUPS
TECHNICIANS
Page 212
hospital-based planner are said to include the ability to
conceptualize large systems, analytical skills,
interpersonal skills, political sensitivity, and knowledge
of the entire spectrum of personal health care services.
(NTIS)PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 213
Reference:
Donna Anderson and Markay Kerr,
•’Citizen Influence in Health Service Programs*"
AmsiAsan itautnal si Eublic Hsaliiix voi.6i* no.8*
p.1518-1523/ (Aug. 1971).
Citizen participation in decisions on provision of
health services is of considerable current interest. Thi-s
study examines the process of participation to determine
the nature of participation and its relationship to
various external factors. Preliminary findings are
presented and briefly discussed.
Reference:
Erica Bates*
"Consumer Participation in the Health Services*"
Inifitoaiiflual iautaal si tlsallh Edusalisni. voi.19*
p.45-50, (1976).
The goals of an Australian consumer health involvment
project are delineated. The project* initiated in 1974*
iPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 214
was restricted to the Fairfield municipality of New South
Hales. A group of consumers known as the Fairfield Health
Resources Committee was established. Due to the small
size of the committee* an effort was made to develop
additional participation in health care by involving 'play
groups' (local groups of mothers and young children who
meet under the leadership of community development
officers). It was determined that play groups were
particularly well suited for developing the ability of
community residents to participate actively in health care
issues. Sixty interviews were conducted with people in
the area to examine each person's recollection of contacts
with health services. The most common complaint by health
consumers was lack of clear information about their
condition. Since health consumers felt that many
physicians gave only superficial care, leaders of the
consumer health involvement project recommended that
consumers give feedback to providers without hesitation.
A management committee consisting of an equal number of
both health professionals and consumers was proposed for
the Fairfield Community Health Center. The importance of
coordinators in the conduct of the consumer health
involvement of consumers in planning a health care systei
before they need to use its services. (NTIS)
iPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 215
Reference:
Dale Christensen and Albert Wertheimer,
"Consumer Action in Health Care,"
Public Health Reports# Vol.91, No.5, p.409-411, (Sept-Oct
1976).
Various aspects of the consumer movement in health
care are considered, including modes of consumer
participation and issues pertaining to consumer
representation on State regulatory boards for health
professionals. In 1976, 12 States required consumer
membership on one or more regulatory boards, and
approximately 20 other State legislatures contemplated
such requirments. Historical trends in the consumer
movement are reviewed. Several mechanisms of action are
available to consumers: (1) economic control through
refusal to purchase; (2) collective control of funds
(third parties) on legislation; and (3) exercise of
consumer sovereignty in the marketplace. The effects of
individual and collective assertions of control by
consumers are discussed in relation to health-related
products, particularly prescription drugs and eyeglasses.
The recommendation is made that consumers become better
informed about common indexes of practitioner and service
quality, service fees, and patient rights. it is notedPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 216
that consumer guides to physician and hospital services
are available for this purpose. Evidence is presented to
illustrate increasing consumer strength in the health
sector, based on the growth of health and welfare programs
for labor and the development of consumer groups. Third
party payments plans are also viewed as a means of
representing the collective interests of consumers.
Additionally, the collective voice of consumers can be
effective in the implementation of change through
legislation. The case for consumer representation on
State regulatory boards is discussed, and problems
associated with the implementation of consumer
participation are addressed. (NTIS)
Reference:
£iliz&Q£x ih£ liasaiial*
Durham, N.C.:	Dept. of Health Administration, Duke
Univ., 1974.
Fourteen papers on community involvement in the
affairs of hospitals are presented. The papers were
presented as part of the 1973 National Forum on HospitalPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 21?
and Health Affairs sponsored by the Department of Health
Administration/ Duke University. The forum papers/ many
of which are written by political scientists/ are said to
reflect a unified concern with the need for citizen
participation in hospital decisionmaking and control. The
readings also suggest that no satisfactory means has been
developed for the direct involvement of the individual or
the community in the affairs of governmental or nonprofit
agencies and institutions in the field of health or in any
other field. Topics addressed include: the hospital and
the community; a review of the issues surrounding citizen
participation; power and conflict as key concepts in
community dynamics; community representation and tha
*free-ride' concept; citizen input in different
decisionmaking systems; and citizen surrogates. The
discussion of the free-ride concept deals with the
tendency of individuals to enjoy collective benefits
without incurring any of the costs of providing these
benefits. It is observed that the strength of a community
organization is not necessarily an indicator of its
representativeness/ and that the free-rider problem tends
to leave community representatives dependent on the
administrative agency that they are supposed to influence.
The paper on citizen surrogates describes the health la*
project operated by the University of Pennsylvania La*
School. Project workers perform fundamental analysis ofPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 21&
health delivery system problems, particularly in major
public and private health benefits programs, and work with
consumer groups to solve these problems. Other papers
discuss: the professional and citizen participation; the
citizen in political theory; determining who can speak
for the citizen; citizen participation and the
administrative agency in urban development; the influence
of consumer sponsorship on medical services; the poor and
the health care system; community decisionmaking; and
the Amercian Hospital Association's Patient's Bill of
Rights. Forum participants are listed. (NTIS)
Reference:
Heather Clarke,
"Challenging the Status Quo:	The Nurse's Role in Health
Care Delivery Planning,"
CaDidiflD lillESfi, Vol.73, No.l, p.40-42, (Jan. 1977).
In their struggles to achieve wider recognition and
more responsibilities, nurses have been breaking into
areas from which, in the past, they have been excluded.
One of these is the field of health care planning. In thePLANNING GROUPS
PROVIDERS/CONSUMERS
Page 219
Canadian Nurse# March 1976/ Bernadet katsoy described a
strategy of the individual nurse could use to promote her
own ideas for change. Here/ Heather Clarke outlines the
role of the nurse in health care delivery planning and the
part played by the RNABC Committee on Health Care Delivery
in promoting nursing participation in this area.
Reference:
	&22L4	iLainina	and	l££imi£nl Assiaiants	ia
Mlan-dui	U&aiin		in	ihs. SanikMfcst and	
E££i£D£ 2l ih£ dDilfid Slaies*
Los Angeles:	Mariscal and Co./ July 1974.
A 12-month training and technical assistance program#
undertaken to assist migrant workers in DHE* Regions VIII
and IX (the Southwest and Far Nest) in becoming effective
members of the policy-making boards serving migrant health
projects# is documented. Initial training# follow-up
training# and technical assistance were provided to ten
migrant health projects in four States. The projects
chosen already had achieved some degree of sophistication
in the policy-making process. The report presents an
overview of the activities# accomplishments# and
JPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 220
suggestions generated by the training and technical
assistance effort. The initial training sessions utilize!
two curriculum components/ one dealing with the role of
the consumer board/ with emphasis on the role of board
members as policy-makers and of project-staff as
policy-implementors/ and another dealing with the
plannning process. Services provided in follow-up
sessions and in technical assistance programs varied frot
site to site. A list of technical assistance services
offered at each site is included/ as are individual
profiles for each of the project sites. Profiles include
a description of training activities and evaluations of
the strengths and weaknesses of health projects/ developed
by the trainees. Inconsistency in attendance and major
differences in levels of sophistication between boards are
cited as factors limiting the effectiveness of training.
The bilingual nature of the training session and their
seminar structure are described as beneficial factors.
(NTIS)
Reference:
Chester Douglass/
"Consumer Influence in Health Planning in the Urban
lPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 221
Ghetto/"
Inquiry# Vol.12/ No.2, p.157-163, (June 1975).
The differential effect of direct and indirect
consumer participation on decisions at the local level
concerning new types of publicly funded health programs is
analyzed. Variations in programs for the delivery of
personal health services were examined in eight Michigan
cities which received Model Cities grants from the
Department of Housing and Urban Development. Four cities
produced health service proposals which tended toward the
establishment of new programs under administrative
structures/ with a large proportion o£ Model Cities grant
funds. In contrast/ the other four cities produced health
proposals which expanded previous health service programs
within existing administrative structures/ using a smaller
proportion of grant funds. The Michigan study focused on
the role of consumer participation in health planning for
the urban ghetto. Three variables were used to
characterize the decision making process in each Michigan
city: characteristics of participants, mobilization o£
Model Neighborhood residents, and size of the Model
Neighborhood in relation to total city size. A health
services attitude index was developed to determine the
degree of consumer versus provider orientation for each
PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 222
study participant. Participants were also classified
according to race and the amount of influence they exerted
in the decision making process. It was found that
consumers uho tended to be black residents within the
Model Cities area did participate in health plannin9
activities but that health care providers uho tended to be
white and lived outside the Model Cities area dominated
decision making. (NTIS)
Reference:
Connie Joann Evashwick,
CfljEnmuiiy Eat-ticieaiifiu id Hfialili &i2X£n£Qli Lis Qtlaio
and £c£S£Qi Status*
Ann Arbors Michigan:	University Microfilme International,
24 May 1971.
The role of community participation in the provision
of health services is investigated. It is noted that
community participation encompasses political science and
business theories of decisionmaking, sociological concepts
of the community structure and interaction patterns,
psychological studies of the effect of participation onPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 223
the on the underprivileged/ and theories of political
action. Historical perspectives on community
participation are reviewed/ with the consumer
participation movement gaining impetus in 1965. The
impact of the 'War on Poverty' and activities of the
Office of Economic Opportunity on community participation
in health are assessed. The Economic Opportunity Act was
conceived to combat the economic and social problems of
the poor/ and initial legislation dictated that programs
sponsored under the act have the maximum feasible
participation of poor individuals. The statement is made
that/ since 1965/ the Federal Government has reinforced
the concept of community participation by introducing it
into other health legislation. Amendments to the Economic
Opportunity Act in 1967 are noted/ as well as support by
the Public Health Service for neighborhood health centers.
Theoretical and philosophical issues pertaining to
community participation are discussed. It is concluded
that consumer organization and mobilization require timer
money/ manpower/ and personal commitment. A bibliography
is provided. (NTIS)
Reference:
i
APLANNING GROUPS
PROVIDERS/CDNSUMERS
Page 221
Joseph Falkson,
"Review Article:	An Evaluation of Policy-Related Research
on Citizen Participation in Municipal Health Service
Systems,"
Medjcal	BfilLiaiU Vol.33, No. 2,	p.156-221, (Feb.
1976).
Literature on citizen participation in municipal
health service systems is reviewed. The review is based
on a series of standard bibliographic search procedures
and methods for assessing the validity of each literature
study or article. A comprehensive bibliography was
compiled from four sources: (1) a MEDLARS search of all
references germane to citizen participation in
neighborhood health centers, hospitals, and health
planning; (2) an Index Medicus search for similar
references; (3) a search of the Countway Medical Library
Index of Harvard University; and (4) review of personal
bibliographies on citizen participation compiled by tha
author of the literature review. All bibliographic items
were classified as nonstudies, impact studies, or
nonimpact studies. An impact study is defined as one in
which the relationship between citizen participation
outcomes is assessed. Impact studies are classified as
experimental, quasiexperimental, or
nonexperiraental andPLANNING GROUPS
PROV IDERS/CON'SUMERS
Page 220
provide the primary source of studies ior the literature
review. An overview of components of the municipal health
service system is presented, and numerous studies on
citizen participation are cited. An annotated
bibliography accompanies the literature review. (NTIS)
Reference:
Eli Glogow,
"Community Participation and Sharing in Control of Public
Health Services,"
Health Services RepQfts, Vol.88, No.b, p.442-448, (Hay
1973).
Decentralization, community control, and other
citizen participation models are discussed as possible
ways of revitalizing public health departments. It is
observed that the combination of conservative decision
making bodies outside the health departments (eg., elected
public officials and private medical interets) and the
bureaucratic, security-conscious leadership within tne
departments has frequently resulted in relatively closed
systems. It is suggested that new leadership is
i
iPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 226
atteapting to open up these systems so that consumers/ the
poor/ minorities/ and other previously uninvolved segments
of society might participate. In a review of the
literature on decentralization and consumer participation/
no overt opposition to consumer involvement is found.
Rather/ it is the degree of citizen participation that is
of concern. Views in this regard range from the common
acceptance of consumer participation as a desirable goal/
to the belief that community control is better than
community participation/ to the fear that even community
control may not be enough. Another point of view is that
the case has yet to be made for the viability of any
decentralized/ control-sharing model. A model of citizen
participation is stressed which emphasizes the community's
democratic selection of its representatives to
policymaking boards for the health department/ and relies
upon a shared authority for policymaking among health
professionals/ elected officials/ and the democratically
selected citizen representatives. The knowledge and
skills required of public health administrators if they
are to work within a context of citizen participation in
policymaking are pointed out. (NTIS)
A
iPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 227
Reference:
Sidney Greenberg#
"Community Participation for Equity and Excellence ir»
Health Care (General Discussion I)#"
Nek iALk Academy at Mdeicine# Vol.46# No.12#	p.1048-1053#
(Dec. 1970).
A discussion among participants in the 1970 Health
Conference of the Neu York Academy of Medicine concerning
community participation and equity of health care is
reported. Concern is expressed by representatives of
several community health projects that funds intended for
use in the commmunity often are used instead to meet
overhead expenses of agencies and institutions. The
importance of active patient participation in health care
and of community representation in policy-making is cited
by another representative. The question is raised as to
how communities might develop se1f-sufficiency in
financing and managing health programs. A representative
from the Detroit Model Neighborhood Health Councils calls
for the health professionals - physicians and nurses - to
'come into our communities' so that health packages might
%be designed as a joint effort. In a discussion of th*
role of health professionals in helping communities to
obtain their goals# concern is expressed over tho
their
goals#PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 228
possibility that professionals seek community
participation and community 'control' only when it is
certain that the community group is going to agree with
the health establishment. (NTIS)
Reference:
Paul Gross,
"Consumer Participation in Community Health Services:
Lessons from Overseas,"
Australian JauimI fli Social Issues, Vol.10, No.l, p.5-25,
(1975).
Community and consumer participation in community
health services are discussed in relation to the
Australian health system. Previously identified problems
in the Australian health services include:	gaps in
national health policymaking; gaps in health planning and
evaluation; gaps and inequalities in availability and
accessibility of health services; discontinuous and
inappropriate care; ineffective and inefficient use of
scarce health manpower; the escalation of health care
costs; and nonexistent quality controls. A number ofPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 229
solution options suggested by experts from other countries
rely to some extent on consumer behavior, consumer
enthusiasm, consumer acceptance of the need for change, or
consumer involvement as a major agent of change.
Traditional forms of involvement in community health
services are outlined, and new forms of community
involvement in public policymaking are suggested.
Proposed mechanisms for improving the visibility of
consumer organizations in community health policymaking
are to involve representatives of the broadest possible
range of government and private sector organizations
concerned with community health and to educate consumers
and voluntary organizations regarding community
participation. References are included. (NTIS)
Reference:
Uuid£liQ£s fat lDXfllit£m£Di Kilb and SuppolL al Cflmmuuilz
£a££d iteallh HlaDDiaa
Cleveland, Ohio:	Metropolitan Health Planning Corp.,
1971.
This document outlines the responsibilities of thePLANNING GROUPS
PROVIDERS/CONSUMERS
Page 230
Metropolitan Health Planning Corporation# Cleveland# Ohio
in providing planning assistance to community groups#
defining the services the corporation can provide# and
establishing the prequisites which must be met by
community groups seeking its aid. Most of these requests
can be satisfied through periodic consultation with the
corporation's staff members. If a special study is
required# it can be designed and conducted by the staff#
depending upon the scope of the project# and the
availability of staff time. Due to the corporation's
limited sources and the numerous community groups seeking
assistance# intensive staff assistance or financial
support cannot be provided to everyone. The corporation
may# at the request of a group# elect to provide intensive
staff assistance or to enter into a contract with the
group# through which the corporation would financially
assist the group's planning activity. The general
guidelines used to determine the merits of a proposed
contractual agreement are subsequently outlined# and the
conditions binding the corporation in its contractual
activities are described. (NTIS)
Reference:PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 231
John Hatch,
'Discussion of the 'How' of Community Participation in
Delivering Health care/"
ftulleiia at the. He.M Yqck Acadany at Medicine^ Vo 1.46/
No.12/ p.1084-1090/ (Dec. 1970).
The experience of the Tufts-Delta Health Center/
Bolivar County/ Mississippi/ is described in a
presentation to the 1970 Health Conference of the New York
Academy of Medicine. Since 1967/ the Tufts-Delta Center
has provided services to a population of 16/000 persons
living in 10 small towns and scattered rural locations.
Eight percent of the population is black/ and/ within this
group/ 85 percent is poor. Once initial entry had been
made into the community/ the Center began intensive
orientation contacts with the population it had contracted
to serve. A locally recruited staff of 12/ together with
the Center's professional staff/ made home visits with a
view toward getting acquainted and discussing the Center's
goals. From these visits/ and from the public meeting5
that followed/ several special areas of concern among the
population emerged: water/ housing, food/ clothing/ pest
control/ and problems of the disabled elderly. Each
community was encouraged to select representatives/ ad hoc
committees to deal with the special concerns of thePLANNING GROUPS.
PROVIDERS/CONSUHERS
Page 232
coamunity. From these committees/ it becaae evident that
the lack of food was the nost pressing problen in the
area/ rather than health problems as traditionally viewed.
The center aided the communities in forming a food
cooperative/ and in dealing with other problems. From the
ad hoc committees emerged the North Bolivar County Health
and Civic Improvement Association/ a nonprofit development
corporation whose form was similar to that of a Baptist
Church convention. The Center becaae a 'junior partner'
in a broad-based program of community development. The
importance of becoming attuned to the cultural life of a
community/ and of	assisting	the	coamunity to	meet its
special needs/	rather	than	attempting to	force an
institutionalized	structure	on the community/		is cited.
(NTIS)
Reference:
John Hatch/
"Community Shares in Policy Decisions for Rural Health
Centers/"
ttfiSfilldlS*. Vol. 43/ No.13/ p. 109-112/ (1 July 1969).PLANNING GROUPS
PROVIDERS/CONSUHERS
Page 233
Community participation in policy decisions of the
Tufts-Delta Health Center# Mound Bayou# Mississippi# is
described. The Center provides comprehensive health care
to about 14#000 persons residing in a rural area; the
target population is 90 percent black# and median family
income in 1960 was under $1000. The infant mortality rate
is three times the national average# and median education
attained by the black population is 4.3 years. The basic
pattern followed by the health center has been the
formation of a series of ad hoc local health associations
(and additional speical-interest groups such as mother's
clubs)# with representation on a temporary areawide health
planning council. This council# with the assistance of
the Center's community health action staff# provided the
forum for working through and planning the formal
organization of permanent local health associations# with
subsequent election of representatives from each to a
permanent health council. The permanent council relates
to the Center administration and staff and is represented
on the Center's board of directors. The council#
operational for over a year at the time of writing# has
been incorporated as a nonprofit community service agency.
This organization reflects the felt needs of its
membership? 60 percent of its program is concerned with
issues not directly related to the health center's service
organizations should be directed toward becoming an 'ally'PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 231
in the community's struggle for self-improvement, rather
than toward narrow involvement aimed at gaining support
for continuation of the organization's Institutional
structure- (NTIS)
Reference:
il&allh Ela&niimi A Ciiiisns Rs.q.q.lU
Olympia:	Office of Comprehensive Health Planning,
Washington State Office of the Governor, Jan- 1971.
Washington's health care system has come under great
pressure in recent years to provide more care and better
care to a greater number of people. Initial comparisons
with national statistics indicate that in general the
residents of Washington are well off in terms of living
longer, being served by more health professionals, and
paying less for health care. Physicians' average service
load, facilities, beds, and patient origins are discussed
and graphed. Health costs are described both narratively
and statistically, in terms of facilities and manpower.
Planning for health care is presented in the form of
needed legislative action based on three elements ofPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 235
public policy. Citizen participation is needed in
decisions about health service and its cost. There should
be a basic opportunities for all to have access to high
quality health care. Public agencies are seen as
participants in providing health care. (NTIS)
Relerence:
Paul Henry,
"Pimps, Prostitutes, and Policemen:	Education of
Consumers for Participating in Health Planning",
A.m£xJjLaQ ihuiLoal al flaalih ELaQaiaa, voi.60, no.ii,
p.2171-2174, (Nov.1970).
The role of the black health consumer is considered
in terms of the training needed if involvement in health
planning is to be realistic. This goal is presented in
terms of a training project, Project CHART. It began as a
cooperative venture of the Graduate Department of
Community Planning of the University of Cincinnati and tha
Ecumenical Council for Continuing Education and offers a
10-week course for neighborhoods that request the service.
Active training sessions are held during evening hours forPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 236
groups of 18 to 20 persons. During the sessions/ students
are helped to define their community and to understand ho*
it operates. Students diagnose their community's special
problems and concerns/ develop plans for neighborhood
change, and, upon completion of the course, implement
their plans. Training teams work cross-f unctionally
toward unified change in health services, schools,
community centers, political parties, job markets, and
housing systems. The teams operate through inner-city and
suburban field stations and include CHART graduates,
university faculty, and graduate students. Techniques
used by CHART teams to orient each training session to the
needs of the comramunity and to the interests of the
individual participants are described. Differences in
perspective brought to the training sessions by black and
white participants are pointed out. Generally, suburban
white students have no doubt that existing systems are
working. Black students on the other hand, are quick to
question the existing system. The training of inner-city
residents - the blacks and the poor in particular - to
participate in planning their own future is seen as an
essential ingredient in urban renewal. (NTIS)PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 237
Ref erence:
W.T. Herzog/
£LflasJAU]££ LaLti£iRaiian in Llsalili ssxyiiss Elannina aad
A^inJjDi^i £ ali anx
Chapel Hill:	Dept. of Health Administration/ North
Carolina Univ. at Chapel Hill/ May 1975.
Issues surrounding consumer participation in the
planning and administration of health services are
discussed/ and approaches to improving such participation
are suggested in a paper based in part on experience with
consumer involvement in World Health Organization
programs. Questions involved in defining the consumer/
deciding who is to be represented/ and establishing the
relationship between the political system and consumer
involvement are considered. The purposes of consumer
participation are reviewed/ including improvement of the
quality of services/ provision of a mechanism for
accountability/ contribution to individual and community
capacities for acting on health problems/ provision of
information/ interpretation of health agency goals and
programs, and augmentation of agency staff. Specific
approaches to improving consumer participation in health
organizations are described within the following
categories: (I) approaches centered within and controlledPLANNING GROUPS
PROVIDERS/COMSUMERS
Page 238
by the community (e.g./ citizens health committees)/ (2)
joint partnership efforts (e.g./ joint provider/consumar
control of services)/ (3) approaches centered within and
controlled by the health organization (e.g., advisory
committees); (4) inclusion of consumers as members of
policy and/or operational bodies of the health
organization; (5) use of communication channels to
increase information exchange between the organization and
consumer groups; and (6) approaches directed toward
changing the nature of the interface between the health
care system and its environment* A list of references is
included. (NTIS)
Reference:
G. M. Hochbaum/
’'Consumer Participation in Health Planning:	Toward
Conceptual Clarification”/
Affisiisan	Riiklis. ifsallii/ voi.59.	No.)/
p.1698-1705/ (Sept. 19).
Problems involved in implementation of consumer
participation in health planning are discussed.
It isPLANNING GROUPS
PPOVIDERS/CONSUMERS
Page 239
noted that some form of participation in health planning
is of great importance to many people for its own sake, as
a visible symbol of their equal human rights, apart from
the more tangible beneficial health results that may stem
from their participation. However, citizen participation
is a matter of actually sharing in the decison-making
process, not merely participating in planning discussions;
it is here that a potential source of problems and
friction arises between health professionals and
consumers. While health professionals usually are
primarily concerned with medical care aspects and argu*
their views on the basis of medical care considerations,
consumers may be equally or more concerned with social,
political, and racial aspects and argue their case
accordingly. In some instances, when consumers demand to
be the only decison makers and regard health professionals
as persons whose job it is to implement consumers'
decisons, even greater conflict arises. It is suggested
that educational and training efforts should be directed
toward both the consumer and the health professional as a
first step in generating constructive attitudes in both
t
groups for effective joint health planning. Problems of
communication, i.e., definition of what is meant by
'consumer' and 'participation' are discussed. the
importance of factual, objective study and evaluation of
the problems involved in citizen participation in healthPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 240
planning is emphasized. (NTIS)
Reference:
William Hollister, et al.,
EaiL£iJL£n££S in Siiial Menial iiaalllix Uli Iiaiialaeiag
Silizsn Eatiiciaaiiaux
Chapel Hill:	Div. of Community Psychiatry, North
Carolina Univ. at Chapel Hill, 1973.
One facet of a five-year project to develop new means
of providing comprehensive mental health services to rural
populations was an attempt to involve community residents
in program planning and development. The material in this
booklet documents that attempt - including the problems
that arose - for the benefit of other persons serving
rural areas. The focus of the project activity was on
eight bridges of communication:	neighborhood advisory
councils; county-wide advisory councils; relationships
with county commissioners; contacts with allied human
service agencies, such as the school system and the Mental
Health Association, and professionals; joint project
participation with special interest groups, such asPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 241
members of the senior citizens council; visits to
community decisionmakers (i.e., persons uho may not be
functioning in official capacity but uho are influential
in community decisionmaking); responsive contacts with
patients or citizens groups, which involved going into the
community and other informal procedures; and volunteers.
Experiences with each of these groups are discussed
separately. The appendix contains a profile of Vante and
Franklin Counties, North Carolina, the rural jurisdictions
which were the focus of the project. (NTIS)
Reference;
Stan Ingman, Susan Goldfrank and Lewis Greenwald,
Eaaiaaal Henial tieallii Cuimcilsi. Qxuamias ai EXIacIive
iiliisa EaLliai&atiaxu
Farmington, Conn.; Dept. of Community Medicine and
Health Care, Connecticut Univ. Health Center, 1 July
1971.
The role of citizen participation in the
establishment and operation of regional mental health
councils is addressed. Correlates of effective communityPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 242
involvement and participation are explored- Case studies
of two regional mental health councils are presented which
document the history of the council's creation, delineate
the method by which board and executive committee members
were selected, identify the process of grant review during
the period in which councils were operational, describe
formal and informal levels of responsibility within the
councils, note the relationship between the local mental
health association and the council, and detail the level
of understanding and opinions with respect to certain
areas (community psychiatry. State mental hospitals, and
social planning). The two councils studied are the
Central Naugatuck Valley Mental Health Council in
Connecticut and the Southcentral Connecticut Regional
Mental Health Planning Council. Barriers to
regionalization under the mental health council concept
are described. A list of references is provided. (NTIS)
Reference:
Inyoiy^jaenj; of CiaQSilQaLs in Elaoniaa*. EflliayzHnkina and
iMadison:
Wisconsin Regional Medical Program, 1974.PLANNING GROUPS
PPCVIDSRS/CONSUMERS
Page 243
This report examines the need for consumer
participation in a/isconsin health planning and evaluation
and presents key elements and conditions for such
participation. A health consumer is defined as any person
now, or at any future time during his life, in need of the
services of health maintenance measures or organized
health delivery systems. The issue of consumer
involvement stems from a lack of communication and trust
between providers and consumers of health services.
Several issuses and problems are discussed, and the views
of organized consumer groups and writers are cited. The
role and actions of a State task force in one particular
situation concerning chiropractic services are examined.
Stages and issues of consumer involvement in healtn
planning are examined. Some reasons for the lack of
effectiveness of consumer inputs are also discussed.
Finally, a development model, adapted from Robert House,
is used to illustrate some of the factors which must be
considered in building a model for developing consumer
capability in health care planning. The model identifies
the knowledge, attitudes, and skills required for
effective consumer input. An appendix presents the
conclusions and recommendations of an earlier report
concerning consumer health care involvement. (NTIS)PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 241
Reference:
Kathleen ittig,
£3£li£i23liHD ID iJfiDllb 21DDD1DD DDlJ SDLVifiS
Delivery! A SfilfiiLtiVS f&Vi£H DOd a ELDDMSd £s.£&aL£h
Aasndax
Hyattsville, Md.:	Div. of Intramural Research/ National
Center for Health Services Research/ Aug. 1976.
The National Health Planning and Resources
Development Act places a major emphasis on consumer
representation in the health planning agencies. This
provision/ if properly exercised/ could make the consumer
a major voice in health care planning at state and
community levels. However/ this study establishes that
consumer participation has been bodily manipulated in the
past and procedural rules are needed to assure its
effectiveness in health planning. The author reviews the
considerable body of consumer research done since the
early sixties/ discusses the reasons for consumer
participation failures and successes and recommends
procedures that can help ensure effectiveness in its new
health planning role. (MTIS)PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 245
Reference:
Leda Judd and Robert McEwen,
liaDiUuMik isx Cddsuulsi iLa£ii£i£iiIi2D in H-salii)
El^imina^
Washington/ D.C.:	Office of Consumer Affairs/ Blue Cross
Association/ 1976.
An introduction to health care planning is presented
in a handbook for consumers. Reasons behind increases in
health care costs are discussed/ and methods of health
care financing are described. An overview of the health
care system in the United States includes discussions of
the size and scope of the system/ its organization and
manpower/ barriers to access/ and quality of care.
Background information on health planning laws is
presented/ and the provisions of the National Health
Planning and Resources Development Act of 1974 (P.L.
93-641) are reviewed. The purpose/ structure/ and tasks
of the health systems agency (HSA) are outlined/ tine
consumer role in the HSA is described/	and the
implications of P.L. 93-641 for health planning at tne
State and National levels are discussed. Perspectives on
serving as a consumer member of an HSA board are offered.
Eleven case histories in health planning, reflecting thJ
kinds of questions with which HSA boards must
range
andPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 246
deal, are presented. A primer of practical advice for
consumer board members discusses the consumer viewpoint,
suggestions for preliminary preparation, and participation
in meetings. Lists of suggested readings and sources of
information are provided. (NTIS)
Reference:
Philip Kalisch and Beatrice Kalisch,
nursing Inyalysafiui in Ibe itesllh Eluaning EtflUfissx
Ann Arbor:	School of Nursing, Michigan Univ., Sept.
1977.
The history and process of health planning are
discussed in this monograph directed to nurses and nursing
students. Background information describes governmental
involvement in health programs, including programs in
European countries as well as such familiar U.S. programs
as Medicare, Medicaid, the Social Security Amendments of
1972, and the National Health Planning and Resources
Development Act of 1974 (P.L. 93-641). The high costs of
health care are analyzed and atributted to factors ranging
from expensive technology to the present system, whichPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 2 47
does not provide regulation of hospitals either by
government or the marketplace. Health insurance programs/
both existing and proposed/ are discussed and their impact
is assessed. In a consideration of the maldistribution of
health services and resources/ the concept of health is
contrasted to that of illness/ and the potential for
nurses in expanded roles to fill gaps in services
heretofore offered by physicians is indicated. Nurses are
termed a key ingredient in preventive/ episodic/ and
catastrophic services - all of which are elements of a
proposed new system of health care. The importance of
nurses' learning about present practices and alternatives
in health care is emphasized/ and distinctions are drawn
between medical and nursing viewpoints and
responsibilities. Only by actively participating in the
planning and politics of health planning can nurses be
sure of their rightful role in the nation's health cam
delivery. A bibliography is provided. (NTIS)
Reference:
Daniel Kane,
"Community Participation
Hasailal IdininislLifLiaQx
in the Health Services System/"
Vo1.16, No.l, p.36-43, (1971).PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 249
A f r
acting u
policy go
health s
.from its
of today
with othe
complianc
super iors
subordina
classifyi
neutral
complianc
collabora
organizat
bene fi cia
persons
par ticipa
contact,
organizat
associati
and comm
as its ma
commonwea
public at
becoming
amework is presented for the understanding ani
pon public demands for a voice in determining
verning the organization and distribution of
ervices. Development of the voluntary hospital
monastic beginnings to the complex institutions
is traced- The voluntary hospital is compared
r institutions on the basis of a model which uses
e/ a term describing the power employed oy
to control subordinates and the orientation of
tes to that power/ as the criterion for
ng institutions. Three methods of integrating
or alienated client groups into an organization's
e structure are identified:	absorption/
tion/ and cooptation.	A typology of formal
ion is cited/ based upon a concept of primary
ry. The typology identifies four categories of
associated with organizations:	members	or
nts/ owners or managers, clients or the public in
and tne public at large. Four types of
ions are then categorized:	mutual benefit
ons/ business concerns/ service organizations/
onweal organizations. A service organization has
in function the service of clients/ while a
1 organization's primary beneficiary is the
large. It is submitted that hospitals are
more characteristics of commonweal organizationsPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 249
than	of service organizations.		That	the	public	must	be
able	to	exercise control	over	the	ends	served	by
commonweal		organizations is pointed		out	and the	suggestion	
is made that health care administrators must provide
leadership broadening the base of support for their
institutions and agencies through substantive efforts to
involve the community in the health services system.
(NTIS)
Reference:
Robert fCane,
"Determination of Health Care Priorities and Expectations
Among Rural Consumers/"
iifiiiLtll 2aiyi££S Esssatctu Vol.4, No. 2/ p.142-151/ (Summer
1969).
A probability sample of rural Kentucky residents vias
interviewed to determine felt need for a new health
facility to replace the recently closed local hospital.
'*hen problems rather than solutions were stressed and
semantic difficulties avoided/ respondents identified a
set of needs agreeing with those recognized byPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 250
professional planners, but with important discrepancies in
desired location. Data from diverse sources such as
market research and traffic flow studies validated the
expressed locational preferences as congruent with
community behavior patterns, emphasizing the need foe
early solicitation of consumer attitudes and establishment
of fully reciprocal communication.
Reference:
Michael Lipsky and Morris Lounds,
"Citizen Participation and Health Care:	Problems o£
Government Induced Participation,"
Jmi£jQal a! lifialili Ealiliss* Eallsx and Law* Voi.i, No.i,
p.85-111, (Spring 1976).
Problems encountered by government-inspired efforts
to increase citizen participation in health care delivery
programs are explored in an analysis of the contradictions
between the organizational requirements inherent in
initiating programs with citizen participation components
and those inherent in consolidating and implementing such
programs. It is pointed out that program administratorsPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 251
attempting to maximize citizen involvement have done so by
projecting images of maximum social impact, maxirauj
control by citizens, institutional solidarity,
experimentation, and innovation, and by minimizing or
ignoring questions of long-term fiscal uncertainty. Often
administrators have recruited social activists taken (at
times incorrectly) to be representative of a commmunity
and promised them opportunities for upward mobility.
Program administrators also have tended to adopt
conciliatory administrative styles in keeping with their
experimental, nonelitist orientation. Such tendencies,
developed in the initiation phase of programs, conflicted
with demands that became apparent in later phases of
implementation. These demands resulted from delayed
recognition oi the need to evaluate programs, to limit
spending, to deal with internal oppposition, and to
respond to the changing interests of sponsors.
Paraprofessionals recruited to program staff tended to
lose their community orientation, and administrative style
tended to shift in focus toward program accountability.
These changing program demands are said to account in
large part for the otherwise apparent failure of efforts
to increase citizen participation in health delivery
programs
(NTIS)PLANNING GROUPS
PROVIDERS/CQNSUMERS
Page 252
Reference:
Kendall MacNeilage,
ClIiifin-iaDsyiasi	in Lasal Usalih 2££j£i£SSx
Raleigh/ N.C.:	Arnold Zogry Associates/ Inc-/ 1969.
A study of citizen participation in health services
concludes that opportunities for citizen involvement are
determined largely by providers/ not by citizens. The
higher the value placed on citizen involvement/ the
broader and more influential the involvement is likely to
be. A survey dealing with this topic covered 33
hospitals, 42 specialized facilities, 68 public agencies,
71 voluntary agencies, and 16 noncategorized
organizations, most of which represented low income
consumers. The most readily identified areas of need were
acute care services, general accessibility of care, and
the lack of information which would generate the maximum
accessibility of existing resources. Five channels for
citizen involvement were described and analyzed. They
were: (1) representation and		requests,	(2)	expression	o f
references through	purchase	and use	of	service ,	(3)
planning and decision making,		(4) volunteer		services,	and
(5) active public	support	through fund r		aising and	the
political process.	(NTIS)				PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 253
Reference:
Berwyn Mattison,
"Community Health Planning and the Health Professions",
American *J2U£nal o£ Euklis Itealiil, Vol.58, No. 5,
p.1015-1021, (June 1968).
The period in which we find ourselves requires a new
kind of health professional, the action-planner for
community health. How he can work in the community, on
what problems, and by what means, is the subject of this
address.
Reference:
Wood HcCue and Ena Nounton,
C£!ii£E£ii£Qsiye Ufialtb. Elanniaa £aun£il o.L Samii ElfitiiLii
Ad HiE££iffl£Dl iD Eilizsn EaLtlslEaiiaDx
Miami:	Comprehensive Health Planning Council of South
Florida, Inc., May 1973.
The structure, activities, and philosophy of the
Comprehensive Health Planning Council of South Florida,PLANNING GROUPS
PPCVIDSSS/CON SUMEPS
Page 254
Inc., are described. The Council, in its fifth year of
operation as of 1973, emphasizes community participation
and 'people-focused' policies; all meetings, including
committee meetings, are open to the public and to the
press. The Council identifies its appropriate functions
as follows: community-wide fact finding; goal setting?
problem identification; alternative solution
identification; priority setting; implementation; and
evaluation. Direct service provision and allocation of
funds are felt to be inappropriate functions for the
Council. While the Council recognizes the need for
adequate delegated sanctioning power to be influential, it
feels that approval or veto power should not rest uitn
local planning agencies. The key body of the Council is
the 36 member policy-making board, whose members are
elected annually by 300 persons holding organizational
membership. Major review and advisory studies currently
active within the Council's structure include the
following: major studies focusing on hospitals, primary
care, health care financing, health manpower, emergency
medical services, and nursing homes; and ad hoc planning
projects concerned with kidney dialysis, unlicensed
physicians, hospital data collection, hospital guidelines
development, annual meetings, and analysis of the role of
various mental health groups in planning, coordinating,
and direct service activities. Gn-going planningPLANNING GRCUPS
PROVIDERS/CONSUMERS
Page 255
activities include mental health# alcoholism# Model
Cities# environmental quality# and drug abuse programs.
Major Council recommendations which have been accepted by
decision makers for implementation are listed# and
challenges facing the Council are defined. (NTIS)
Reference:
Lisbeth Meisner# Alberta Parker# Lee Austin# Cora Qrr# and
Mary Lou Ortega#
Itainina P£q<iL3Gl £or CoQ£UH!e£s EolisYrMaising Holes in
ilsialili Cats Ecaiscis#:
Berkeley:	California Univ.# 1969.
A training program for the consumer members of
policy-making boards of three federally funded
neighborhood health centers and one Model Cities health
planning committee in the San Francisco Bay Area is
described. Background information is provided for each of
the centers and the Model Cities project# including
funding# organizational structure# and community
characteristics. The objectives of the training program#
the Berkeley Consumer Health Project# are delineated# andPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 2So
staff members are identified. Formation of the
policy-making boards, their liaison with the community,
and the roles of the boards are discussed. Planning
meetings, including the establishment of a workshop
program, are outlined, followed by more detailed
descriptions of eight workshops. These training workshops
dealt with problems within the boards, professional
personnel, confidentiality of information, emergency
services, the politics of health, hiring community
residents, and community representation. The second part
of the workshop program was concerned with planning for
programs within the individual centers. Finally, tne
workshop program was evaluated by its participants.
Policy suggestions for future consumer training programs
and participant comments are included. Portions of this
document are not fully legible. (NTIS)
Reference:
Lisbeth Meisner, Christine Swearingen, and Alberta Parker,
iJLainina ExaaLam lai ccLDsamans in ajtllsoo:	o£ EaliaY
Haisins £al£s in itealib	Einal Eaaani*
12
Berkeley:	California Univ., 1970.PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 257
The final report of the Berkeley Consumer Health
Project/ which involved the training of community
representatives participating in Model Cities healtn
planning committees/ is presented. The Project was 3
continuation of a previously funded program to train
consumers having advisory or policy making
responsibilities in neighborhood health centers. The
Model Cities programs which the Project was designed to
assist were in various stages of development; some were
unorganized and not yet functioning. The Project staff
decided not to develop an independent Model Cities
training program/ but to revive training sessions with the
neighborhood health center groups and invite Model Cities
staffs to participate. One Model Cities program and three
neighborhood health centers agreed to continue. A series
of workshops was planned around actual problems faced oy
one of the participant groups. The Consumer Health
Project also became the liaison between consumer groups
and professional and voluntary health groups.
Publications based on the Project's experiences were
prepared. Evaluation of the Project focuses on the
reasons for failure to include Model Cities health
consumers in the training programs. (NTIS)PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 258
Reference:
Jonathan Metsch and James Veney,
"Consumer Participation and Social Accountability,"
Medial Care# Vol.14, No.4, p.283-293, (April 1976).
Specific guidelines defining the roles of consumers
in the planning and management of health care programs are
urged if consumer participation is to be a positive force
in health care delivery. The trend toward vague or
nonspecific statements in recent legislation mandating
consumer participation in health care delivery is likely
to assume that consumer participation will fail to produce
social accountability. A discussion of issues involved in
the successful participation of consumers in health
programs helps to explain why consumer participation has
not had the expected impact on policy development. These
issues involve the characteristics of provider
par ticipants, consumer eligibility and selection
processes, consumer-provider interaction, and the
difficulty of defining the outcome of consumer
participation. It can be concluded that the appropriate
means of implementing consumer participation have not been
found, that existing assumptions about the organization of
the participatory process need rethinking, and that the
problems of implementing consumer participation arePLANNING GROUPS
PROVIDERS/CONSUMERS
Page 259
symptomatic of an underlying contradiction between
assumptions about consumer participation and the realities
of the decisionmaking process in the health care sector.
References are included. (NTIS)
Reference:
Jonathan Metsch and Harry Rosen/
•'Consumer Participation in Health Care Delivery/'*
njlh loik iinlyatsity Ediisatioo auailfiilix Voi.7, No.2,
p.16-20, (Winter 1976).
Guidelines and strategies for encouraging consumer
involvement in local health care programs are outlined.
The demand for participation in decisionmaking by
consumers is traced to health programs funded under
Federal legislation that were designed to foster community
involvement as a means of facilitating community
development. Consumer participation in health delivery in
health delivery programs in the State of New York is
discussed. The relationship between providers of health
care and third party payers is explored in relation to
consumer intervention. Lt is pointed out that consumerPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 260
participation components of health programs are generally
restricted to the roles of legitimating and marketing*
rather than with priority setting or control. The
statement is made that consumerism will remain in the
realm of rhetoric instead of commitment unless there are
fundamental changes in the way health resource allocation
decisions are made. The need for explicit objectives in
health care programs is stressed. Training for both
consumer and provider representatives on joint planning
boards is viewed as an important support service that can
be provided by public agenices. Factors hindering
effective consumer participation are examined, and tne
importance of responsiveness of the voluntary sector of
health care is explored. It is concluded that consumer
participation is governmentally mandated but provider
implemented and that there is minimal consumer involvement
in the early stages of the decisionmaking process.
Strategies for improved consumer participation are
described. (NTIS)
Ref erence:
Herbert Notkin and Marilyn Notkin,
"Community Participation in Health Services
A ReviewPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 25i
Ar tide,"
Medical £a£S SfiViaaz. Vol.27, No.11/	p.1178-1201/ (Dec-
1970).
Community participation and/or control of health
facilities in local communities by tne people being served
and their representatives is discussed/ with special
emphasis on poor and ethnic minorities. The historical
and sociological background of health care is traced/ and
it is noted that poor and ethnic groups have traditionally
had little voice in its administration. In combination
with the War on Poverty and the beginning of legislation
relating to community participation in health care/
several other factors have led to an increased demand for
power and control over community affairs by the poor and
disadvantaged. The current status of communnity
participation in the health field is detailed. Current
organizational patterns are examined/ from those least
threatening to the local health care establishment to
those that may become hostile and militant. Current
issues of power/ role relations/ group psychology, career
ladders/ militancy and radicalism/ and community-staff
relations are analyzed/ and it is concluded that/ while
problems still exist/ the scope and amount of community
participation will increase and accelerate. (NTIS)PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 252
Reference:
P.C. Nutt,
“The Merits of Using Experts or Consumers as Members of
Planning Groups:	A Field Experiment in Health Planning,”
kzatem. ai	Jaunaal/ voi.19, No.3,	p.378-394,
(Sept. 1976).
A field experiment is described which compared the
innovativeness and quality of solutions from health
planning groups made up of health services users
"activists" - or professional consumers - and experts -
physicians, nurses, administrators, and therapists. The
experimental findings suggest several guides for planning:
(1) In the report, planning groups with consumer members
identified solutions with significantly lower quality than
planning groups with expert members? (2) Important
distinctions were found among types of health consumers.
Activists tended to generate more new information, whereas
those most familiar with the mode and delivery of services
generated more acceptable solution ideas? (3) The
conflict bewteen the staff and the decision groups should
be periodically heightened to keep them from becoming
advocates of the status quo when more pervasive change is
both possible and desirable? and (4) Agencies that must
maintain decision groups made up of both providers andPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 263
consumers and also seek meaningful consumer contributions
should try to mitigate both influence attempts by experts
and activist behavior by the consumer members.
This research points out the immense importance of
carefully selecting the members of a planning group.
Little support for user participation in planning was
found, but the innovations which occurred when activists
were planning group members is a discovery that can oa
profitably exploited by planning agencies.
Reference:
Alberta Parker,
The Consumer as Policy-Maker:	Issues of Training",
AmiLLisLaa Jaatnal al Eiililis itealih/
p.2139-2153, (Nov. 1970).
Vol.60, No.11#
For the consumer to function effectively in the new
roles of adviser and policy-maker in the health field,
skills and knowledge are required. This paper deals with
the training of consumers serving on policy-making boards
of neighborhood health centers and with issues raised ih
the training. The general issues are raised in thePLANNING GROUPS
PROVIDERS/CONSUMERS
Page 26 1
context of a specific demonstration project - the Berkeley
Consumer Health Project.
Reference:
Kurt Parkutn,
LzzI&ls SLelaisd Iq izluniaLi	in iisniib
Einrminn-t
Madison: Dept.	of Rural Sociology, Wisconsin Univ.,
1973.
Research on participation and involvement in
comprehensive health planning is reported, with emphasis
on factors related to voluntary participation. Literature
on voluntary associations and activities is reviewed, and
Reeder's social action theory is discussed. Two aspects
of Reeder's theory were tested:	(1) the hypothesis that
belief variables explain behavior better than reference
category variables; and (2) the hypothesis that there is
consistency among people's attitudes, beliefs, and
behavior toward a referent. Reeder's theory was applied
to a random sample of health consumers and providers in
three local agencies responsible for comprehensive healtlhPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 265
planning in a large area of Pennsylvania. Information was
obtained through personal interviews. It was found that
most people volunteered for comprehensive health planning
activities for three general reasons: (1) they felt they
had the ability to make a contribution because of their
background and experience; (2) work was consistent with
their values; and (3) participation would contribute to
their goals of increasing knowledge of iraproving‘health
services. Both hypotheses in Reeder's theory were
supported in terras of voluntary participation in health
planning. An appendix contains the interview schedule for
health consumers/ and a bibliography is provided. (NTIS)
Reference:
Kurt Parkum/
SLansnasi:	EaniicianUnn in Ufinaaj&Is lisalth Insurance
SYslnmi k sinlx al Lhs. annisti
Harrisburg/ Pa.:	Div. of Behavioral Science/
Pennsylvania Dept. of Health/ 1971.
The sygekasse (sick chest) system of delivering and
financing health services in Denmark is considered as aPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 266
well-organized strucutre developed from a social movement.
Although the State has considerable influence, the system
is run by the member representatives rather than health
professionals. The member representatives are mostl/
older men with little formal education; this is
considered an element of an effective mechanism of
cooperation among providers, consumers, and
administrators. Trends are noted from the
all-inclusiveness in the delivery of health services
toward more limited services and from independence toward
increasing government control. Reforms of 1973 mark a
movement from direct democracy in the sygekasses system,
and the emphasis will be on the government bureaucracy and
the election of political officials rather than tha
voluntary member rule. A history of health insurance in
Denmark is provided, and the sygekasse system prior to
1973 is delineated by membersnip, finances, the
organizational structure, the relationships with the
health providers, the representatives, and the
administrators. The legislation adopted in 1964 to change
the system is discussed in brief in the appendixes.
Supplemental data are provided in graphical and tabular
form; a bibliography is included. (NTIS)PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 267
Reference:
Robert Pecarchik, Edmund Ricci, and Bardin Nelson,
'•Potential Contribution of Consumers to an Integrated
Health Care System,"
Put?! ic	EfiaorJtSt Vol.91, No.l, p.72-76, (Jan.-Feo.
1976).
Based on a theoretical framework and on practical
experience in the area of Pennsylvania served by the Mon
Valley and Welfare Council, the authors have
conceptualized the role that the informed consumer can
play in today's complex health care delivery system. They
conceive of this role as a practical one that can
significantly help a modern, rapidly evolving health cgr«
system to meet the challenge of change.
Reference:
Peter Rogatz and Marge Rogatz,
"Role for the Consumer,"
Social	p.52-56, (Jan.-Feb. 1971).PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 26-3
The role of the consumer in establishing
health-related policies and in planning for comprehensive
health services is discussed. It is observed that simply
mandating consumer participation in advisory councils an!
committees does not assure that decisionmaking processes
will no longer be dominated directly or indirectly by
professionals. Introduction of meaningful consumer
participation in the decisionmaking process is viewed as
most important at the local level/ where the greatest
opportunity for such participation exists. It is argued/
for example/ that lay persons are capable of understanding
the matters dealt with by a hospital utilization committee
and of contributing constructively to the deliberations of
such bodies. Another area for consumer participation is
found in professional medical education/ an aspect of the
health care system usually regarded as outside the purview
of the consumer. It is observed that education is one of
the most critical factors in reorienting the health care
system in the United States. Therefore, criteria for tne
selction and evaluation of students, staff, and faculties
of professional schools should be reexamined in the lignt
of consumer needs and experiences and with the benefit of
consumer participation. In a discussion of rationale for
consumer participation in program and service planning, it
is noted that the perceptions and underlying assumptions
of providers differ substantially from those of consumers.Page 269
PLANNING GROUPS
PROVIDERS/CONSUMERS
The
cri t
deal
rece
to
cons
need
heal
more local the focus of a
leal it is that these
t with. It is noted that
ive enough consumer inpu
consumer demand (a p
iderable reorientation)/
for patient-advocates or
th care program. (NTIS)
particular prog
differences be r
z until programs
t to be reasonab
rocess that
there will be
ombudsmen in
ram/ the more
ecognized and
and services
ly responsive
wil require
a continuing
almost every
Reference:
Harry Rosen, Jonathan Metsch and Samuel Levey,
CansuiEiit and	Hnnlili	— Sasial sod
tianassilai Pansaesiivss*
New York, N.Y.:	Halsted Press, 1977.
Consumer participation in the health care system is
the subject of this compilation of articles. A conceptual
framework for analyzing the growth and development of the
consumer movement in the United States is presented; the
framework considers analogous trends in the health sector.
Consumer participation is examined in terms of
organizational behavior and difficulties inherent
LnPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 270
bureaucratic management. The role of consumers in the
health care context is discussed as are problems
surrounding the implementation of consumer participation
in health care. Specific topics covered by the articles
are the management of public service institutions/
consumer participation and social accountability/
community participation and health resource allocation/
the shifting power structure in health/ hospital
governance/ and the public accountability of hospitals.
Medical care as a right/ community participation and
sharing in the control of public health services/ citizen
participation strategies/ consumer participation in health
planning/ and representational standards in comprehensive
health planning are some other topics included. Research
programs on consumerism are cited that encompass
neighborhood health centers/ community health/ and
hospitals. Some articles end with a list of references/
and subject and author indexes are included. (NTIS)
Reference:
Rudolph Sellers/
"Black Health 'Worker and the Black Health Consumer
Roles for 3oth/"
Ne 4PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 271
American JoytQaj. of Public Health/ Vo 1.60, No.11/
p.2154-2170/ (Nov. 1970).
Using black health workers to deal with black
consumers is discussed in the context of a neighborhood
health center for children/ and control of black health by
blacks is urged. Present-day health care fails to meet
the needs of	black consumers because	those in
decision-making	positions are unaffected by health
institution decisions and are not consumers of the same
health institutions as poor blacks. A proposed health
care model emphasizes the following points:	the board of
directors must be controlled by consumers affected by the
decisions it makes; health purveyors must be residents of
the area being provided health services; and no consumer
should be denied health services of the institution for
lack of money. Community participation in the
organization and development of the Hill Health Center in
an inner city neighborhood in New Haven, Connecticut, is
described. The Center was developed through cooperation
between neighborhood organizations and a contract with
Yale University Department of Pediatrics to provide
comprehensive health care services to 8,000 children and
youth, provide jobs and training to area residents, and
operate through community participation. Area residentsPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 272
participated in the site selection process, serve on the
personnel committee, and serve on the Health Center board.
The role of the black health worker is to be in tune with
the consumer and to build trust between the institution he
serves and the consumer. He can only effectuate change
with the support of his constituency, the consumer.
(NTIS)
Reference:
Allan Morton Shoff,
ai £itiz£n	on CajmmiJLy Menial Haalii!
Elanniaa*.
Philadelphia:	Graduate School of Arts and Sciences,
Pennsylvania Univ., 1974.
Two hypotheses concerning the impact of citizen
participation on the planning decisions that determine
resource allocation in community mental health programs
are examined through a retrospective analysis of community
mental health programs in Los Angeles County, California
and through a survey of program staff members and regional
community liaison committee members. The hypotheses are:PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 273
(1) as citizen participation in the planning of community
mental health programs increases, the citizens' effect on
the decisionmaking process increases; and (2) as citizen
participation increases, emphasis on indirect primary
prevention decreases and, correspondingly, emphasis on
direct clinical services increases. A discussion of the
importance of both prevention and citizen participation in
community mental health planning points up the conflict
implied in the second hypothesis: whether to allocate
scarce resources to deal with immediate problems, or t)
aim at a better future through the promise of indirect
primary intervention. The methods and materials used in
testing the hypotheses are described, and the background
against which community mental health planning in Los
Angeles County has taken place is discussed. An increase
in citizen participation in the planning of community
mental health programs was verified. The increase was
identifiable, although not uniform, in all parts of the
country. Increased citizen participation was found to
affect the planning process at both countywide and
regional levels. Regional effects were not dramatic or
uniform, but countywide effects were impressive. Tne
second hypothesis proved not to be testable by the data
collected. Difficulty was encountered in distinguishing
the intervention preferences of community liaisons ani
staff groups. However, the responses of the communityPLANNING GROUPS
PROVIDERS/CONSUPERS
Page 271
liaisons were consonant with the argument that citizen
participants prefer direct secondary and tertiary serviced
to indirect and primary interventions. Unexpectedly, the
preferences of the staff members agreed with those of the
community liaisons, perhaps indicating a lack of
acceptance of the public health model and/or reflecting
the pressure on staff members for providing direct
services. Relevance of the findings for community health
planning and for planning as a discipline is discussed.
Supporting data and a bibliography are included. (NTIS)
Reference:
K.J. Simmons,
"Community Health Planning with or without Nursing,"
Surging Outlook, Vol.22, No.4, p.260-264, (April 1974).
The role of the nurse as a volunteer participant in
community health planning is discussed, and suggestions
for implementing such a role are offered. The nursing
profession is questioning the appropriateness of its
participation in community health planning. Issues and
problems within the profession have precluded extensivePLANNING GROUPS
PROVIDERS/CONSUMERS
Page 275
participation by nurses in the community planning process*
Reasons for viewing community health planning and the role
of nursing as being not only compatible but mutually
dependent are discussed. A strategy for systematically
involving nurses in community health planning includes
five levels of activity: (1) staff planner for the chief
executive of the nurse's employing institution; (2)
appointed member of the institution's long-range planning
committee; (3) institutional representative to 3
community-based planning group; (4) community member of 3
planning agency board or advisory committee; and (5)
sponsor or applicant for an institutional or
community-based demonstration project. Activities
included at each level are described. Among constraint*
on nursing involvment in community planning are inadequate
nursing staff and/or departmental organization in th®
institution, denial by the nurse of her planning role, and
the reluctance of others to accept nurses as planners.
Rewards of invovlement in community planning are
described. (NTIS)
Reference:
Gerald Sparer, George Dines, and Daniel Smitn,PLANNING GROUPS
PPOVIDSPS/CON SUMERS
Page 276
"Consumer Participation in OEO-Assisted Neighborhood
Health Centers/"
American Journal cl Enblic EaaliUx voi.60, no.6,
p.1091-1102/ (Jun. 1970).
Experiences of the Office of Economic Opportunity
(0E0) with consumer participation in Neighborhood Health
Centers are analyzed to determine which factors influence
consumer involvement. OEO site visit teams conducted
two-day site appraisals of 27 centers/ conducting reviews
and discussions with staff members and attending meetings
of consumer groups. Of the 27 centers visited/ seven were
rated high in degree of consumer involvement/ nine
moderate/ and ten low. No	pattern relating the
administrating agency to degree of involvement was
apparent. Five organizational components were scored for
each center:	committee structure and function/ status o£
bylaws/ regularity of meetings/ board election procedures/
experiences/	and completeness of minutes. Elections
scored high/ less frequently than any other factor.
Committee organization appears to be the key element in
group involvement. The effect of outstandinj
personalities on group functioning is important. Gnly ona
of the ten low-rated	groups had an outstanding
personality/ while four of the seven high-involvement
iPLANNING GROUPS
PROVIDERS/CONSUPERS
Page 277
groups had an outstanding member. Of the 27 projects,
seven had experienced conflict related to the consumer
group. Only one of the low-rated groups had experienced
conflict. In none of the conflict cases was the conflict
considered to have altered the operational status of the
project. (NT IS)
Reference:
Carl Stevens,
Cflnsimisi. £aLli£i22lioii in M£3i£.alr£2]:.2 Haiksis*
Boston:	Harvard Center for Community Health and Medical
Care, April 1973.
A conceptual framework is developed within whici
consumer participation is shown to be potentially
contributory to more efficient resource use in medical
care markets. Attention is drawn to the potential value
of consumer participation as a catalyst and synergist to
upgrade the significance of the physician's duty of full
disclosure,' i.e., a generalized version of what usually
is termed 'informed consent.' In carrying out this duty,
the physician would be expected to disclose to the patient
PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 279
not only the diagnosis, but also the probable benefits,
costs, and risks of all kinds associated with the therapy
proposed and with likely alternative therapies (including
no treatment). It is further suggested that the consumer
participation role may afford assistance in articulating
the 'frequently conflicting' resource allocation
implications of two levels of decision—making; (1)
macro-prospective allocation decisions and events
(frequently public-political); and (2) macro-immediat2
allocation decisions and events (involving individuals in
their roles as 'marketeers"). Portions of this document
are not fully leyible. (NTI5)
Reference:
Marvin Strauss,
COBSUEDSI £B£li£i2aii£D 10 lifiOlltl £l3O0iQ£x
Thorofare, New Jersey:	Health Education Monographs,
Charles S. Slack, Inc., 1972.
An assessment of the significant issues involved in
consumer participation in health planning is contained in
this monograpn, one of a series published by the SocietyPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 27 3
for Public Health Education. Designed primarily for staff
members of State and areawide comprehensive health
planning agencies, these materials are also useful in
continuing education and consumer education programs. The
articles in the publication deal with legislative an!
administrative devices to foster consumer participation in
health planning, pragmatic alliances of citizens' groups
and citizens' lobbies, consumer-oriented national
organizations, and consumer representation in all types of
groups and organizations. Other articles are concernel
with consumer participation as an end in itself, conflicts
within the consumer movement, the power of consumers to
force action, and the implied power of the consumer
movement. A bibliography on consumer participation and
health education publication abstracts are included.
(NTIS)
Reference:
Gabriel Tafolla,
Ciiic ana uaaiih CaasuiBai. Ra£ii£A&a.Liar]
Austin, Tex.:	Urban Research Group, Inc., Feb. 1974.
tPLANNING GROUPS
PPCVIDSRS/CONSUMERS
Page 233
The object of the Chicano Health Consumer
Participation Project was to develop environments in which
Chicanos can effectively participate in planning,
development, and implementation of solutions to local
health problems among Mexican-Americans in the United
States- It was also intended that the expertise of
Chicano leaders and community groups would be developed
through active participation in the development of plans
and strategies. Each site was visited and analyzed and a
list of four potential community coordinators were
carefully screened, selected and trained. Each site
received endorsements from local organizations and
established programmatic linkages with existing health
agencies, and received technical assistance in planning
design and project development. Urban Research Group
staff worked with the community corporations to prepare
the councils of government for the arrival of project
proposals. (NT IS)
Reference:
Robert Tranquada,
"Participation of the Poverty Community in Health Care
Planning,"
PLANNING GROUPS	Page 231
PROVIDERS/CONSUMERS
Silsncs and ledisine^. Vo 1.7, p. 719-7 28, (1973).
Experience in six projects involving consumer
participation in health care planning for low incoms
communities is compared with the literature on the subject
in an assessment of such participation in neighborhood
health centers/ maternal and child care projects/ hospital
services, regional medical planning, and national health
association involvement- It is noted that the serious
consideration of participation by low income consumers in
health services planning and implementation	is	i
relatively new idea as yet incompletely validated or
evaluated. The impetus for consumer participation in
health service planning, it is observed, was derived iron
the recognition of the need for involvement of minority
groups and the poor in programs that only incidentally
included health care. Low income communities present
problems for consumer participation not found in wealthier
communities. In the poor community, generally acceptable
agencies for expressing valid community opinion are less
likely to exist, and bases of power within such a
community are severely restricted by the nature of the
community. However, once the poverty area resident grasps
the potential significance of a health care planning
effort, he is likely to be more vociferous in maintaining
kPLANNING GROUPS
PROV IDERS/CONSUMERS
Page 232
his right to a decisionmaking role than is the resident of
the middle class suburb. Experience with respect to the
identification of the community/ the means by which
community will is expressed in the poverty setting/ the
division of responsibility between the professional and
the consumer/ and critical factors in the
professional-consumer relationship are reviewed as
reflected in the literature of the late 1960s and early
1970s. Particular significance is attached to the
potential social and economic impact of health care
projects in impoverished communities. It is concluded
that the economic potential of such projects creates the
most problems in cooperative planning and management.
(NTIS)
Reference:
Benjamin aells,
“Role of the Consumer in Regional Medical Programs"/
J<2MLnal oX Euilic Health, Vo 1.60, No. 11,
p.2133-2138, (Nov. 1970).
Public Law 89-739 brought the consumer into the
«PLANNING GROUPS
PROVIDERS/CONSUMERS
Page 283
planning of health services on an official basis. What
should the role of the consumer be in this area ? This
function, potential and actual, is examined with respect
to Regional Medical Programs.
Considerations of consumer interests in activities of
the Regional Medical Program led to two important
conclusions. First, in the Regional Medical Prograa
valuable functions, ideas and leadership in consumer
groups were discovered. As a result, their roles were
voluntarily extended in a manner quite similar to that
which is legally required under the Comprehensive Healtn
Planning Act. Second, as an outgrowth of consumer
participation, in part, planning and thinking has become
more comprehensive in its scope despite the legal
limitation of projects to predetermined categories.
Reference:
Janie Wheeler,
Lsnnl Rasnioinnis q! a SsmmunilY	£ais Elan ns li
Alissis ills Rintiis o1 ths. gansuaaL^.
Akron, Ohio:	United Way of Summit County, March 1976.PLANNING GROUPS
providers/chmsumers
Page 231
Legal factors in the planning and design of effective
health care systems for consumers are addressed- Primary
emphasis is placed on physical health delivery services
and their legal ramifications- A major administrative
factor which contributes to problems in the health care
delivery system is identified as the absence of
substantial and equitable participation by consumers in
the determination of health care policies. Based on the
principle of accountability/ the statement is made that
both providers and consumers should have grievance anj
appeal mechanisms. Problems associated with the financing
of health care are discussed- It is felt that consumers
must request that the financing of health care be
separated from the provision of services and the ability
to pay. Legal requirments contained in the National
Health Planning and Resources Development Act of 1974
{P.1.93-641) are noted. The role of consumers in health
systems agencies and hospitals is assessed. Legal actions
that consumers can take to improve the health care
delivery system are examined. The impact of the 1976
Federal budget proposal to consolidate 16 health program*
into a single grant to States is explored. The rights of
consumers are detailed in relation to the provision of
health care, information is appended on health insurance
proposals, national health expenditures from 1950 to 1971,
and the results of some health consumer interviewsPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 235
bibliography is provided. (NTIS)
Reference:
Samuel .ilolfe,
"Consumerism and Health Carey"
AdliDiSiiatian 2&yi£iix Vo1.31, No.5, p.528-535,
(Oct. 1971).
The role	of the	consumer in	the	decisionmaking
processes of	health	care services	is	discussed in tha
context of the	history	of consumerism.	its	present status,
and future directions. Consumerism in health in the U.3.
has had its greatest impact in the collective bargaining
arrangements between labor and management (with respect to
health benefits). It gained further impetus following the
civil rights movement/ and the associated legislation in
recent years which has brought to the fore a new breed of
citizen/ be he Black, Chicano, or poor ahite, not content
with second class citizenship, and demanding better health
care. It is suggested that there is a growing
dissatisfaction with the traditional means of citizen
participation, such as voting or petitioning; people wantPLANNING GROUPS
PROVIDERS / CONSUMJERS
Page 235
to be directly involved in decisions affecting their
welfare. Yet in many instances, where citizens have
become involved in the decision-making process, they have
been poorly prepared for such a role. Research on the
subject has disclosed that in order for partnerships
between consumers and providers of service to be
effective, both groups have to undergo new learning. The
consumer c	an bring	to	the	agency or	institution the
perspective	of the	man	in	the street,	bringing up
grievances	which in	turn,	may	generate conflict. Yet, it	
is noted,	conflict	and	i ts	resolution	can be great
learning e	xper iences	for	ser v	ice providers	and consumers.
(NTIS)
Reference:
Robert Young,
Manual Lql Elaimins a Q2mL£h£.n2±x.2. Estsaiul
Efi^lth Ssrvicss Qeliv££Y Sysiemx
New Haven; South Central Connecticut Comprehensive Healtn
Planning, Inc., Feb. 1971.
Guidelines are presnted to assist consumers inPLANNING GROUPS
PROVIDERS/CONSUMERS
Page 237
planning for the delivery of comprehensive personal health
services within their community. The manual is designed
as a 'how-to-do-it' handbook/ and assumes the existence of
a community-based planning body ready to go to work. Six
elements of a comprehensive health services delivery
system are identified: preventive services,
medical-surgical services, physical services, dental
services, mental health, and rehabilitation. Methods of
delivery are differentiated, and bases for making planning
decisions are identified. Categories of health manpower
are defined, the roles of different kinds of physical
facilities in the system are identified, and financial
considerations are addressed. Methods of ownership of the
health care delivery system are also touched on. The
kinds of information about health conditions in the
community that are needed for planning are described, and
ways of collecting the information are discussed. Eight
basic principles of planning for the improvement of the
health of a given population are identified and discussed:
(1) establishing overall goals; (2) identifying and
quantifying need; (3) defining objectives; (4) assassinj
and measuring resources; (5) designing a program; (5)
time phasing; (7) evaluation; and (3) implementation. 1
glossary of health planning terms is included. (NTI5)ORGANIZATIONAL ASPECTS
Page 233
Reference:
Donald B. Ardell,	*
"Public Regional Councils and Comprehensive Health
Planning:	A Partnership ?",
Ajnstisaa Insliiule ai ELaan^ts ^annual, voi.36, No. 6,
p.393-404, C Nov. 1970).
After examining the critical issues and still fluid
status of comprehensive health planning/ a case is made
for merging it with comprehensive metropolitan planning
under the leadership of public regional councils/ such as
Councils of Government (COG's) and other regional planning
agencies. Despite the predominance of private interests
in the health field, public leadership in health planning
is advocated as the strongest basis for comprehensiveness.
Reference:
Donald 3. Ardell,
"CHP and Multifunctional Regional Councils:
Reappraisal"/
Inquiry* Vol.ll, Ho.4, p.263-268, (Dec. 1974)ORGANIZATIONAL ASPECTS
Page 23)
The author had previously published a series of
articles on a proposed new partnership between the
categorical health forces interested in comprehensive
health planning (CHP) and the comprehensive planners
concerned with multifunctional regional councils.
Critical issues in health, the nature of the healti
system, characteristics of the major players, and the
record of health planning prior to CHP were reviewed; anJ
a case was made for merging CHP with regional council
organizations having broad planning functions. This
article reassesses the earlier works and suggests a
revised thesis for relating multifunctional regional
councils and health planning.
Reference:
Mary Arnold and Douglas Hink,
"Agency Problems in Planning for Community Health Needs",
Medical Care, Vol.6, No.6, p.454-466, (Mov.-Qec. 1968).
The article presents an analysis of interagency
planning problems based on a study of six voluntary health
agencies in one metropolitan community. The authors'ORGANIZATIONAL ASPECTS
Page 290
thesis is that a cooperative spirit does not necessarily
lead to the implementation of coordinated health plans and
that/ even where there is a strong desire and willingness
to work together/ there are some major obstacles in the
very structure of the organized community that militate
against the implementation of cooperative efforts.
Some obstacles listed include: (1) differences in
priority given to the type of community need identified?
(2) differences in the way commonly-recognized needs were
defined	in terms	of	the agency's	own response;	(3)
current	pressures	and	demands for	agency time	and
manpower; (4) lack of clear-cut community norms for
allocation of agency responsibilities for initiation of
new activities; and (5) amount of organizational energy
and time required for initiating and implementing changes
in program activities.
Development of competitive planning structures within
a directing and coordinating body is proposed as a
strategy for coordination.
Reference:
Howard Braun/ Robert Kugelman/ and Marilyn Massey/
’•An Evaluation of the Agency Assessment ProgramORGANIZATIONAL ASPECTS
Page 29L
Implications for the Health Systems Agency Communityn,
AnLS£i&ajQ Jautnal qX Health Planning, vol.i, rio-i, p.52-59,
(July 1976).
The National Health Planning	and Resources
Development Act of 1974	(P.L.	93-641) was designed to
consolidate and strengthen the nation's health planning
and resource development capability.	This will com*
through a restructuring of the health planning agency
network and the provision of increased responsibility and
authority. If the agencies are to be successful in their
efforts to provide effective health planning and resources
development, it is imperative that they utilize the
lessons of the P.L. 89-749 era. Tnis article focuses on
an evaluation of a relatively recent CHP experience - the
assessment of areawide agency compliance with national CHP
agency performance standards.
The evaluation findings indicated the following:
(1)	a generally low level of performance within the
314 (b) agency era;
(2)	an emphasis on certain functions which is
inconsistent with the suggested model for health planning
agency activities?
(3)	an emphasis on those functions which demonstrate
a responsiveness to the changing Federal emphasis?ORGANIZATIONAL ASPECTS
Page 292
(4)	a higher level of achievement by those agencies
which, implicitly or explicitly, acknowledged the logic of
the suggested model; and
(5)	the appropriateness of an initial emphasis on the
development of sound organization and management
procedures by conditionally designated Health Systems
Agencies.
These conclusions provide a firm basis for the
recommendation that a developmental sequence of agency
activities be specified and, within reasonable limits,
mandated for the new Health Systems Agencies. This
recommendation implies the necessity of first specifying
agency activities. The performance standards as require!
by P.L. 93-641 should serve to structure agency
activities. As soon as HSA performance standards ar *
available, a model of functional interrelationships and s
"logical elemental sequence" should be developed. This
model should guide the orderly implementation of Health
Systems Agencies.
Reference:
Fort Washington, Pa.:	Health Planning Research Services,ORGANIZATIONAL ASPECTS
Page 293
Inc., 1974.
Guidelines for use by health systems agencies (HSA's)
or potential PSA's in making and implementing decisions
regarding the establishment or continuation of subarea
councils are presented. The guide has relevance for three
types of organizations: organizations that have subarea
councils and elect to retain them; organizations that are
considering the possibility of forming subarea councils;
and organizations that face overriding political or other
considerations that dictate the formation of subarea
councils. The approach each type of organization should
take to using the guide is described. The guide opens
with a review of the provisions of the National Health
Planning and Resources Development Act of 1974 (P.L.
93-641) concerning subarea councils. General and specific
considerations to be taken into account in making the
decision to establish subarea councils are discussed. A
list of activities in which subarea councils might engage
is provided, followed by information on the organization,
development, and utilization of subarea councils.
Subsequent sections discuss providing for subarea councils
in agency bylaws and in policies and procedures manuals
and reviewing existing subarea council programs with e
view toward compliance with P.L. 93-641. Step-by-stegORGANIZATIONAL ASPECTS
Page 291
procedures for assessing an agency's needs in regard to
subarea councils are presented. A review of the
relationship between the governing body and the subarea
council and suggestions regarding subarea council
composition are appended. (NTIS)
Reference:
James Glass/
"Substate Districts and Comprehensive Health Planning
Agencies:	Conflict or Cooperation/"
Sianlil and £banfl££ Vol7, No.4/ p.18-24, (Oct. 1976).
Problems involved in the operation of regional health
planning agencies and private nonprofit comprehensive
health planning (CHP) agencies and in the merger of
regional and CHP agencies are investigated. Governmental
fragmentation/ lack of program coordination/ and
inadequate communication have resulted in a number of
problems related to the planning and delivery of healti
care. The problems of fragmentation and competition are
examined at the multicounty regional level through an
analysis of relationships among CHP agencies and substatiORGANIZATIONAL ASPECTS
Page 295
districts. Historical trends in multicounty regionalism
are reviewed. The basic concept of State-authorized
substate districts is identified as the creation of a
single set of raulticounty organizations to promote program
coordination and planning. The repsonsibilities of
substate districts are delineated in relation to enabling
legislation. Four problem areas are identified that are
faced by substate organizations in evaluating the
feasibility of administering comprehensive health planning
through multipurpose districts: support, attitudes,
political issues, coordination, and competition. The
benefits of merging CHP agencies and multicounty substate
districts are examined. (NTIS)
Reference:
Rae Kramer, Valerie Rosenhoch, and C.Townsend,
CfiiHlfiilSl	SIXUfiillLS	ISSUES
and Qe^isms fat ii2Mx
Syracuse:	Areawide and Local Planning for Health Action,
Inc., N.Y. Center for Health Planning, Feb. 1977.
Information relevant to the structure,
role andORGANIZATIONAL ASPECTS
Page 2)i
management of subarea councils (SAC's) of health systems
agencies (HSA's) is presented. The materials are intended
for use as a guide in making decisions related to the
establishment and operation of SAC's. The Health Planning
and Resources Development Act of 1974 (P.L.93-641) states
that an HSA may establish SAC's to advise the agency on
the performance of its functions. Materials are presente]
on HSA-SAC organizational relationships and on SAC
geographical boundaries/ size/ composition/ governance/
organization/ and membership. The SAC role is discussed
relative to HSA functions in the areas of plan assemblage
and analysis/ public issue involvement/ fund raising/ and
and plan implementation. Aspects of SAC management -
non-SAC members in HSA/SAC activities - are considered/ as
is the issue of developing and maintaining the interest
and participation of SAC members. Sections on HSA
support/ orientation and education of SAC members and the
community, meetings/ expenses/ and the extent of SAC
activity are included. Relationships between SAC's and
county government/ the local government/ other SAC's/ the
media/ and other agencies are considered. Examples of SAC
bylaws and operating procedures and a list of sources of
additional information are appended. (NTIS)ORGANIZATIONAL ASPECTS
Page 297
Reference:
£fifiidiaaiina Sauncili Eulfis aui
&£l2li£asliiiis.t
Madison/ Wisconsin:	Midwest Center for Health Planning/
Dec. 1976.
The roles of the Statewide Health Coordinating
Council (SHCC) are discussed/ and the relationships
between the SHCC and other health planning mechanisms
created by the National Health Planning and Resources
Development Act of 1974 (P.L.	93-641) are defined. It is
noted that the SHCC is a direct organizational descendant
of several advisory and policy councils mandated in the
past under Federal financial assistance programs to
States. The SHCC is State-financed and staffed;	its
members are State-appointed/ with the majority coming from
nominees of health systems agencies (HSA's); it has both
advisory and operating functions. Its federally mandate!
roles include the coordination of planning efforts
undertaken by the various MSA's in the State/ including
the development of a uniform format for health systems
plans and annual implementation plans; plan development/
involving the preparation of a State	health	plan
consisting of the health systems plans of the State's HSA;
resource allocation/ including review and commentORGANIZATIONAL ASPECTS
Page 29 3
responsibilities relating to the allocation of Federal
funding to the HSA's; and advisory functions. Following
a review of the concept, role, and functions of the SHCC,
factors that can affect the organizational structure of
the council are discussed. General areas in which
councils should develop procedural guides are noted.
Schematic drawings showing the council's place in the plan
development process and options for SHCC-categorica1
committee interrelatinships are included. (NTIS)
Reference:
Siuals USA sand	153& States,
Cambridge, Mass.:	Arthur D. Little, Inc., 1978.
Visits made to 13 single health systems
States and to 3 Section 1536 States analyzed
health planning activities and problems,
purposes of the visits were to describe
terms of structures, roles, relationships,
performance; to identify situations felt t
agency (dSA)
these States'
The specific
operations in
and function
o be primarily
a function of single HSA or Section 1536 status and
resulting work programs; to learn how the various publicsORGANIZATIONAL ASPECTS
Page 299
affected by health planning perceive the effectiveness of
the chosen organizational structure? and to analyze the
results in a way that permitted the development of
recommendations for additional or modified policy
guidance, program administration, legislative an 1
regulatory changes, and guidelines for Section 1536 ani
single HSA States. Many of the 16 States had developei
structures and processes under P.L. 93-641 that were
constructive and represented adaptations and proactive
solutions to often difficult problems. Evidence from the
study suggested that the single statewide HSA structure is
both workable and feasible. Issues surrounding the
viability of Section 1536 structure were evaluated and it
was recommended that DHEW retain the Section 1536 option,
alter criteria for Section 1536 desgination status, an!
change some of the structural and procedural requirements
under Section 1536. (NTIS)
Reference:
Walter Wenkert,
"The Case for Sub-Area Councils",
Amexisan Journal H-sallh Elsnniim/ voi.2, No.i, p.25-23/
(July 1977).ORGANIZATIONAL ASPECTS
Page 300
A case is made for sub-area councils as an integral
part of the planning process, adequately staffed, and
given opportunity to contend with the planning and revie*
issues.
Sub-Area Councils organized as an integral part of
the planning process can help to promote greater citizen
involvement. The result would ensure a partnership of
citizens and professionals and a continuous interaction
between paper-planning and action-planning.
Since SACs are based on the geographic area where
people obtain the bulk of their health services, they tend
to be concerned about primary care, hospital care, chronic
care, and mental health - and how to pay for these.
Conviction about the close ties of citizen
involvement with planning-action comes from the way some
of us were forced to come to grips with the challenges
that faced us when we began to organize the area-wide
planning agencies under Public Law 89-749 of 1966. The
guidelines, rather slim by today's standards, instructed
us to devote two full years to organization, tnen move on
to planning.
Reference:ORGANIZATIONAL ASPECTS
Page 301
Jonathan P. West,
"Health Planning in Multifunctional Regional Councils:
Baltimore and Houston Experience",
Inquiry* Vol.12, Ho.3, p.180-192, (Sept. 1975).
This article examines the organizational text and
political dynamics of health planning in the Baltimore and
Houston metropolitan areas, where the CHP agency operated
as part of a Council of Government. The article analyzes
the intra-organizationa1 relationships between the health
planning component and its parent council and the
decision-making process in selected cases in both planning
areas. It concludes by weighing the advantages and
disadvantages of the governmental model. Some of the
problems facing health planners in Baltimore and Houston
are common to many public or private CHP agencies (e.g.,
the subjective and political basis of decision-making, the
limitations on CHP agency powers, attempts to circumvent
requirements for "need" assessment): but other obstacles
are more difficult (e.g., public officials vetoing
planners' decisions) or overcome more easily (e.g.,
integration of CHP with other regional planning efforts)
due to the organizational relationships with the
multifunctional planning council. Thus, the examination
of CHP in Baltimore and Houston provides perspectives fromORGANIZATIONAL ASPECTS
Page 302
which to evaluate some of the advantages claimed for tha
governmental model as an alternative organizational ton
for health planning.
Reference:
Jonathan P. West and Michael D. Stevens,
'•Comparat ive Analysis of Community Health Planning:
Transition from CHPs to HSAs",
Jmumal 2f iisallh Ealilicsx	aaJ Law/ '/oi.i. No.2,
p.173-181, (Summer 1976).
With the implementation of the National Health
Planning and Resources Development Act, comprehensive
health planning is moving into a new phase. In search of
lessons to guide future planning efforts on the part of
the Health Systems Agencies (HSAs) established by the act,
this paper reviews organizational and operational
characteristics of ten relatively ’’successf ul” local
comprehensive health planning agencies. Several problems
are delineated that HSAs will lively share with their
predecessors and strategies for confronting these problems
are suggestedORGANIZATIONAL ASPECTS
Page 301
Reference:
Kenneth Wheeler/
"Regional Health Authority:	A Possible Approach to Rural
Health Problems/"
Inauirv. Vol.47/ No.2/ p.15-31/ (June 1970).
Health needs in rural areas are discussed and a new
structure is proposed for the delivery of health services
to meet rural needs. Health problems and health progress
are examined in terms of the lack of rural health care,
barriers to health care/ regionalization/ and the
administration of health care for non-urban regions.
Various means for effecting regional health services are
identified/ including parallel actions by service
providers/ interinstitutional arrangements by which adde 1
services are provided/ private medical corporations/ an)
regional health authorities. The following are noted as
reasonable goals for a regional health authority in rural
areas: (1) generate in the population the level of health
which is clearly possible; (2) create patterns of health
services which treat individual patients with dignity;
(3) place health in its appropriate context/ in
interdependence with all other economic and social systems
of a community; and (4) develop for the regional health
authority a political base which will provide forORGANIZATIONAL ASPECTS
Page 301
participation by elected officials, health professionals,
and citizens with an interest in regional health.	To
achieve these goals, the regional health authority must
provide for:	(1) an adequate supply and efficient use of
health resources (facilities, serivces, and manpower)
(2) a system to bring service and training within a region
into close association? (3) a system for balancing the
benefits of regional uniformity with flexibility	to
respond to special individual needs? (4) a system to
relate regional health efforts to other aspects of
regional development? (5) a system to balance the values
of efficiency and reasonable cost with the values of
citizen participation in decisions affecting community
services; and (6) combined or at least uniform policies
and enforcement for public health jurisdictions within a
region. The administration of a regional health program
is discussed. (NTIS)
Reference:
Jere Wysong,
"Health Planning and Health Systems Agencies,"
Health SatYicaS Eas£^££llx Vol.lO, No. 4, p. 401-404, ( 1975).
ORGANIZATIONAL ASPECTS
Page 303
Federal regulations on the development of health
systems agencies (HSAs) are noted, and the impact of USAs
on the health delivery system is examined. One major
concern involves a fundamental disagreement over the
regulatory powers given to HSAs and, in particular,
whether the agencies have been given too much or too
little power. Programs for consideration in H3A
legislation revision include utilization review for
office-based practices, certificate of need for
physicians, and HSA authority over reimbursement rates and
fee shcedules for physicians. The health system in the
United States is characterized by market justice and
individualism concepts, and it is felt that such
ideologies encourage medical exploitation of minority
groups and inhibit collective action against vested
interests whose behavior is detrimental to health. The
interorganizational relationship aspect of HSAs is
discussed in an attempt to assess the impact of HSAs on
other health system components or units of governments.
The implications of the National Health Planning and
Resources Act are explored as regards the HSA. The
relationship between HSAs and PSkOs (professional
standards review organizations) is addressed. Tne
recommendation is made that evaluation studies be
conducted on the political, organizational, and technical
issues involved in the implementation of HSAs. (NTI3)PLANNING FUNCTIONS
DECISION MAKING - GENERAL
Page 305
Reference:
R.a. Canvin and D.P. 3oldy,
"Resource Planning Within the Health Care Planning Tearas",
Social S.£i£D£LS 3ml !i£'ii£in£/ Vol.10, p.171-176, (1976).
In 1957/ the DHSS recognized that in planning/
hospitals tended to act in isolation from other parts of
the community health services and exhorted clinicians t)
participate in planning and liaison with other agencies.
The reorganization of both the NHS and local government/
*
together with the current economic climate/ make joint
planning for efficient health and social services even
more important.
The DHSS/ therefore/ require the health needs of the
community to be asessed at District level and plans
formulated to meet those needs. Various definitions of
"need" are discussed in the paper and normative need as
defined by professionally desirable standards, is proposed
as a basis for planning. Thus, a person falling short of
the desirable standard is identified as being in need.
Thus "needs" can be defined such that a person with
characteristics X is in need of care Y, is understood tj
mean that standard of care Y is desirable for a person
with characteristics X. If, because of financial or other
constraints, the desirable standards cannot be achieved,PLANNING FUNCTIONS
DECISION MAKING - GENERAL
Page 307
the lower practicable standards must be adopted, defining
the "designated need".
The first step in the proposed planning process is
the specification of appropriate standards of provision.
These standards can either be DHSS norms, or they can
relate to more specific characteristics of the population.
Combining these standards with the projected population
allows estimates to be made of future resource
requirements. Financial and other constraints will, in
general, mean lower, practicable standards and that a
range of alternative feasible options are open. Here we
must appeal to research evidence and professional advice
in order to help the officers concerned decide on agree!
courses of action.
The use of the proposed planning structure is
illustrated within the context of services for the elderly
in a district. Using DHSS norms the services were ranked
according to the percentage shortfall between the norn
provision and the current provision. The ranking places
day care facilities (Geriatric and Psychiatric day
hospitals and day centres) with the highest priority.
Norms were used because there were no agreed
standards with which to replace them. It is argued that
the HCPT should seek to define more clearly the types of
person suitable for the receipt of each type of service
and estimate the number of such people. This is not an
kPLANNING FUNCTIONS
DECISION MAKING - GENERAL
Page 301
easy	task and	is further complicated	by the	f act	tha t
there	are likely	to be several acceptable	forms	of	care
for a	given type	of person.			
	The planning	approach proposed does	not pr	etend	to
answer the question of what is the ‘'best” allocation, nor
does it help in deciding priorties between different
client groups. It does, however, provide a framework
within which priorities within a given client group can be
explored by HCPTs.
Reference:
David Dunlop and Holly Caldwell,
"Priority Determination for the Provision of Healtn
Services:	An Economic and Social Analysis",
Social	ani Msditins/ voi.n, d.471-475, (1977).
This paper addresses the proolems of determining
priorities for the provision of health care services.
First, the necessity of establishing priorities for the
provision of health care services is discussed and the
rationale for public intervention in their delivery and/or
consumption is presented. Attention is then focused onPLANNING FUNCTIONS
DECISION MAKING - GENERAL
Page 303
four basic issues which are embodied in the process of
establishing priorities in the provision of health care.
The four issues include: (1) the issue of social equity
and the implications of alternative definitions of the
concept; (2) the issue of who makes priority decisions
for the delivery of health care; (3) the question of cost
and how it affects priority determination; and (4) the
importance of the concept of "health" and its production.
Related to the last issue is the need foe
understanding the component role of health care services
in improving human welfare. At this point/ attention is
focused on the implications for effecting alternativj
health care delivery patterns.
Reference:
George Godber/
"Decision-Making Structures in the British National Health
Service",
tiosailal 2XJ3il££SSr Vol.57, No.3, p.82-96, (Mar. 1976).
The author describes the central, regional, and local
level decision-making processes in the British National
iPLANNING FUNCTIONS
DECISION MAKING - GENERAL
Page 313
Health Service, arguing that despite its present
straitened circumstances, the service is a sound means of
providing quality care in the public interest- Six
k
significant decisions affecting the structure of the
health service are noted: (1) service should be available
to all persons without payment at the time of use; (2)
the main source of funding should be central taxation,
with minor contributions from social security insurance
funds and local taxation; (3) the ownership of nonprofit
hospitals should be transferred to the government; (4)
the administration of health services should be at the
local government level, leaving preventive and supportive
services and family practitioner services for medicine,
dentistry, and pharmacy to local agencies; (5) hospitals
should be planned and administered in large regions by
boards of local citizens; and (6) overall responsibility
for the provision of comprehensive health services should
reside at the national governmental level. (NTIS)
Reference:
Hsallti Sistsm EiiaLiiz S-filiiiiiit.
Providence:	Health Planning and Resources Development,
Rhode Island Dept. of Health, May 1977.
iPLANNING FUNCTIONS
DECISION MAXING - GENERAL
Page 311
A priority setting scheme for health status an 3
health service goals and interventions is proposed.
Health system planning is considered to be an umbrella or
framework planning activity designed to improve health
system decisionmaking and execution. Such planning
represents an attempt to relate ends (goals and targets)
to means (intervention strategies). The following healtn
system priority setting factors are detailed: (1) the
health effect, economic effect, and social implications of
health status ends; (2) service implications, economic
impact, social support, and health implications of health
service ends; and (3) benefits, economic cost,
acceptability, and feasibility of health status and healtn
service means. In comparing particular ends and means, it
is recommended that all factor and subfactor values be
expressed in terms of a five-level ordinal scale to permit
the combining of all factors using a common scale. Health
effect is noted as the most significant factor and,
therefore, is given twice the weight of the other factors.
Priority setting steps include the derivation of subfactor
scores, factor scores, and priority scores and final
ranking. A selected list of references is included.
(NT1S)
iPLANNING FUNCTIONS
DECISION MAKING - GENERAL
Page 31?
Reference:
Lee Holder and 0. Lynn Denis ton,
"A Decision-Making Approach to Comprehensive Health
Planning”/
EJUi2li£ lisalill RSDfltiS/ Vol»83/ No.7/	p.559-568, (July
1968).
Community health planning is a 10-step decision
making process which is both political and educational.
It is a process by which problems, objectives, and program
activities are articulated, resources are allocated, and
support is developed to implement agreed-on programs. Its
outcome is action to implement the plans accruing from the
process. Participants in the process learn by doing - by
discovering and assimilating facts, by analyzing and
interpreting them, in the light of the community
situation, and by democratically discussing and ultimately
deciding what to do about deficiencies discovered. The
planning process is a way to integrate needs, as
profesionaly defined, with demands, as defined by
consumers of services, and to balance the various forces
in the community into an integrated whole. Differences
and conflicts which emerge in community health planning
can be managed through political processes, using planning
data as a common baseline of understanding.
PLANNING FUNCTIONS
DECISION MAKING - GENERAL
Page 313
Reference:
John Kirklin, William Bridgets, and Thomas Hearn,
"Panel Discussion on:	'The Allocation of Medical
Resources:	Who Should Decide and How'",
iLLakama JflJJtnal o£ Medicine, Vol.14, No. 3,	p.316-321,
(July 1977).
The panel discussion includes three papers which were
presented at the Continuing Symposium on Moral Issues in
Medicine at the Medical Center of the University of
Alabama. The panel discussion addresses the following
questions: (1) the allocation of medical resources: who
shall decide and how?; (2) the conflict between a limited
national health budget and the increasing cost of medical
care: how shall we resolve this?; (3) can we as a nation
afford such expensive procedures as transplantation/
dialysis, and coronary bypass surgery ?; and (4) if there
are limits to what can be done, who shall decide the
limits and how will the decision be implemented?
Reference:
Morris Schaefer,
»PLANNING FUNCTIONS
DECISION MAKING - GENERAL
Page 311
in iisjiiii jLiawuiia and
AdaliiislLaliaiit
Chapel Hill:	Dept. of Health Administration, North
Carolina Univ. at Chapel Hill, 1973.
Conceptual and operational guidelines for improving
rationality in health care planning and administration
trhough decision-making and evaluation techniques are
discussed in two papers prepared originally for the World
Health Organization. The introduction to the discussion
of decision-making in health planning covers myth*
concerning decision-making (e.g., the separability of
compromise and decision). The nature of the
decisionmaking process is then discussed. A basic model
of decisionmaking is described and illustrated
schematically. Individual human decisionmaking is
compared with decisionmaking by three types of groups:
the organization, the interorganization, and the
legislative group. Economic, technical, legal, social,
political, and administrative rationalities affecting
health planning decisions are considered. Technical
concepts regarding decisionmaking are applied to the
decisionmaking process involved in health planning. The
organization of decisionmaking roles in health planning is
considered as are the health planners' functions in
lPLANNING FUNCTIONS
DECISION MAXING - GENERAL
Page 31a
decisionmaking	and	the place of	various decision	types	(by
outcomes and	by	s truetural	characteristics)	in	the
planning process. The discussion of program evaluation in
health planning opens with an introduction overview/
followed by a review of concepts of program evaluation?
norms/ design/ and methods of evaluation; information
requirements and information systems in evaluation? and
evaluation agendas for planning. (NTIS)
Reference:
Vi. Skerry/
"PL 93-641:	Beyond Planning Toward Control"/
Hospital Progress# Vol.57, No.3/ p. 10/30, (Mar.1976).
The author voices concern about the authority the navi
planning bodies will possess, for three reasons:	(1) no
outside body, however expert, can correctly identify the
needs of the individual instituitons and the patients it
serves as effectively as its management which lives daily
with the reality of these needs; (2) the local planning
agencies called for in the Act are not destined to be
under the direction of health planning experts; and (3)PLANNING FUNCTIONS
DECISION MAKING --GENERAL
Page
315
the Act provides no legitimate mechanism whereby tha
provider can appeal the regulating decisions of the
agencies created by this legislation.
Reference:
Aluyn Smith/
"Priorities for Allocation of Resources/"
Eflyji Sacisii flf iisallh slaiitaal* Voi.96, No.2/	p.67-69/
85/ (Arpil 1976).
Issues in the allocation of public resurces for
health care in Great Britain are examined in light of tne
National Health Service's lack of 'integrated/ coherent
policy' to guide such allocation. It is first noted that
there is increasingly less certainty about whether
medicine/ in its tecnological sophistication/ deserves
high priority among the options available for public
expenditure. It has been generally accepted that health
does not depend exclusively/ or perhaps even mainly/ on
health services. Advances in preventive and curativj
medicine are leading to the predominance of morbidity
problems that are inherently intractable. The consequentPLANNING FUNCTIONS
DECISION MAKING - GENERAL
Page 317
need for a transfer of resources from the preventive and
curative phases toward the mitigative phase of medical
activity/ and especially toward social rather than
specifically medical interventions/ has not been
recognized as a major reallocation priority. The problems
and expense involved in transferring responsibilities foe
the chronically ill from hospitals to doraici11iar/
services are noted. The replacement of physician
dominance in health care by a more collaborative
management process involving other health professionals
and patients/ as reflected in the emerging concept of the
health care team/ is discussed. Other factors influencing
resource distribution relate to the distribution of care
among demographically definable categories. It is
concluded that the most important constraint on
reallocation of resources is the lack of an adequate
rationale on which to base such reallocation. (NTIS)PLANNING FUNCTIONS
DECISIONMAKING - STATE
Page 313
Reference:
Robert Bradbury,
"Policymaking and the Planning Process:	Separate Roles
for Boards and Staffs",
Amaiiaac ilQuiDal 2l lisaliii Elannin^/ Vol.i, No.4, p.37-43,
(April 1977).
The author outlines an approach to health plan
development that distinguishes planning from policymaking
and board from staff functions. Several keys in the
planning process are identified that focus on community
health and health system performance. The importance of
effectiveness studies in the planning process is
emphasized.
Reference:
Lee Cloe,
"Health Planning for Computed Tomography:	Perspectives
and Problems",
AfflfijLican iJauxnal 2L Jj2anIflSD2laak/ vo 1.127,	p.i87-i90,
(July 1976).PLANNING FUNCTIONS
DECISIONMAKING - STATE
Page 319
Computed tomography (CT) has been introduced to the
health care system at a time when health care planning is
still evolving. Unlike the recent past/ final
authorization of large expenditures and new services such
as CT now lies outside the providers of care and is based
on laws and regulations that are not familiar to many
physicians. A brief review of the principal federal
statutes is presented. Recognizing the unique problems in
certain service areas such as CT/ the state of Indiana has
formed committees to collect information and develop
recommendations to assist its health planners in their
actions and decisions under the federal statues. The
quantitative problems which the Indiana CT committee must
address are presented in some detail/ problems that other
health planners face as well.
Reference:
Avery Colt/
"Public Policy and Planning Criteria in PuDlic Health"/
JsuLnal aL Eublic iteallb/ Voi.59/
p.1678-1685/ (Sept.1969).
No.9,PLANNING FUNCTIONS
DECISIGNMAKING - STATE
Page 320
The central point of this paper is that the first
step toward effective planning by a state comprehensive
health planning agency should be the adoption of a
comprehensive health policy oriented to definite goals,
and the development of specific criteria for measurement
and evaluation. In short, planning goals and criteria
should not be mere window dressing.PLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 321
Reference:
B. Abel-Sraith,
"Health Priorities In Developing Countries:	The
Economist's Contribution",
lDig£naliflnal Journal ol iiaallb Services# Vol.2, No.l,
p.5-12, (1972).
Though many new techniques have been developed to
assist countries in allocating their resources, there are
special difficulties in using these techniques in health
services. The key problem is to find an acceptable
measure of health output. The author argues that health
should not be measured in crude economic terms and points
out why no alternative measure has yet been evolved. In
view of this, systems such as PP3S
(planning-programming-budgeting system) cannot be applied
to health; complex health methodologies are of limited
value; and the teaching of health planning should not
center around the study of models. Progress can best be
made by studying the total effects of particular programs
where practicable in an experimental situation. The
author argues that the greatest contribution which the
economist can make to health planning is not in the
development of models, but in cost-effectiveness studies.
The value of such studies is illustrated by an example -PLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 322
the study of the expansion of medical education in
developing countries, which could be contributing
substantially less to health than if the resources were
used in alternative ways.
Reference:
Mary Arnold,
"Use of Management Tools in Health Planning,"
Pyblic	Beoorts* Vol.83, No.10,	p.820-826, (Oct.
1968).
The application of techniques developed in the field
of administrative management to the area of health
planning is discussed. Background information on the
development of the science of management is givenf
together with a description of two new approaches to
management - the dynamic model and output orientation.
Emphasis has shifted from focusing on a rationality of
structure to an orientation to mission or task. There are
some problems in using these new planning tools, chiefly
in 'the nature of specifying objectives, and detailing
program activity. Health planning does not always lendPLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 32J
itself to the concepts involved in engineering and
mathematical models. To effectively use these tools/
there must be familiarity and facility in understanding
their purpose/ which can then lead to stimulation of nej
perceptions and new ways of thinking. The problems to ba
solved in planning/ whether at the organizational or the
societal level/ is to find a tool that will aid in
defining the utilities to be maximized and the timespan to
be considered. 'Management tools can help us plan how to
get somewhere and learn where we are going/ but the/
cannot help us decide where we want to go." (NTIS)
Reference:
David Earl Berry/
InlfiLtfllaliftiisbiES ci £££D£ini£ Raiiaiialii.* and itealtii Cat 2
Elaaninflz.
Chapel Hills Dept. of Health Administration/ Norto
Carolina Univ./ 1971.
The extent to which economic rationality is present
in health care planning efforts is investigated. It i»
felt that if a determination can be made of the nautre/PLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 321
proportion, and function of economic rationality present
in health planning efforts, this information would be
useful in improving predictive models of human behavior
and in constructing normative models to guide health
planning efforts. The nature and magnitude of the health
V * ••
industry are discussed. Planning theory is examined in
terms of: comprehensive or pure rational models,
satisfaction models, and innovative models; advanced
planning theory; concept of economic rationality; and
links between economic rationality and health care
planning. The case studies described are concerned with
interrelationships between economic rationality and health
care planning: (1) health component of the High Point,
North Carolina model city plan; (2) planning of the North
Carolina Medicaid bill; (3) Ancker Hospital site
controversy in St. Paul, Minnesota; (4) health centers
and community needs in Philadelphia, Pennsylvania; ani
(5) changes in minimum prices by the Florida Milk
Commission. It is concluded that economic rationality is
essential to health planning, and several attributes of
rationality are suggested to aid in the conduct of health
planning efforts. Implications of the economic:
rationality concept are discussed. Appendices provide
additional information on the economics of health care
planning, and a bibliography is included. (NTIS)PLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 325
Reference:
Thomas V. Bice,
•’Comments, on Health Indicators:	Methodological
Perspectives,”
InifiLMiianal daucaal al iisalili Suxicis^ voi.6, No. 3,
p.509-520, (Nov. 1976).
Basic conceptual and methodological problems in the
development and use of health indicators are addressed.
Based on social indicator studies, it is pointed out that
two sets of criteria are employed in selecting indicators:
(1) choices among output measures are made primarily by
political institutitons which transform social values into
expressions of social policy; and (2) the selection o£
health indicators beyond those measuring output must
ultimately be guided by a theory of what causes variations
in output indicators. Positive versus negative health
status indicators are examined. The issue of whether
health indicators should measure positive as well as
negative health is considered to be symptomatic of the
fundamental conceptual problem stemming from the lack of
an adequate definition of health. Mortality and morbidity
are noted as two health status indicators. It is observed
that certain tendencies of the health indicators movement
may deter progress toward producing useful information forPLANNING FUNCTIONS	Page 325
TECHNICAL - CONCEPTUAL PROBLEMS
decision making. These tendencies involve the quest for
'elegant* mathematical formulations of health status
indices and the tendency to conceptualize health in terms
of expansive definitions. To improve the utility of such
information, it is suggested that health indicators
measure variables specified by a social system model and
be scaled according to units relevant to decision making
criteria. (NTIS)
Reference:
R.F. Bridgman,
"Some Methodologic Problems in Health Practice and Health
Planning",
inl££naiiax)al jlautDal Q1 HaaLLh itaa/ voi.2, no.i,
p.51-61, (1972).
During the past 20 years health planning has received
a great deal of attention, and a large number of
conferences, seminars, and papers have been devoted to
this fascinating subject. However, because of a lack of
practical experience, many health agencies, especially
those in developing countries, are afraid to embark uponPLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 327
sophisticated and costly procedures. Instead/ they
continue to use the *'rule of thumb" in deciding on easy
solutions in order to please local authorities. Health
services have been compared to a tangled skein. The
present paper suggests a practical approach to begin to
disentangle the situation. Total health programs could be
divided into three main parts: (1) environmental control
and community protection# (2) personal preventive
services# and (3)curative services# including
rehabilitation. Each of these three main components
should be defined and clear borders between them should be
delineated because the methods of planning differ in each
case. Leaving aside the first sector because it is in
fact the responsibility of many government agencies#
methods of assessing and planning personal preventive
services are studied separately from those which could be
applied to curative services. The distinction between
these two last sectors is that between needs and demands,
framings are given against easy oversimplification and
ignoring of methodologic problems which could result in
failure of the best theoretical health plan. Finally#
health planning is within the reach of any health agency#
even those in developing countries.PLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 329
Reference:
Milton M. Chen# J.W. Bush and Donald L. Patrick#
"Social Indicators For Health Planning And Policy
Analysis"#
Policy ScifiUSLfiS/ Vol.6# p.71-89# (1975).
The concept of health involves two dimensions: The
level of function at a point in time and the probability
of transition to other levels at future times. By
applying measured social values to the distribution of the
population among a set of levels# a Function Status Index
aptly summarizes the Level-of-Well-Being of a population
at a point in time. By incorporating empirically
determined transition probabilities into a simple
stochastic model# a Quality-Adjusted Life Expectancy can
be computed that approximates a comprehensive social
indicator for health. The indicators possess the
statistical properties required for time series and
interpopulation comparisons# for studying outcomes and
quality of medical care# and for health system
optimization in planning and policy analysis.PLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 32)
Reference:
Robert M. Crane/
"Development and Use of Criteria in Review and Planning"/
American jJfiULaal at iiaallh Planning/ Vol.l/ No.4/	p.1-10/
(April 1977).
The importance of using specific criteria in review
and planning has increased dramatically. This article
describes the reasons for this increase/ presents the
results o£ two studies concerning the development and use
of criteria/ and describes Federal efforts that are
underway to assist Health Systems Agencies (HSA's) and
State Health Planning and Development Agencies (SHPDA's)
in this task.
Reference:
Chicago:	American Hospital Association/ 1975.
The methods used in determining health care needs are
reviewed in a report directed to hospital administrators/PLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 330
institutional planners, and areawide health planners. The
report opens with a background discussion of pressures to
determine need and a summary of the findings of the
American Hospital Association advisory panel on needs
determination. The panel concluded that the need for
health care services is not an absolute and determinable
quantity, but rather a reflection of the cultural and
social values of a given community as well as the
political and economic circumstances of the community.
Two kinds of input were identified as necessary components
of a process for determining need; group process methods,
which derive normative information from affected
individuals and groups; and quanatitative methods, which
derive numerical information on health facilities and
manpower resources, utilization rates, and characteristics
of the population served. Group process methods for the
most part are those that accomplish the determination of 3
community's health care goals, while quantitative methods
methods provide numerical dimensions for the goals. Tne
group process methods reviewed include brainstorming,
nominal group process, and the Delphi method.
Quantitative methods include health status indicators,
resource allocation, the Hill-Burton bed need formula,
locational analysis, geographic service areas, and
utilization models. The strengths and weaknesses of each
method are pointed out. A list of references is provided.PLANNING FUNCTIONS	Page 331
TECHNICAL - CONCEPTUAL PROBLEMS
(NTIS)
Reference:
Michael L. Dolfman,
"Toward Operational Definitions of Health/"
lolmialijmal Jaumal ai Sabaal flajlilu voi.44, No. 4,
p.206-209/ (April 1974).
A format for generating operational definitions of
health is developed/ with an emphasis on development of a
model to capture the operational implications of health.
At the operational level/ health refers to a family of
concepts or entities rather than one specific entity.
Health is	related to the concepts of functioning/
adapting/ and normality. To create an operational model
of health/ the following information is needed: (1) the
class of subjects to which the state of health can be
attributed; (2) the kind of environment in which the
subject would be observed; (3) the kind of stimulus this
subject would be subjected to in his environment; and (4)
the response of the subject to the stimulus. This
information	is then applied to the concepts ofPLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 332
functioning/ adapting and normality to provide insight
into the meaning and implications of health. Two
necessary conditions are specified which/ taken together/
constitute a sufficient condition for health. The model
can also inform on how to investigate health and can
distinguish the indicators needed to inform individuals
that they have uncovered the state or condition
represented by the notion of health. (NTIS)
Reference:
Jack Elinson/
SLacial Indicaifltfi Esssacctu p.59-71/ (1974).
A review of efforts directed at the development of
more effective sociomedical health	indicators	is
presented. It is noted that various forms of mortality
data and biomedical measures of morbidity have become
inadequate as measures of the level of health in
economically developed countries. The insensitivity of
mortality rates is said to be quite noticeable in the
United States, where little evidence is found to suggest
that increases in health services have resulted inPLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 333
improvements in the level of health. Intermediate between
biomedical measures and sociomedical measures are measures
of functional physical capacity necessary to carry out the
activities of daily living (bathing, dressing, feeding,
and so on). These measures are said to have some
advantages, but do not reflect physical impairment.
Attempts to develop sociomedical health indicators have
included measures of social disability; typologies of
presenting symptoms, used to estimate probable needs for
care; measures focusing on behavioral expresssions of
sickness (such as social interaction, locomotion,
sleeping, speech and communication); research based on
operational definitions of positive mental health,
happiness, and perceived quality of life; and assessments
of met and unmet needs for health care, which are measures
of social capacity to care for the sick. It is noted that
sociomedical indicators reflect both objective conditions
and social values. Such indicators are policy-oriented in
that they represent operationally defined and measurable
expressions of social goals. (NT1S)
Reference:
Jack Elinson, Anne Mooney, and Athilia E. Siegmann,PLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 334
iteallh Gfials and. tt&alib lodicalciLSi Efllicv, ElaoQiQa auj
ExaluaiifiD*
Washington, D.C.:	American Association for th»
Advancement of Science, 1977.
The subjects of health planning and health status
indicators are explored in a series of 10 papers, most of
which were presented at the February 1977 Annual Meeting
of the American Association for the Advancement of Science
in Denver, Colo. The background and implementation of the
National Health Planning and Resources Development Act
(P.L.93-641) are reviewed in relation to challenges and
*
problems associated with health planning. The history of
Federal health statistical activities is traced and
applications and suggestions regarding the use of health
statistics in health planning are described. Several
papers	provide approaches to systematic quantitative
methods for assessing unmet medical and dental needs in
health service areas. Measures of physical, dental, and
pyschological health status are discussed and viewed in
terms of descriptors
and policy-oriented	indicators.	Methodological
perspectives on health status indexes are presented and
the importance of using health status indicators as
tools for health planning is emphasized. The future ofPLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 335
health planning in the U.S. is discussed in econonic and
social terms and the readjustment of priorities is
recommended over a national health insurance program.
(NTIS)
Reference:
Charles Flagle*
"The Role of Simulation in the Health Services"*
Afflfiiican JauLual a.L Entilis itealiii/ voi.60, no. 12*
p.2386-94/ (Dec. 1970).
The possiblity of using simulation in studying*
planning* and administering health services is discussed.
Difficulties in developing simulation models are
indicated* but major problems are not so much technical as
finding the planning authority and decision-maker with
whom to achieve rapport.
ReferencePLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 33S
L. Jeff Harris, et al.,
AlamJ-tliffifi Ian HfiaUb £JLann£C&x	An Qx£xjlL£Ma
Santa Monica, Calif.:	RAND Corp., Aug. 1977.
This report constitutes an introduction to five
manuals intended to aid health systems agencies (HSAs) and
the State health planning and development agencies in
using health status measures of the population to develop
health resources plans. Each manual focuses on a specific
problem and shows how planning agencies can obtain and
analyze data to aid in making decisions. The five problem
areas for which algorithms have been prepared include
infant mortality, breast cancer mortality, heart attack
mortality, preventable death and disease, and high blood
pressure. Health status measures are employed in the
algorithms to identify the need for specific health
interventions and to measure progress toward goals.
Legislation authorizing the establishment of HSAs and
mandating the use of health status measures in planning is
described. Traditional health planning is discussed, and
limitations that may be overcome with the use of health
status measures are explored. HSAs are affected by their
limited access to data and analytical resources, and their
power to affect the health status is consequently liaited.
These limitations explain the choice of disease
explain the choicePLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 337
indicators. The function of the algortihss in the H5A
evaluation cycle and their use are detailed. General
principles common to all planning based on health status
measures are discussed. Appendixes contain information on
comprehensive measures of health status and tabular data
on the health status of the population at five sites. The
bibliography presents sources of information concerning
health planning and health indexes. (NTIS)
Reference:
Jeffrey Human,
"Normative Planning For A Better Long Term Care System",
AiB£ii££D ilQuioal 01 flsaliii Eljanniua* Vol.l, No.2, p.43-47,
(Oct. 1976).
The author	reviews the nature	of	forecasting	and
normative planning in the context of		long	term care.	The
shortcomings of	traditional approaches	are	identified	, and
recommendations	are put forward	for	Health Systems	
Agencies, the	Congress, the Executive		Branch,	State
Legislatures, and Blue Cross plansPLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 333
Reference:
James Ketchel#
C£ii£lfiEfli£Qi fti a	X.2L tialuallna ID a
qL a Xfiluolaat Haaiib glapping QtaaaiiaLiQUz
Columbus:	Dept. of Psychology/ Ohio State Univ./ 1972.
A methodology is developed for assessing the
effectiveness of the Mid-Ohio Health Planning Federation
and similar types of volunteer organizations.
Comprehensive health planning is discussed/ and relevant
literature on organizational theory and effectiveness is
reviewed. The study in Ohio was designed to validate
candidate assessment methods and to obtain descriptive
information about member perceptions of the federation and
about their attitudes toward the behavior in it. The
human relations movement was used as a basis for
generalizing to other volunteer organizations. Meaningful
performance criteria and predictor variables were
delineated to evaluate the effectiveness of the
federation. Factor analysis was then employed to reduce
the large number of structured interdependencies.
Instruments utilized to evaluate candidate assessment
methods included forms for a survey of organizations and a
profile of organizational characteristics. A scaled
expectancy rating device was devised to rate
groupPLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 339
behavior. It was found that correlational techniques are
beneficial in delimiting parameters which should b3
isolated and studied in controlled investigations. Forms
used in the Ohio study and supporting tabular data are
appended. A list of references is provided. (NTIS)
Reference:
William Kissick,
"Planning, Programming and Budgeting in Health",
Medical £a££/ Vol.5, No.4, p.201-220, (July-Aug. 1967).
The author begins with a short history of planning in
general and the trends in health planning in the U.S. in
particular. He states that a "new style of problem
solving" is required in which there is more deliberate
attention to the allocation of ends and sharpening of
defintion of ends. PPBS (planning-programming-budgeting
system) is one of the techniques of this new style and the
expectations for PPBS in the U.S. Public Health Service
are discussed, together with the problems and issues
associated with it, such as: (1) lack of definition of
the health system; (2) the adaptation of PPBS, which wasPLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 340
developed for use essentially in a closed system/ to the
health system which must be viewed as an open system; and
(3) the emphasis in program analyses on cost-benefit and
cost-effectiveness ratios versus the concern in health
with intangible benefits. Other obstacles in health
planning mentioned are: (1) the relative weakness in the
U.S. tradition of research and analysis in the field of
health care; (2) the weakness of local bodies to deal
with major issues; and (3) the scarcity of people trained
in the necessary modes of thought and analysis.
Reference:
Philip R. Lee/
"Health and Nell-Being/"
Annals ni ilia Ametlcan Academy nl Calllical nnl facial
SclfiDCfi* Vol.373/ p. 193-207/ (Sept. 1967).
Methods of measuring health status/ costs of illness/
and related factors are reviewed in a discussion that also
touches on the formulation of national health goals. It
is noted that measuring health status has traditionally
been dependent on the negative aspects ol health:	deattiPLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 341
rate and morbidity. Although these measures are still
important/ they no longer yield adequate information for
establishing goals and policies. Increased emphasis on
disability/ costs/ and the social and emotional
consequences of disease is noted. The complexity of the
process involved in setting specific goals in the health
field is discussed. It is observed that significant
improvement in health or achievement of specific health
objectives requires a unified effort/ as well as
achievement by society of the following objectives:
economic conditions that eliminate poverty and its
attendant health hazards; legal and social systems that
stress social justice and equality of opportunity in fact
as well as in theory; education for all citizens based on
their capacity to absorb education; and public
information and communications that permit citizens an
informed choice and provide adequate/ unbiased health
information. Efforts of the Federal Government to extend
the right of access to the means of good health to all
people have included programs designed to advance
research; meet manpower/ facility/ and other resource
needs; stimulate local/ regional, and State initiative
and improve cooperation with the Federal Government;
remove financial barriers; improve quality and
availability of services; and protect the consumer and
improve the quality of the environment. (NTIS).PLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 342
Reference:
Monroe Lerner,
"Conceptualization of Health and Social Hell-Being,"
Health SfiUlfifi &£S££££bx Vol-8, No-1, p.6-12, (1973).
The development of health indexes is examined in a
keynote speech delivered at a multidisciplinary conference
of researchers in October 1972 under the auspices of
Health Services Research. It is felt that the most
important objective in constructing an index of health
status is to evaluate the effectiveness of current health
care delivery systems of programs, especially those of an
experimental nature and financed with public funds.
However, evaluation requires a definition of health in
operational terms, and one of the problems in attempting
to define it is that health has a multidimensional or
qualitative characteristics and cannot be measured
directly. Health has dimensions or components which have
to be identified and weighed (indicators). The quality of
health services provided by medical practitioners can be
evaluated directly on a personal basis. It may be
desirable to evaluate health scientifically, considering
the true nature of social reality independent of any
practical application. It is recommended that old ways of
measuring health be reexamined, especially the use ofPLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 343
infant aortality rates as health indicators. Measurements
of morbidity and impairment allow a number of sociomedical
conditions to be considered. (NTIS)
Reference:
C. Mackenzie/ Brenda Fraser/ and W. Meekison/
"Critical Requirements in Regional Health Planning/"
Canadian Jnnnnal al Enblic iiaaiilu voi.66/ No. 4/
p.299-306/ (Jul.-Aug. 1975).
A pilot study used the 'critical incident technique'
in a semirural region in British Columbia/ Canada to
determine if health providers and consumers within the
region would identify factors they perceive to De
important or critical in a health care system. In
particular/ the study sought to ascertain if providers and
consumers would identify issues being discussed at ths
national and provincial levels in Canada. The Cariboo
Regional District was chosen as the study area. Health
providers were categorized as professional/ auxiliary/
voluntary/ and lay government. The critical incident
technique used in the project is a procedure foePLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 344
collecting observed incidents of human behavior having
special meaning according to predefined criteria. After a
sufficient number of incidents have been collected/ they
are sorted into categories and a description of critical
requirements for a system can be obtained. Sixty-two
health provider questionnaires were returned (50.0
percent). Eighty-eight health consumers returned
questionnaires (55 percent). 8y sorting reported
incidents into categories/ it was possible to identify
major areas of concern about the health care system in
these two groups. Health providers identified
relationships with government and health care facilities
as two major areas of concern. Health consumers
identified waiting periods for service and costs of
uninsured services. Health planning issues such as
overall rising costs/ regionalization/ integration/ and
increasing consumer input were not identified as major
concerns by health providers or consumers within the
region. It is suggested that health planners may find the
critical incident technique a useful adjunct in
determining health priorities within a region. (NTIS)
ReferencePLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 345
G. Majone,
"The Feasibility Of Social Policies"/
Policy SC.JLfiHC.feS/ Vo 1.6/ p.49-69/ (1975).
The notion that/ given sufficient ingenuity and
resources/ any social problem can be solved/ in a mannef
consistent with the announced policy objectives and with
the accepted institutional framework/ has been a major
source of failures and frustrations. This paper suggest
that policy analysis should concentrate on the
investigation of the conditions of feasibility of public
programs. Feasibility is defined in terras of all relevant
constraints: social/ political/ adrainsitrative/ and
institutional/ as well as technical and economic. The
emphasis on the pure logic of choice and optimal decision
rules/ so characteristic of normative theorizing in
decision theory/ management science/ and welfare
economics/ has tended to obscure the fact that in the
field of social policies/ the range of feasible choices is
severely limited by a variety of constraits. Most "bad"
decisions are not just suboptiraal; on closer examination,
it usually turns out that they were not even feasible at
the time they were made. Only by understanding the
reasons why/ under certain circumstances/ a given goal
cannot be achieved/ can we hope to gain better knowledgePLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 346
about the working of social institutions. Just as the
essence of the scientific method is the critical analysis
and refutation of proposed theories, rather than the
accumulation of evidence in favor of pet solutions, so the
most stringent tests of feasibility. Also in analytic
case studies, the search for constraints that were ignored
by the decisionmakers has considerable heuristic value, as
the author tries to demonstrate with a critical discussion
of some aspects of the British National Health Service.
Reference:
Walter Merten,
"PERT and Planning for Health Programs",
Eiifelic Efiflllll Reugrts, Vol.Bl, No.5, p.449-54, (May 1966).
PERT can assist the public health administrator in
precisely estimating program progress, coordination,
rational phasing of activities, delineation of
responsibility for various program components, and
preliminary and final evaluation. In addition to multiple
screening, PERT could be applied to other public health
programs as well as budget and personnel utilizationplanning functions
TECHNICAL - CONCEPTUAL PROBLEMS
Page 347
processes. Various types of large meetings# immunization
programs# processing and obtaining data for vital records#
and the promotion of legislation are program areas to
which the techniques might be profitably applied. Further
experimentation could lead to an almost limitless number
of complementary PERT-public health relationships.
Reference:
Jonathan Metsch and James Veney#
"Measuring the Outcome of Consumer Participation#"
JfliLLnal cl Health aoJ aacial HehajLiftt*. voi.14#	p.368-374,
(Dec. 1973).
A method developed to measure comparitively the
outcome of consumer participation with similar programs
through a content analysis of consumer advisory board
minutes is described. The technique was developed to
study the implementation phase (first year of activity) of
consumer boards at nineteen voluntary hospitals in a large
city; the boards were mandated by the city. The study
was undertaken with the objective of determining the
extent to which the nineteen study hospitals could be
(PLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 348
differentiated on three measures of consumer
participation: (1) a consumer-provider interaction score
was developed to measure the extent of consumer activity
in the form of recommendations and requests; and (3) an
administrative action score was developed to measure the
responsiveness of administrators to consumer input. Ail
of these measures were based on content analysis which is
described as a technique for the systematic description of
the manifest content of communication that replaces the
direct observation of behavior. In the course of study it
became apparent that not every recommendation or request
of the board nor every administrative response was of
equal importance; eight weighted generic categories were
developed to describe the activities. Weighting
methodology is presented and the outcomes are tabulated,
it is concluded that the use of weighted content analysis
can provide substantial insight into the often mandated#
consumer participation component of social planning and
management. (NTIS)
Reference:
Selma J. Mushkin#
"Evaluations:	Use with Caution/"
1PLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 349
Evaluation# Vol.l, No.2, p.30-35, (1973).
The increasing use of policy analysis and program
evaluation as a planning tool is discussed, and it is
suggested that the state of the art is not sufficiently
advanced to warrant widespread use of this technique. To
use evaluation results for policymaking, one needs to knoj
what goes into the formulation of an evaluation study#
what its limitations are, and what its findings really
mean. Above all, it is necessary to refine evaluation
methods to be as scientific as possible. Several
evaluation studies are cited which have had a direct
impact on the decision to cut back on Federal programs.
It is noted that even the most sophisticated processes of
evaluation which may work well under some circumstances#
have weaknesses when applied to public policy problems.
Cost-benefit analysis, for example, suffers from the
difficulty of measuring the value of human life in
dollars. Experimental evaluation is constrained by
ethical problems, and the application of regression
analysis suffers from an inability to produce the causal
connections required to examine any hypothesis made.
Evaluations based on single-year survey data yield little
understanding of the dynamics of social change. It is
only through continuing efforts at evaluation that
1PLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 350
deficiencies in current knowledge are likely to be
identified. It is concluded that evaluations applied to
policy without cautious understanding become a way not to
improve, but to sentence programs to premature death.
(NTIS)
Reference:
HS.&d	tiauual lot A£££wid£ £fiffl&££tl£02iX£ ti££llh
£l£mUD3
Philadelphia:	Government Studies and Systems, Inc., Sept.
1974.
Concepts, methods, and procedures relevant to need
assessment are presented in a manual for comprehensive
health planning agencies. The opening chapters provide an
overview of the need assessment process for agency staff
and council members. The meaning of need assessment is
discussed, as are the related concepts, vocabulary, and
major processes. The relationship of need assessment to
plan development is also considered. Subsequent chapters
break down the need assessment process into its major
phases and, within eaxh phase, detailed steps. The input,
lPLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 351
participants, process, and output of each step are
described and illustrated with examples and tables. The
process consists of two main phases: analysis of health
status and health system needs, and analysis of health
action needs. Analysis of health status improvements
needs is complete when planners have estimated the gap
between desired and actual health system priorities.
Analysis of health actions is the prelude to the
establishment of objectives and priorities, the phase of
comprehensive planning that follows need assessment. The
manual includes procedures for forming need assessment
panels. Computer techniques for calculations and
modeling, advanced data collection techniques, and group
estimation and consensus techniques are also described. A
list of references is provided. Supporting materials are
appended. (NTIS)
Reference:
Arnold Packer and Gordon Shellard,
"Measures of Health System Effectiveness,"
RfiSfiatCb*. Vol.18, No.6, p.1067-1070, (Nov.-Dec.
1968).
IPLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 352
A set of measures for evaluating the effectiveness of
a health system is proposed. An earlier Measure of the
ineffectiveness of a health system in which the system is
first viewed from the perspective of an individual and
then from that of an entire community was used in
developing the new set of effectiveness measures which
take into account interaction effects that may occur
between a health care system and the individuals it is
designed to serve. For example/ the effect of the
saturation of scarce medical resources when the number of
cases to be treated exceeds some threshold value may be
expressed mathematically within the framework of the model
upon which the measures of effectiveness are based. The
saturation factor might be important in the provision of
health services to the poor when lengthy lines may
discourage an individual from seeking needed treatment or
in the case of large-scale epidemics. Insight into the
measures described is provided by applying them to
determining the effect of adding family planning services
to a health care system. Mathematical notations are
accompanied by explanatory text. (NTIS)
Reference:PLANNING FUNCTIONS	Page 353
TECHNICAL - CONCEPTUAL PROBLEMS
Philip N. Reeves,
’’Issues in Health Plan Development:	A Critique of the
Guidelines for Plan Development under P.L. 93-641",
Affl£ti£3D Jfiunnal si Haalili Elanninfl* vol.i, no.3, p.27-35,
(Jan. 1977).
The draft guidelines for development of health
systems plans and annual implementation plans represent a
logical, coherent integration of the best of currently
available planning concepts and methods. However, there
are at least six major areas in whicn the current state of
the art is clearly inadequate. These are linkages between
plan components, synchronization, plan integration, level
of detail, cross-impact analyses and policy planning.
This article describes each of these issues and identifies
some of the projects which seem likely to contribute to
their resolution. Finally, it urges each health planning
agency to take advantage of the latitude in the guidelines
to develop solutions and to share the results with others.
Reference:
Philip Reeves,
1
1PLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 354
"A Systems Approach to Development of a Health Services
Plan",
Inquiry# Vol.ll, No.4, p.247-55, (Dec. 1974).
The author proposes that a long-range goal plan be
developed within the context of the total health plan as a
normative statement describing the desired health services
system of the community in measurable attributes, so that
the result will be a catalog of the total set of all parts
of the health system with adequate description which
reflect the community's desired standards. Such i
document can be developed through the process of systet*
analysis. Once it has been developed, it can be used
effectively for guiding the data management effort#
identifying problems, setting priorities, reviewing and
k
commenting upon proposed changes in services and
facilities, and analyzing the secondary and tertiary
effects that a specific action may have on other
components of the health system. Although this article
was primarily directed at the needs and functions of
areawide health planning agencies, the process can easily
be adapted to meet the needs of state planning agencies
and of organizations which provide health services.
I
lPLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 355
Reference:
Larry Shuman* Harvey Wolfe* and R. Dixon Speas*
"Role of Operations Research in Regional Planning*"
Q££££ti£D£ S£5£££Cilz. Vol.22* No.2* p.234-248* (1974).
The growth of regional health planning and operations
research in the United States is explored* and its
important problem areas are highlighted. It is noted that
operations research workers have not met with much success
in beiny accepted as integral members of regional health
planning teams. This is due in part to a lack of
understanding by health planners of the skills offered by
operations researchers and in part to the analyst's
inability to demonstrate that he can close the gap between
theoretical modeling and the implementation of his
results. Literature on operations research applications
to health planning is reviewed critically with respect to
the feasibility of models and the appropriateness of
assumptions. Specific problems with literature studies
are identified* and recommendations are made for improved
coordination between operations research workers and
health planners. Quantitative studies for health planning
are cited* and the use of operations research approaches
in regional health planning is discussed. (NTIS)PLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 3S6
Reference:
Athilia Siegmann,
"Classification of Sociomedical Health	Indicators:
Perspectives for Health Administrators	and Health
Planners,"
lni£L£Lalianal Jautaal 2L Hsalih Ssj:*icas* voi.6, No.3,
p.521-538, (1976).
The conceptualiztion and operationalization of health
status measures are discussed. Traditional health
indicators are noted, and a classification scheme iJ
devised for sociomedical health status indicators. The
application of sociomedcial health status indicators is
addressed. Health indicators are conceived as a subset of
social indicators and, as any social indicator, are viewed
as derivative from social issues* Interrelationships
between different frames of reference for defining and
measuring health, accompanying distinct health problem
patterns in the United States, are examined from a
developmental perspective. These patterns include
infectious and communicable disease patterns, chronic
degenerative diseases of aging and acute nonlethal disease
patterns, and health problems and patterns associated with
an individual's lifestyle. Mortality and morbidity rates,
identified as traditional health indicators, are notPage 351
PLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
considered to be adequate for the assessment of health
status in developed countries. The deficinecies of
mortality and morbidity rates are used to develop a
classification scheme for sociomedical health status
indicators	that relates		health definition frames of		
references/	measures	of	health status/ and		health
problems.	The role	of	socioraedical	indicators	in the
formulation	of health	status measures is		assessed.	(NTIS)
Reference:
barren Smith/
”Cost-Effectiveness and Cost-Benefit Analysis for Public
Health Programs”/
Public Ufialili Eeu.ottSz Vol.83/ No.11/ p. 899-906/ (Nov.
1968).
The author presents several examples of
cost-effectiveness and cost-benefit analysis/ moving fron
trivial hypothetical instances to some reasonably complex
examples of real analyses. Despite difficulties with
these methods of analysis/ they can be useful decision
aids/ although even their most ardent proponents wouldPLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 350
probably not suggest that they be decision determinants.
These techniques are a crucial element in PPBS and at
first, their applications to social problems will be
crude. But like most methodologies in a state of test and
revision, there are bound to be successes and failures as
refinements are made in these techniques.
Reference:
^5isms. Aoalys-ia A&aliad la iiaaliii
*
Washington, D.C.:	Advisory Committee on Medical Research,
Pan American Health Organization, 1972.
The symposium focused on applications of systems
analysis in health administration, health services
planning, multiphasic health screening, and hospital
management. The report opens with an introductory
statement outlining the concept of comprehensive health
planning. Symposium papers address the following topics:
systems analysis and health administrative research; a
stochastic model for health service planning? systems
analysis and the planning and evaluation of automated
multiphasic screening; autoraatd multiphasic healthPLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 3o<3
screening ate Medical Diagnostic Centers/ Inc./
Norristown/ Pa.; and systems analysis applied to tha
operation of technical services in hospitals. Discussions
that followed the symposium presentations are reported,
and a general summary of the symposium proceedings is
provided. It is noted that systems analysis can aid in
four types of evaluation of health activities: evaluation
of plans presented to administrators; evaluation of
operational activities of programs and projects; clinical
and epidemiological evaluation; and evaluation of tha
relative importance of individual projects and programs-
It is pointed out that systems analysis should be
considered as an administrative tool/ not as a finite
science/ and that its value in health services planning
should not be overemphasized. (NTIS)
Reference:
Juaith niagner/
"Criteria For Project Review"/
J_QU£Ddl fll UfiHlitl EldDIlilia/ Vol.l/ No.4/ p.11-16,
(April 1977).PLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 360
This paper explores several problems associated with
the development of valid criteria and standards for
project review of new institutional health services. The
work is based upon experience in developing suggested
criteria and standards in eight specialized health
services under contract to the Health Resources
Administration. Assumptions underlying the development
process are explored, particularly in terms of their
impact on the validity and usefulness of the criteria and
standards to health planning agencies.
The major areas of difficulty encountered were
problems in defining the health service itself, defining
the appropriate nealth planning area, defining tha
appropriate role of the Health Systems Agency in project
review, and validating criteria and standards.
Reference:
Alan Williams,
"Measuring the Effectiveness of Health Care Systems,"
Jautnal qL Etaanniiaa ansi Sasial Ma^iC-ina* voi.29,
p.196-202, (Aug. 1974).PLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 361
Problems invovled in attempting to measure the
effectiveness of health care systems are pointed out,
criteria for measures of effectiveness are suggested, and
a strategy for rationalizing health care systems is
proposed. The basic elements of the proposed scheme are:
(1)	a set of descriptive categories concerned with the
client's state in points of pain-free social functioning;
(2)	relative evaluation process that converts these states
into index terms; and (3) an absolute valuation of points
in money terms. The general properties of each element
are described, and a brief account is provided of
empirical work designed to implement the first element.
The scheme has the following features: it enables
preventive as well as therapeutic activities to be
incorporated; in principle, it can embrace mental as well
as physical illness; it treats one week of suffering at
any particular level of intensity as being equally
undesirable regardless of the identity of the patient; it
relates only to patients and does not account for
inlectivity or pain caused to others by the patient's
condition, shortcomings of the scheme which are said to
present difficult but not insuperable problems; and
satisfaction felt by patients is not regarded as an
independent consideration. The scheme is intended to
facilitate cost-effectiveness studies by providing a
quantification of purely humanitarian benefits to be usedPLANNING FUNCTIONS
TECHNICAL - CONCEPTUAL PROBLEMS
Page 362
in conjunction with economic cost and benefit data. Tne
scheme also could generates as a byproduct/ improved
indicators of the state of health of a community if used
as part of a national survey. The scheme is said to offer
an escape from the intellectually imprisioning confines of
the measures of workload/ throughput/ and input. An
outline for the assessment of care for the elderly/ the
area chosen for testing the scheme is appended. (NTIS)PLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 363
Reference:
B. Abel-Saith,
An Inistnaiianal Siud* ol Haallii Expenditures, and 11s
Relevance lac iiaallti Elaooins, Public Health Paper No.
32,
Geneva:	World Health Organization, 1967.
The paper reports findings of study into development
of standardized structures for national accounting within
the framework of health planning, and comparable
international data on health services expenditures and
methods for twenty-nine countries is compiled. The author
discusses health services organizations, types and trends
in national health expenditures, and the use of economic
data in planning.
Reference:
M.R. Alderson,
"Evaluation ol Health Information Systems,"
fitilisD Efidical fclillfilin* Vol-30, No.3, p. 203-208, (1974 ).PLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 364
The background of health informations systems in
Great Britain is reviewed, and techniques, problems, and
applications associated with systems for collecting
medical data are discussed. The health information system
is defined as a mechanism for collecting, processing,
analyzing, and transmitting the information required for
organizing and operating health services and for research
and training. The primary objective for such systems are
to provide local managers with relevant information, to
periodically provide data which are indicative of the
general performance of the health services, and to assist
planners in studying the functioning of services and
trends in demand and workload. Problems involved in
implementing health information systems are discussed in
terms of data completeness, accuracy, timeliness,
retrievability, appropriateness, an! confidentiality. It
is observed that published papers indicate the gradual
extension of routine information systems, but that special
studies of the use of information relative to specific
problems or to general publicity than studies dealing with
routine data collection. Examples of health data
collection techniques and applications are drawn primarily
from the experience of Great Britain's National Health
Service. Central to the National Health Service's
information-related efforts is the hospital activity
analysis, a basic system of information processing thatPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 365
allows expansion as circumstances permit. The need for
the extension of data collection to primary medical care
in Great Britain is noted. (NTIS)
Reference:
Marion Altenderfer and Howard V. Stambler,
A&aJxLical and Data &££ds I21 ti&ailb HaD££M££ Elaimiuai 4
Eiaaaalis: fii££yiflH/
Rockville, Md.:	Bureau of Health Manpower, Manpower
Analysis Eranch, 1976.
Observations on health manpower data and analyses are
offered as an aid to health planners in carrying out their
manpower activities. The document provides an overview,
rather than comprehensive technical descriptions of data
elements and methodologies. Following a general
discussion of the health planner's approach to manpower
decisions, the following topics are considered: (1)
important problems and considerations, including
timeliness and accuracy of data, comparability of
definitions and coverage, confidentiality, disaggregation
of data, sample versus universe surveys, the health carePLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 366
setting, avoidance of data collection as an end rather
than a leans, and flexibility; (2) broad categories of
data needed; (3) determining current health manpower
supply and requirements, including characteristics of
population served, characteristics and distribution of
practitioners, allied health manpower, requirements
standards, and health manpower education; determining
future manpower supply and requirements, including supply
projections, requirements projections, assumptions for
projections, and use of models; and priorities for datg
collection. A bibliography is provided. (NTIS)
Ref erence:
Velma I. Berry and Paul Reichelt,
Enctlfiios ic liiiliziag	Hal a Xai Cjecisisa Mak ino*
Chicago:	Illinois University at the Medical Center, 1975.
In order to investigate occupational frustration and
fatigue among the nursing staff of an urban teaching
hospital, the routinely collected data for each unit were
compiled for recent years. it was assumed that the data
were accessible and that it would be easy to examine suchPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 367
factors as the patient/staft ratio to determine if the
service was understaffed in relation to past years. It
quickly became apparent that the available data in no way
constituted a data system. Problems encountered in
utilizing the data include the following: (1) No
centralization of data collection or comparability of data
across departments/ e.g./ sometimes the hospital i5
divided along administrative lines and sometimes alon9
clinical service lines. (2) Patients are counted by
discharge but not by admission/ so it is difficult to
ascertain the efeect of admission upon staff workload and
to detect inhospital patient transfers. (3) Information
on hospital of such factors as length of stay, daily
census/ and number of staff is available only in summary
form without sufficient detail for determining if the
available staff is sufficient in terms of work load. (4)
Lack of concensus as to whether staff means number of
persons or number of full-time equivalents leads to
various interpretations of the data. Recommendations
resulting from the study center around the importance of
establishing a centralized system of data collection basod
upon concensually validated guidleines. (NTIS)PLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 368
Reference:
J.H.F. Brotherston,
"Health Planning and Statistics:	An Overview From
Scotland"/
lDl££££li&D£l JflilLUal fll	£££Xi££S/ Vo 1.3, No.l,
p.35-44, (Winter 1973).
The necessity to guide and monitor health services
planning with a closely related information system is now
recognized. However, in most countries practice falls far
short of theory. There are many difficulties to overcome
on the way to achieving a well informed and sophisticated
planning system. The difficulties are administrative,
technical, and pyschologic. There is often a gap to be
bridged between the planners and the providers of
information. In Scotland, the integration of the
previously separate administration of hospitals, general
practice, and public health under single health boards
offers new opportunities for planning health programs.
This change is an incentive to reform and upgrade the
information services for planning. Some of the proposals
are describedPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 369
Reference:
Haia fallaclian lac U&allb Syrians £lannina at trie
AcaaMids Lacal/
Miami: Comprehensive Health Planning Council of South
Florida# Inc.# 1972.
Because accurate data collection is time-consuming
and expensive# the Comprehensive Health Planning Council
of South Florida has determined that successful data
collection should be carried out only to the extent needed
for relevant decision making. This mill help the Council
avoid becoming over-committed to data collection at the
expense of analysis# decision making and implementation;
it will also help eliminate unproductive or repetitive
data. Data collection by a health planning council should
be based on the questions: (1) Nhat information is needed
for decision making and where can it be found; (2) Will
the community cooperate with the planning council in
assembling data; and (3) How much staff time can be
devoted to data collection and how long can the planning
process wait. Specific uses of resulting information fro*
any collection of data must be determined in advance# and
the cheapest and most valid method of data collection must
be selected. Characteristics of data needed for areawide
health planning are: a large response rate for a smallPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 370
base/ validity, flexible use of raw data for different
analysis processes, and currency. (NTIS)
Reference:
John Derry, et al.,
"An Information System for Health Facilities Planning,"
Aa&Lifcan Jautoal al	Rail!a	Raaliiu voi.53, No. 8,
p.1414-1421, (August 1968).
Recognizing that effective planning for health
requires data to be available at appropriate times and
places, a system for this purpose was developed. The
project - CHIPS (California Health Information for
Planning Services) - is presented in terms of its origin,
organization, and operation and its implications for
future action are discussed.
Reference:
Todd Frazier,PLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 371
"The Questionable Role of Statistics in Comprehensive
Health Planning"/
AJB££l££D JfllJLBal il£	ElillliC itealltl/ Vol.60/ No. 9/
p.1701-1705/ (Sept. 1970).
Nhat kind of statistics are needed for comprehensive
health planning ? Are they available ? If not what can
be done ? These and other relevant questions are raised
in this article.
Reference;
Ira Gabrielson/ Estelle Siker/ Katherine Sohler/ and
Edward Stockwell/
"Relating Health and Census Information for Health
Planning"/
American Jcncnai ci Enblic E&aliii/ voi.59. No. i,
p.1169-1176/ (July 1969).
A report is offered on experience in coordinating
health information from various sources with the 196/
census pretest in New Haven in the hope that an ongoingPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 372
information system could be developed for health planning.
Reference:
John Gentry/
"Planning of Community Health Services:	Facilitating
Rational Decision Making"/
Inquiry, Vol.13/ No.3, p.4-21, (Sept. 1971).
The nature and potential usefulness of information
currently available for the rational planning of community
health services are assessed. Examples of measurable
health needs/ existing services/ and resource requirements
are provided for six program components: health
promotion; primary disease prevention; secondary disease
prevention; tertiary disease prevention; diagnosis and
treatment; and rehabilitation. Illustrations of specific
health services data available within each of these
components are presented and notations are made of the
potential use of these data in planning models and
answering basic planning questions. Extensive data are
also available for a number of health manpower categories/
health care facilities/ and the utilization of hospital
tPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 373
facilities. The usefulness of vital and health statistics
data is dependent on the capability to rank specific
health problems according to their importance and
vulnerability and to apply meaningful cost-effectiveness
and cost-benefit concepts. Available data are sufficient
to identify areas in which knowledge or technological
capacities are inadequate and which require priority
attention. (NTIS)
Reference:
£uid£ ifl Hala 1st Usal-th Susiea LUnasiS/
Rockville, Md.:	Bureau of Health Planning and Resources
Development, Division of Planning Methods and Technology,
1976.
A primer on topics relating to health planning data
is presented as an aid to governing bodies of health
systems agencies and statewide health coordinating
councils, and to staffs of planning agencies which lack
experience in collection and analysis of health planning
data. The guide is the first product of an ongoing series
of projects supported by the Bureau of Health Planning andPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 371
Resources Development# DHEte# to augment the capabilities
of health planners to determine needs# identify sources of
data# and to collect# analyze# interpret# and use data to
support the planning process- The guide is designed
primarily to identify and describe data available to
health planners as of March# 1976 as well as data which
will be available in the future through emerging data
systems. Following a preliminary discussion of
availability and limitations of data# survey data# levels
of aggregation# and the Cooperative Health Statistics
System# an overview is presented of health systems
planning data pertaining to population at risk# health
status# inpatient facilities and services# ambulatory
care# and home care. Examples of data uses in health
systems planning are described# including efforts to
determine deficinecies in a primary medical care delivery
system# a study concerned with reducing the number of
surplus obstetrical beds in an area# and a regional study
of chronic renal disease services. Appended materials
include: a description of the Geographic Base File/Du3l
Independent Map Encoding (GBF/DIME) system and its
applications in health planning; brief descriptions of
the seven components of the Cooperative Health Statistics
System; an annotated listing of publications and
technical materials made available by the Census Bureau;
a description of the Federal-State Cooperative program forPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 375
Local Population Estimates/ including names and addresses
of participating agencies; a listing of selected
health-related data sources/ including Federal/ State/ and
local government agencies and private organizations; a
glossary and a list of references. (NTIS)
Reference:
David Gustafson/ and Arne Thesen,
'•Information Systems for Policy Makers in the Health Care
System/"
HdDd.a£IB£Ol S£idilldiiSL5/ Vol.5, No.l/ p. 31-43/( 1976) .
The basic purposes and concepts of policy-oriented
information systems are analyzed, and conclusions are
drawn concerning policy information systems in health
care. It is suggested that traditional computer-based
data retrieval systems are not suitable because
policymakers are less concerned *ith what is than with
what could be; and management information systems
incorporating quantitative models for prediction or
optimization do not have maximum utility in environments
where a large number of reasonably similar questionsPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 376
require answers. A suggested taxonomy of an information
system includes the following elements: a person of a
certain psychological type, who faces a problem, within
some organization, for which he needs evidence, which is
made available through some mode of presentation. A
delphi study of health manpower professionals was
conducted to determine the adequacy of existing approaches
to policy level information systems, as structured, bear
little relevance to the decision making needs of the
policy area. It appears that hard data from an elaborate
information system cannot be of much help in answering
policy questions. Host existing information systems lack
the capability to conduct either impact or policy
analysis. It is concluded that tne traditional view of
hard data	as the only	information worth	collecting	i s
narrow,	short-sighted,	and dysfunctional.	Tabulati ons	of
the study	questions are	included. (NTIS)		
Reference:
Jerome Boyd Hallan,
ils£ cl laXatmaiiau in Esaliti Elannins*
Chapel Hill:	North Carolina University, 1972.PLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 377
A case study of the uses of inforaation in the North
Carolina Regional Medical Program (NCRMP), Durham is
reported. The study objectives included: (1) determining
the adequecy of available information in aeeting health
planning objectives; (2) determining the capacity of a
health planning agency to utilize and adapt available
information in fulfilling planning requirments; (3)
identifying approaches by which the utility of planning
information can be enhanced; and (4) identifying methods
useful in developing planning information. Tnree major
phases of the study included: (1) an extensive literature
review uhich examined the use of information in planning,
methods of studying information use, and methods by which
planning information can be developed; (2) a review of
both NCRMP's administrative organization and its planning
and decision making; and (3) an analysis of information
use in the NCRMP by examination of certain historical
events and through assessment of personnel regarding their
perceived participation in planning and their use of
information during such planning. A conceptual framework
of the use of information in health planning, developed to
aid the analysis of this latter phase, is discussed. Flovi
charts and graphs, results and recommendations, references
and survey instruments accompany the text. (NTIS)PLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 378
Reference:
Linda Hoffman, Dianna Gordon, and Stephen Russell,
lDictmaiiflD RfisuixfiafiDls cl ike R&aliii Cate Elaxmai aad
AdfiiDiSltalQLi:
Toronto:	Systems Dimensions Ltd>, 1975.
The information needed by health care planners and
administrators in the United States and Canada to make
policy, program, and budgeting decisions is reviewed in
terms of the economic and social problems facing health
care delivery in North America. Relevant social and
economic problems are defined; courses of government
action are discussed; and implications relative to the
need for management information are considered. Courses
of government action to counteract spiraling health care
costs included the introduction of new forms of health
care services, and the implementation of controls to
minimize inefficiencies. In light of such courses of
action, health care planners will require evaluations o£
the relative merits of various forms of delivery, analyses
of the direct costs of illness, and cost-benefit analyses
of the effectiveness of various treatments. Hospital
administrators will require deman forecasts, planning and
budgeting information, and analyses of services costs
according to diagnostic categories. Government response
iPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 379
to a lack of coordination anong health and social services
and to the need for consumer education Hill result in a
need among hospital administrators for standardized
medical records and medical record linkages to assist in
the integration of health care, mental health, and social
uelfare services. Health care planners Hill require
cost-effectiveness analyses of the success of national
insurance plans in making health services acessible, as
nell as evaluations of educational programs directed at
the prevention of illness. A bibliography, is provided.
(NTIS)
Reference:
ld£niilicaii£n qL lb£ fiata Eiamfiois H££d£d hx ttealib
£Y£l£lD£ A££Q£i£S Ifil iifiSIiiJUl EdiilitifiS fl&d S££ILL£2S
Elannlna^
Syracuse,N.Y.:	Areauide and Local Planning for Health
Action, Inc., 1975.
A comprehensive health planing project in New York is
described uhich was designed to obtain information on data
elements required to fulfill hospital planning
IPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 380
responsibilities. Six project objectives were identified:
(1) to provide a better understanding of how institutions
and health planning agencies can use data for their
respective planning responsibilities; (2) to identify and
obtain information already being collected which is needed
for hospital activities; (3) to make recommendations
concerning the format design and dissemination of hospital
data by the New York State Health Department; (4) ta
provide baseline data and statistical information about
hospital operations; (5) to eliminate unnecessary
%
duplication of data collection analysis;	and (6) to
develop a process which would lead to	a greater
understanding of mutual data needs and uses. Respective
planning concerns and responsibilities of institutions and
health planning agencies are discussed, along with their
common data needs. The process used to identify needed
data elements is described and general categories of dat£
are identified. Recommendations are given concerning the
establishment of a hospital data report series.
A]ternative	ways	to format	and	disseminate data are
discussed.	The	improvement	of	existing data use and
management by health planning agencies is addressed.
Report appendices concern need certification in New York
and sources for hospital planning data. A selected
bibiliography on hospital planning techniques and data is
provided. (NTIS)PLANNING FUNCTIONS	Page 381
TECHNICAL - DATA AND STATISTICS
Reference:
John Knowelden,
"Information for Community Planning and Coordination of
Long-Term Care Services"/
Medical	Vol.14, No.5, supp./ p.78-84/ (May 1976).
Information needed to plan and coordinate the
long-term health care of an entire community or population
group is delineated. This information falls into three
categories:	(1) indicates the number of persons in need
of care and the nature of their problems; (2) describes
the material and the personal resources available to meet
the need; and (3) monitors how far the resources are
directed toward those in need. The most important
consideration is the first category - defining the group
in need of long-term care. This involves definition and
measurement of the size of the group and the nature of the
long-term care problem. Among the items to be included in
a data set applicable to community planning and provision
of long-term care# major caring agencies/ transfers
between types of care, use of other services/ and family
characteristics. Because long-term care data involve so
many agencies, a uniform data collection system is not
considered practical. A case is made, however, for
setting up special registries to receive and collate data
*
tPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 382
Iron all agencies. Consideration is also given to
organizing the data for community use in faally files.
(NTIS)
Reference:
Jerome Lubin, Junior Knee, Royal Crystal, and Virginia
Slade,
21d.LL£li£2 tCL CflSELLfitlfinsiJtS UfidilU Elaimina/
Los Angeles:	California University, 1973.
Materials on the use of statistics in conprehensive
health planning are presented in a guide for health
planners. The guide opens with a discussion of the role
of statistics in comprehenisve health planning and
evaluation, including an overview of comprehensive health
planning methodology and of the data required for
comprehensive health planning. Approaches to integrating
or linking the data in information systems for planninj
are also discussed. Subsequent chapters deal specifically
with health statistics, demographic and socioeconomic
data, health manpower statistics, health facilities data,
and health services statistics. Each chapter touches on
*
IPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 333
data sources/ Methods of data collection/ and applications
in conprehenisve health planning. The final chapter
discusses the orgnization of statistical activities for
environmental health planning. Accompanying the text are
tables showing categories of facilities and facility
characteristics/ categories of data/ Major sources of
facility data7 and the organization of data component
areas for environmental planning. Flow diagrams
illustrate the design of a comprehensive health planning
information system and the development of a data use plan.
Appended materials include a list of the subject content
of the 1970 census and summary tape files/ a list of
reports from the census use study and other supporting
documentation. A bibiliography is provided. (NTIS)
Reference:
Jerrold Michael/ George Spatafore and Edward Williams
"A Basic Information System for Health Planning"/
Bubl jc	BAEttLiS./ Vo 1.8 3/ No.l/ p.21-28/ (Jan.
1968).
The current philosophy of comprehensive health
>PLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 384
planning has stimulated a demand for a basic information
system which will provide the objective measurement
required to assist in decision making. The suggested
system includes (a) a numerical health index to aid in
defining and measuring health and environmental problems;
(b)	a classification system for health activities; and
(c)	a coded list of output measures of effort. The
relationship of health activites to health and
environmental problems is displayed in a matrix.
Reference	• •	
R. Moroney,		D. Cil
"The Uses	of	Small
PIanning"	/	
InsuiLk/	Vol.	13, No.
In 1	972,	the He
Carolina	in i	tiated
Durham Co	unty	. This
activitie	s o	f the
primarily	to	develop
planning.	A	major
lings, E. Salber, and E. Schmidt,
Area Analysis in Community Health
2, p.14b-151, (Junel976).
alth Planning Council of Central North
a study of the health care needs o'
paper deals specifically with the
data subcommittee that was formed
an information base useful for health
concern of this subcommittee was thePLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 335
development of techniques that would provide data in such
a way that the study participants and decision-aakers
would readily coaprehend problems and issues. The one
aethod used - saall area analysis - is discussed in terras
of its usefulness in assessing community health needs.
Reference:
John Noble/ Jr./
"Designing Information Systems for Comprehensive Health
Planning/"
Inouirv# Vol.7/ No.4/ p.34-40/ (Dec. 1970).
Critical issues face planners wishing to design and
develop human service information systems/ regardless of
the substantive orientation or intended scope of these
systems. These issues are functional/ methodological,
legal/ political/ and economic in character. Some of the
serious questions these issues raise are presented. While
the author acknowledges that these questions cannot be
answered easily/ they obviously deserve careful
consideration by personnel of comprehensive health
planning programs contemplating development of information

IPLANNING FUNCTIONS TECHNICAL - DATA AND STATISTICS		Page	386
systems. Excellence of design	and	likelihood	of
successful implementation depend	upon	how well they	ar e
answered.			
Reference:
David Nordstrom/
Health Eiaimfiiis Guide ic Jlsinu Efitiadical Lil£££lu££*
St. Paul:	Minnesota State Health Planning and
Development Agency/ May 1977.
A methodology is presented to aid professional health
planners in their use of periodical literature.
Periodical literature is valuable because it enables
researchers to keep abreast of advances in their field
(current awareness) and allows information directly
related to an investigator's particular question to be
obtained (literature searching). Abstract journals and
primary journals to aid in keeping generally informed of
important facts and current ideas in health planning are
listed. Indexes useful to a systematic search of
periodical literature for information on a specific topic
are given. About 30 tools are listed in all. Information
i
IPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 381
given with each citation includes the publisher and
address, cost of subscription, and a short annotation of
the journal's contents. The use of computers to perform
literature searches is noted. (NTIS)
Reference:
Anthony Oreglia,
ol Census Bala Lol tisallli Saciitfia Elamuos and
Maaaii£ffi£Dix
Lafayette, Ind.:	Health Services Research and Training
Program, Purdue Univ., 1973.
A manual on the use of census data for health
services planning and management is presented. Section
one oi the manual is comprised of general guidelines on
the availability of census materials and is specifically
designed for users who have little or no knowledge of such
materials. The subject content and geographic coverage of
the 1970 census of population and housing are discussed.
Data products resulting from the census are detailed,
including printed reports, suraary tapes, comparisons
between printed reports and summary tapes, and microfilm.PLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 338
Other data products are also noted. These involve census
maps, address coding guides, public use samples,
population surveys and special reports, and special
tabulations. Information is provided on data delivery
facilities and intercensus coaparability. The second
section of the manual addresses the availability of
specific census data items relevant to health service
planning and management. Such data items pertain to age,
sex, race, income, education, and disability. Specific
uses of census materials in health planning and management
are delineated in the third section of the manual. The
use of ADVATCH in health planning and management is
considered in the final section of the manual. ADMATCii is
an address matching system capable of geocoding
computer-readable records containing street addresses.
Appendixes contain the 1970 census questionnaire and
procedural information on the availability of census data.
Bibliographic references are included. (nTIS)
Reference:
Anthony Oreglia and R. Paul Duncan,
"Health Planning and the Problem of the Ecological
Fallacy",
)PLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 339
Aasricaa ilautaai at ttaaiih Elanaiua* voi.2, No.2,	p.1-6,
(Oct.1977).
Health Systems Agencies are required by P.L. 93-641
to use existing data where possible. Host of these data,
however, are available only in a form aggregated to
geographic areas such as census tracts, counties, and even
entire states. This paper examines what can happen in the
planning and decision making process when geographically
aggregated data are used in place of data pertaining to
individuals.
Reference:
Anthony Oreglia, Denise Klein, Lee Crandall and Paul
Duncan,
EUa Ac.auis.Uiaa and Analysis ttaadfeuaii lat iiuaUi)
Elaxmats, vol.i,
Lafayette, Ind.:	Purdue University, Health Services
Research and Training Program, 1976.
Guidelines concerning the assemblage,
analysis andPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 390
application of data for health planning and resource
development purposes are presented in a handbook directed
primarily to health planners in health systems agencies.
The handbook, viewed as a sequel to the "Guide to Data for
Health Systems Planners', provides details on practical
step-by-step approaches to data management. The first
volume of the two-part handbook deals with activities
based on assemblage of extant data. The opening section
discusses the need for data in health planning and
considers methodological issues related to data collection
and analysis. Subsequent sections concern two of thre?
major elements in an information framework: (1)
population, socioeconomic, and health status data; and
(2) health resources data. Population, socioeconomic, and
health status data are discussed prirarily in terms of
procedures for obtaining and analyzing data available fro*p
the U.S. Bureau of the Census, the National Center for
Health Statistics, and State boards of health. Health
resources data are discussed in terms of selected types of
health facilities and manpower, i.e., hospitals and
physicians. Within each section, a chapter is devoted to
explaining the need for the type of data under
consideration. Other chapters within each section
describe the purposes and uses of data (primarily as
required by legislatively defined agency functions),
detail procedures for obtaining and analyzing the data,PLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 391
and identify data sources. Appendices containing
supplementary documentation follow many of the chapters.
Bibliographic references are included. (NTIS)
Reference:
Anthony Oreglia, Denise Klein/ Lee Crandall/ and Paul
Duncan/
AcfluisiiiflD and Analysis ttan^knak iat H&altfe
llannnxs/ Vol.2/
Lafayette/ Ind.:	Purdue University/ Health Services
Research and Training Program/ 1976.
The second volume of a two-part handbook on data
assemblage/ analysis/ and application is concerned with
the third and final element of the health information
framework: health services utilization data. Whereas
Volume l deals with the acquisition of extant data,
emphasis in the second volume is on studies based upon
primary data collection. The opening chapter discusses
the need for health services utilization data and outlines
the studies to be described in subsequent chapters. For
each topical area (ambulatory care services/ hospitalPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 392
inpatient services, nursing hone inpatient services,
ambulance	services, and family health survey), a
description of study methodology covers the definition of
concepts and variables, the study instrument, the data
collection design, field procedures, and data processing,
and storage. Data analysis and use are then discussed,
usually with reference to specific examples of planning,
resource development, or project review decisions to be
made by health systems agencies. In the first four
studies described, data are obtained from providers of
health services. In the fifth - the family health survey
consumers are the source of data. To provide concrete
examples of the use and analysis of data, a hypothetical
health	service area,	called Central HSA, is used
throughout. Central HSA .is above average in size
(population approximately two million) and representative
of both rural and urban dwellers. Appendices, such as
forms, and instructions to data
codebooks,	sample
co 11 ec tors,	fo1 low
references.	(NT IS)
Keference:
Anthony Oreglia, Denise Klein, and Lee Crandall,PLANNING.FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 393
2nd fiaia h&s.4& si hsallt Luisas Assnsl&s and
Zlals. As&nsL&s. Hod&L Em.Lm. 93-641,
Lafayette, Ind.:	Dept. of Sociology and Anthropology,
Purdue Univ., Mar. 1975.
Decisions which health systems agencies and State
Agencies will be required to make in fulfilling their
health resources development and project review functions
are described, and the specific types of information and
data required to support such decisions are identified.
Decisions are specified as those requiring the following
types of data:	population and socioeconomic data, health
status data, health resources data, health services
utilization data, and environmental and occupational
health data. For each data type, related project review
and health resources development decisions are noted, and
a tabular summary of specific data items required to reach
each decision is included. A directory of existing data
sources presents a series of abstracts arranged according
to subject (status, facilities, utilization, cost, and
quality) which provide information on data available for
health planners as of March 1975. The directory includes
national sources of data and examples of State and local
data sources. Abstracts include the source of data, title
of publication, title of data, authors, availability andPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 394
cost inforoation/ tine period covered/ geographic
coverage/ type of coverage/ data elements, and consents.
Reconmendations made by six sources for data elements to
be collected by health planners are reviewed. The review
includes criteria for selection of the six sources/ a
bibliography of the sources/ a brief description of each
source/ and a tabular presentation of the data elements
themselves. Three of the six sources reviewed have been
distributed to all comprehensive health planning agencies,
fcith the exception of the Cooperative Health Statistics
System/ each source is directed specifically to an
audience of health planners. (NTIS)
Reference:
E. Earl Richards,
"Managing Information for Health Planning,"
linfcao Hfedilh/ Vo 1 • 1, No . 1, p.26-27/ (Arpil 1972).
The experience of the Atlanta Southside Comprehensive
Health Center in utilizing an information system to manage
health planning is described by the project director. The
system maintains master records on each individual andPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 395
family of the target population# and# in addition:
calculates the nunber and types of encounters with Center
personnel; produces patient pharmacy profiles; produces
in-house research reports to assist the staff in
evaluating utilization; scores psychological tests to
pinpoint the cause of a child's maladjustments# controls
an immunization history recall system; classifies all
third party billing; and prints monthly and quarterly
statistical reports. The addition of on-line data display
terminals is anticipated# which would make a patient's
profile instantly available. A team approach is used in
which physicians# dentists# nurses# and social workers
supervise less highly trained workers in different areas
of the city using information generated by the information
system. The Atlanta Southside system provides: (1) a
tool to evaluate the Center's impact on the health of the
community; (2) ready access to large amounts of
information; and (3) evaluation of the effectiveness of
patient encounters. (NTIS)
Reference:
Carol St. Pierre#
iiedlilL Rlauina and £>. Buckminislfii Eull&tls ILatld GaiBfiz.PLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 396
Arlington, Va.:	ERIC Document Reproduction Service, 1971.
R. Buckminister Fuller's World Game is a scientific
■eans for discovering expeditious ways of employing the
world's resources to provide a higher standard of living
for all humanity. The philosophy behind the gaae is the
exploration of resources to do more with less, or to
combine two or core actions to produce a result greater
than the sum of the two. The goal is to give man the
right to life instead of having to earn it. The goal,
philosophy, and computer technology of the World Game can
also be applied to world health planning. Health is an
individual right and all humanity must have the
opportunity to enjoy life to the fullest. In order to
develop world health planning, the planner must take full
advantage of computer simulation to test data and possible
health care strategies. For maximum efficiency, planning,
and research, agencies must be integrated. Politics will
be the largest pragmatic obstacle to world planning since
politicians are often slow-moving and evasive about
dealing with death and disease. The primary philosophical
obstacle is goal-defining. The World Game can help people
plan to get somewhere, but it cannot tell them where they
want to go. (Author/ERIC)PLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 397
Reference:
Harry Sultz, Frank Rens, and Donald Brothers/
CiLLE S*si£i Eased ad CeBAUieL CraBbics*
Buffalo:	Dept of Social and Preventive Medicine/ State
Univ. of New York at Buffalo/ 1971.
System thinking and its application to health
planning is discussed in this report on the Community
Health Information Profile (CHIP) of western New York.
Based on a combination of computer technology/ geographic
theory/ and graphics/ the CHIP system utilizes
health-related data collected and retained in a number of
agencies and institutions. By using computer-drawn maps/
the health planner can locate health facilities within
population concentrations of greatest utilization/ and
identify population groups at risk. Precise geographic
identification is particularly important for the analysis
of data about small areas/ such as locally designated
special areas/ hospital service areas/ air quality control
regions, mental health catchment areas, and areawide
health planning regions. Basic demographic data, vital
health statistics, facility and manpower resources, and
information on the various types of community service
programs is easily obtainable, and these, combined with
clinical information, can be of great help to the healthPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 399
planner. A technique developed by the O.S. Census Bureau
called Dual Independent Hap Encoding System (DIME) for
geographically relating data from different courses is
described. Figures illustrating computer-drawn laps,
■entioned in the text are not included. Portions of this
document are not fully legible. (NTIS)
Reference:
Charles Tilquin/
"Modeling Health Services Systems/"
CaLfc* Vol.14/ No.3/ p.223-240/ (March 1976).
A conceptual model for analyzing any system of
personal or collective health services is presented and
used to examine the qualities and shortcomings of existing
health care models. The conceptual model uses two
fundamental concepts: patient state and physician state
of information. Patient state refers to the physiological
and psychological state of the patient, while the
physician state of information refers to the physician's
diagnosis of a patient at a given moment. Application of
the conceptual framework to formal models of admissionPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 399
systems, progressive care systems, special units (e.g.,
obstetrical and coronary care units), hospitals, and
multi-institutional systems point up that fundamental ta
the analysis of a health care system is the definition of
the care regions that serve as a basis for determining the
trajectories representing the dynamics of patient flow
through the system. It is observed that formal models in
which conceptualization has been bypassed in an effort to
go directly from reality to the scientific model are less
representative of reality than are models deduced from a
general conceptual framework. The descriptive approach to
formal modeling (attempting to explain what a system is)
and the normative approach (attempting to describe what
the system should be) are discussed. It is shown that tne
two approaches are similar in that they aggregate
individual aspects of resource demand on the same basis/
i.e., the care region. The presentation closes with a
synthesis of the concepts presented and a description of a
global model of the health services system, which is
illustrated schematically. Emphasis is placed on the
close conceptual parallel that exists between personal and
collective health services systems. (NTIS)PLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 400
Reference:
Iranslaiinfl kz&auisle Haallb Planning Ansae* Lafutiaiioa
Ifllfl Adieu EtaaLaas/-
Maumee# Ohio:	Health Planning Association of Northwest
Ohio# 1974.
A prototype comprehensive health data system for
comprehensive health planning agenices is proposed by the
Health Planning Association of Northwest Ohio. The scope
of the program would be capable of developing the
following elements in stages: (1) outpatient# preventive
care# home heath care# and ambulatory care# (2)
inpatient# acute care# long-term care# convalescent care#
and rehabilitation care; and (3) nonpatient#
environmental influences# and socioeconomic conditions. A
list of agencies contributing to the project's financing
is included. The collection of data bank information is
primarily from secondary sources. Tne proposed areawide
data and research center would be operated for the benefit
of 12 counties in northwest Ohio# and would undertake a
continuous research process within the selected project
area to determine the needs of citizens in the area.
Steps for the development of the data and research center
are outlined# and a data committee is described which is
comprised of providers# consumers# and professionals froiPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Pa ye 40L
public and private agencies dealing with health problems.
A number of these people have experience in data systems.
Major priorities of the program would be the analysis and
utilization of historical resources, with attention to
major gaps especially in morbidity and hospital
utilization, pilot studies on patient origin/utilization,
and investigation and evaluation of population groups witi
special problems. Portions of this document are not fully
legible. (NTIS)
Reference:
iirban In£(2i:i22ii0Q S_£Sl£21.S and Esgyijzsjien£5 lor iisalib
Inl££TyIion,
New York:	CONSAI) Research Corp., 1967.
A study on urban information systems and requirements
for health information is reported. The purpose of thj
study was to explore the usefulness of urban information
systems in comprehensive community health planning. Four
study hypotheses were developed: (1) health planning
requires data and urban information systems can provide
this data? (2) health information can be incorporatedPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 402
into urban information systems to place health planning in
a broad context of municipal decision making; (3) the
incorporation of health information processing into an
urban information system will facilitate processing
efficiency and reduce information handling costs; and (4)
there is a relationship between certain health variableJ
and other social, economic, population, and physical
variables and the use of an urban information system in
analysis and planning. Comprehensive community health
planning is described, with emphasis on its relationship
to other planning activities and evolutionary changes in
the health care Held. Components of the health system
are identified, along with traditional and potential
community health planning information requirements.
Existing information sources and systems are noted, and
their potential roles with respect to health planning
activities are discussed. State of the art and
technological aspects of urban information systems are
described. Conclusions and recommendations are presented
on the relationship between urban information systems and
comprehensive Health planning. An appenidx provides
details on selected urban information systems. (NTIS)PLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 4)3
Reference:
Hannu Vuori/
"The Uses of Automated Health information Systems In the
.Management and Planning of Health Services"/
Pub 1 ic idsalth/ Vol.91, No.l/ p.33-43/ (Jan.1977).
The term health information system is often being
used without a clear definition of its objectives/
components and area of application. This paper reviews
the types and major uses of systems designed for
collecting/ processing, analyzing and distributing
information required for organizing and operating health
services. Theoretical considerations based on information
theory/ systems theory and the prevailing planning
ideology for the development of the data base of such
systems as well as practical guidelines for the inclusion
of specific data items into the data base, are presented.
Reference:
Helen Wallace/ Victor Eisner/ and Samuel Dooley/
"Availability and Usefulness of Selected Health and
Socioeconomic Data for Community Planning"/
iPage 404
PLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Aniec iggn liOHIDai Dl EiiXllS EsalliU. Vo 1.57/ No. 5,	?.
762-771, (May 1967).
The need to Identify geographical areas of highest
priority for health and social services to families led to
a study of the availability of health and social indexes
in San Francisco, and a comparison of two methods (factor
analysis and map plotting) for determining their
usefulness. The most useful health and socioeconomic
indexes are discussed. Means of supplementing indexes
derived from the U.S. decennial census are also dealt
with.
Keference:
George Warheit, Roger Bell, and John Schwab,
EldQQiU!! XfiL gel	AssfiSSffieoX Ap^LOa^es^
n.p., 1574.
A manual of needs assessment methods and techniques
is presented as a resource for those interested in
conducting needs assessment studies in community settings.
iPLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Page 405
Although focused on assessing mental health needs and
services/ the basic processes and procedures applicable to
the general discovery of the human needs of a community
are outlined. Five needs assessment approaches are
discussed: the key informant approach, the community
forum approach, the social indicators approach, the
rates-under treatment approach, and the survey approach.
The key informant approach is based on information secured
from those in the community who are in a good position to
know the needs and utilization patterns. The forum
approach relies on the perceptions of the individuals
willing to attend a public meeting. The social indicators
approach draws inferences of need from the descriptive
statistics found in public records and reports. The
rates-under-treatment approach is defined as a descriptive
enumeration of the persons wno have used the services of
the community health and welfare agencies. The survey
approach is the collection of data from a sample or entire
population of persons living in the community. Activity
checklists, worksheets, data collection instruments, and
other research aids are included. References are
provided. (NTIS)
Page 406
PLANNING FUNCTIONS
TECHNICAL - DATA AND STATISTICS
Relerence:
Kerr shite and Jane Murnaghan,
"Health Services Planning:	Models and Means,"
h&allh	Vol.5, No.4, p.304-307, (sinter
1970).
The author believes that given such sources of data
as hospital discharge data and the content of ambulatory
medical care that can be derived from a population to bi
served, together with data on health services facilities,
personnel, and related resources, health services planning
can become a practical reality. The means for specifying
objectives and for testing models to achieve these
objectives woula be available. Practical refinements
could be made in the models, and alternative methods of
organizing personal health services could be simulated and
compared before important decisons are made and scarce
resources committed. Useful information will convert
planning from a fanciful theoretical exercise into a
practical and powerful tool for improving health services
for all.
;PLANWING FUNCTIONS - TECHNICAL
MODELS - AMBULANCE
Page 407
Reference:
Colin E. Bell and David Allens
"Optimal Planning of an Emergency Service/"
Socio-economic Planning Ssiencii Vol.3/ p.95-101/ (1969).
Queuing theory models are developed for computing the
size of emergency ambulance fleets required to meet
specified standards of service. As a function of the
demand for ambulance service and the distribution of
duration of service calls/ tables are given for the number
of ambulances required to respond immediately to 95 (or
99) percent of service requests.
By analyzing a queuing system with unlimited service
(ambulance) availability vie provide approximate results to
overcome the difficulties of computing steady-state
results for a multi-server (ambulance) queuing system.
Our results provide guidelines for determining the
size of an ambulance fleet based at a single garage. The
authors discuss the extension of their results to more
complex situations.
This paper provides a mathematical basis for a proper
balance between the inordinate expense of a large fleet of
ambulances and the possibly inadequate service provided by
a small fleet. In the first section/ the authors develop
the required queuing theory techniques. These methods ore
PLANNING FUNCTIONS - TECHNICAL MODELS - AMBULANCE				Pa ge	408
then applied	in the following	section	to	determining	
optimal fleet	size for a city	whose	ambulances		are
dispatched from a single base'. In		the fina	1 sections,		the
applicability	of these results	to other		ambulance	
operations is	discussed.				
Reference:
James A. Fitzsimmons,
"A Methodology for Emergency Ambulance Deployment,"
Management Scisn^e, Vol.19, No.6, (Feb.,1973)
An important feature of emergency ambulance systems
is that the probability of any given unit being busy is
dependent upon which of the other units are busy.	An
analytical model incorporating this feature is developed
and found to be reliable in predicting the entire response
time distribution for an actual operating system. A
computer version of the model coupled with a pattern
search routine constitutes the ambulance deployerant system
referred to as CALL (Computerized Ambulance Logic
Location). This methodology may be used to find the
deployment of amoulances that minimizes response time, 89PLANNING FUNCTIONS - TECHNICAL
MODELS - AMBULANCE
Page 409
illustrated by an application for the City of Los Angeles.
CALL was used to select from a possible set of 34
firehouses 14 for the location of emergency ambulances.
Although the objective was the minimization of mean
response time, the final deployment substantially reduced
the probability of excessive response times as well.
Another ancillary benefit from the use of CALL was a
substantial smoothing of workload among the 14 ambulance
crews.
Reference:
William K. Hall,
"The Application of Multifunction Stochastic Service
Systems in Allocating Ambulances to an Urban Area,”
Sasaatcil/ Vol.20, p.558-570, (1972).
Alternative policies for the allocation and
distribution of ambulances are studied for the city of
Detroit, Michigan. Data on emergency occurrence and
service processes were collected and analyzed, and these
data analyses are utilized to model the ambulance system
as a multifunction stochastic service system with
Page 410
PLANNING fUNCTIGNS - TECHNICAL
MODELS - AMBULANCE
semi-Markov arrivals and state-dependent server selection.
Numerical results are developed predicting the performance
of both single function recovery systems and dual function
police-ambulance systems under alternative operating
policies.
Reference:
toilliam K. Hail/
’’Management Science Approaches to the Determination of
Urban Ambulance Requirements/”
Elanuins Scisucss/ Voi.5, p. 491-499,
(1971).
This research paper summarizes a systematic approach
to the determination of urban ambulance requirements.
Quantitative measures of ambulance system performance and
alternative system configurations were developed, and
these were examined for the city of Detroit, Michigan.
Sampling techniques and data analysis procedures were used
to develop an analytical model of the Detroit emergency
recovery system, and this model was then utilized to
predict the performance of
alternative
systewTECHNICAL
Page 411
PLANNING FUNCTIONS -
MODELS - AMBULANCE
configurations under varying operating policies. Results
and conclusions are presented for the specific systeai
under consideration? extensions of these techniques to
other emergency systems are also suggested.
Reference:
Louis Sasmor and Jeffrey L. Hauer/
Aafculaiaty Haalih Cara ElaQDinsi Ihsaxx and Applixaiioa,
Pittsburgh:	Health Systems Division of Westinghouse
Electric Corporation/ 1972.
A new method for projecting the 10 year ambulatory
health care demands of a population has been developed
which uses descriptors obtained from healthy populations
and then tailored to a particular population. The model
can be applied either to regional or to single facility
populations. This approach offers a more detailed and
locally adjusted projection than other current approaches.
The model requires information on: the population by age
and sex groups; the population's use of physician
services as measured by overall visit rate and the
distribution of patient visits among specialties and amongPLANNING FUNCTIONS - TECHNICAL
MODELS - AMBULANCE
Page 411
locations such as hospitals and clinics/ the physician s
workload as measured by activity distribution/ time needed
to perform each activity/ and productive time available?
and use of ancillary services. (NTI3)PLANNING FUNCTIONS
MODELS - EVALUATION
TECHNICAL
Page 413
Reference
K.S. Bay, D. Flathman, and L. Nestman,
"The Worth of a Screening Prpgram:	An Evaluation of a
Statistical Decision Model for the Benefit Evaluation of
Screening Projects,"
&i££i£aa Jautiml at tufciia iteaitj}, voi.6,	No.2.
p.145-148, (Feb.,1976).
A statistical decision model is applied to the
benefit evaluation of screening projects to derive an
expression which provides upper and lower limits for
average benefits in terms of prevalence of screen
positives and negatives, and the average cost of screening
and referral. Possible applications of such a technique
are discussed and a numerical example is given.
Reference:
John Dennis Chasse,
»A Bayesian Approach to Health Project Estimation,"
American Jantnal at Eniliic iisaltk, Vol.6, No.3, p.7 47-754,
(Aug«/1976).PLANNING FUNCTIONS - TECHNICAL
MODELS - EVALUATION
Page 414
This paper illustrates how a Bayesian statistical
approach was used to estimate the outcomes of the National
Tuberculosis Program in India. Such an estimate, it is
argued, is necessary for a proper judgment about the
project's social usefulness. The process of medical care
delivery is reduced to a set of conditional probabilities.
The numbers are estimated using a source material, medical
records, the results of medical research, and the opinions
of experts. Bayesian methods of estimation are used and
their value is discussed. The final discussion contains a
brief treatment of the role of project analysis in public
decision making. The place of Bayesian methods in project
analysis is briefly illustrated, demonstrating their
operational value in the field of public health decision
making.
Reference:
John 0. McClain and Vitnala R. Rao,
•’Trade-offs and Conflicts in Evaluation of Health System
Alternatives:	Methodology for Analysis,”
ilaaliil	R£S£ii££i]/ Vo 1.9., No. 1,
(Spring, 1974).
p.35-52,Page 415
PLANNING FUNCTIONS - TECHNICAL
MODELS - EVALUATION
The authors propose that neither pure "Delphi
Techniques" nor pure mathematical methods can effectively
be used in health planning- In order to blend the best
characteristics of both types of techniques, a methodology
is presented which the authors feel is applicable to a
health services problem situation involving determination
of cost/utility trade-offs and conflict resolutions- The
approach consists of the fallowing seven steps:
1)	Identify solvent variables of the health system
for study of cost/utility and conflicts.
2)	Develop real or hypothetical alternative systems
for consideration and review and relevant cost estimates.
3)	Collect judgmental data (ranked preferences or
ratings) for the alternative systems from a sample of N
persons.
4)	Use the judgments to form clusters of persons with
similar opinions and test the face validity of the
resulting groups.
5)	Estimate an interval score for the utility of each
system for each cluster.
6)	Perform cost/utility analysis on the utility
scores for each cluster and identify possible conflicts.
7)	Use the utility scores to arrive at a composite
solution using mathematical programming or other methods.PLANNING FUNCTIONS - TECHNICAL
MODELS - EVALUATION
Page 415
Reference
George W. Torrance, Warren H. Thomas and David L.
Sackett,
"A Utility Maximization Model for Evaluation of Health
Care Programs/1'
Health	EaasaEILh/ Vol.7 / No. 2, p.108-113, (Summer/
1972).
A linear utility scale is described/ complete with
measurement instruments/ that allows assignment of utility
values to health states for any disease or treatment
program. Given that the change produced by a health care
program in the health states of a population is
determinable, this utility scale permits assessment of the
effectiveness of that program in terms of the change it
produces in overall health utility. This is the basis of
a model that will rank programs by their
effectiveness/cost ratios or select them into a subset
achieving the maximum effectiveness under specific cost or
other constraints. Two algorithms are described, suitable
respectively for priority ranking and for selection of
programs giving maximum effectiveness under constraints,
and the application of the model is discussed.
>PLANNING FUNCTION - TECHNICAL	Page 4l7
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Re ference:
Robin Barlow,
"Applications of a Health Planning Model in Morocco/"
Inlfimaiianal Jauinal at Uzallh S&lxIqsss voi.6, No.l,
p.103-122/ (1976).
The proposition is made that public health planning
should be out that certain objectives or types of output
are relevant for public health/ including the reduction of
mortality and morbidity/ economic' improvement/ and
palliative care. A model for health planning is described
and can be applied in underdeveloped countries such as
Morocco. The model recognizes institutional complexities
and is designed to permit the application of output
maximization techniques. Components of the model include
real resources, institutions/ activities/ and objectives,
the implementation of the planning model is discussed/
with an emphasis on the life saving effects of
hospitalization, on the costs of hospitalization, on the
life saving effects of vaccination, and on the costs of
vaccination. Supporting tabular data are provided for the
model, • based on information obtained in general hospitals
of Morocco during 1960-62 and 1971-72. It is concluded
that/ within the context of the public health system in
Morocco, the model is a potentially useful planning
iPLANNING FUNCTION - TECHNICAL	Page 418
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
instrument. Preventive health activities (e.g.,aass
vaccinations) are shown to be a less expensive way of
saving lives than curative activities. (NTIS)
Refernce:
Martin A. Baum/ David F.	Bergwall/ and Phillip N.
Reeves/
"Planning Health Care Delivery Systems/"
Amsiisism sJaunisii al Eublis. tisaliii/ voi.65/ no.3,
p.272-275/ (March, 1975).
The increasing concern and interest in the health
delivery system in the United States has placed the health
system planners in a difficult position. They arc
inadequately prepared in many cases to deal with the
management techniques that have been designed for use with
systems problems. This situation has been compounded by
the failure, until recently, of educational programs to
train their health profesionals in these techniques that
allow the planners dynamic feedback on his proposed plans.
This same technique provides the planning student with a
better understanding of the system planning process.PLANNING FUNCTION - TECHNICAL	Page 419
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Reference:
Ronald Ervin Beller
Toward a RfisauLSs. Elaimina 2Lsd£l X&l SammuiiilY aasaiialsi
A Conceptual Madsl al lh& Paiiaai It-salmani Sysisaz.
Gainesville/ Fla.:	College of Health Related Professions/
University of Florida/ 1971.
A conceptual resource planning model for patient care
services in community hospitals is described. A
statistical profile of a community hospital is presented
along with a comprehensive listing of hospital programs
and their basic objectives. Outputs of a community
hospital's patient care program are analyzed. Output
concepts advanced by other researchers are presented/ and
an output concept is proposed that has the following
*
characteristics:	(1) the basic output unit of patient
care is a fully or partially processed patient; and (2)
output units are placed in equivalence classes according
to the discharge diagnosis of a patient's health problem/
the stage of illness at hospital admission/ the proportion
of the total treatment process completed/ and the
objective state of a patient's health at dismissal.	The
treatment process is viewed according to	two
subprocesses:a provision of essential medical services/
and provision of supplemental care. The patient as aPLANNING FUNCTION - TECHNICAL	Page 420
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
subprocess of the treatment system is considered. It is
felt that inputs to patient treatment are constrained by
the output goals of patient care and by production
processes used to treat patients. Various types of input
/
resources are discussed and classified. It is pointed out
that feedback information resulting from a comparison of
care outputs with established criteria, affects a
treatment system by modifying inputs, the treatment
process or its subprocesses, and output criteria through
changes	in objectives and removal or dimimution of
constraints. The treatment process model is applied to a
specific output, the treatment of uncomplicated inguinal
hernia.	Appendixes provide additional information on
techniques used to develop the model. A bibliography
included. (NTIS)
Ref erence:
Lawrence D. Dodin, T. Owen Carrol, Allen Lee, and Sally
Stuart,
’•Financing Mental Health Services in the State of New
York,"
R£2£ar£ii, V°l*20/	5, (Sept-Oct.,1972)PLANNING FUNCTION - TECHNICAL	Page 421
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Mental health care is a major public-sector problem
in the State of New York. The authors were asked by the
Ways and Means Committee of the New York State Assembly to
recommend a new fiscal structure with shared funding
between the state and the counties to better achieve the
objective of the state's mental health-care program. They
developed a simulation model for the problem and used it
to design new funding plans; the results of this analysis
have been written into legislation introduced into the New
York State Assembly.
Reference:
J.W. Bush/ M.M. Chen/ and J. Zaremba
"Estimating Health Program Outcomes Using a Markov
Equilibrium Analysis of Disease Development"
JsujlddI Euklifi. iisaltli/ Vol.61/ No.12/ Dec.,
1971.
The purpose of this paper is to explain how a Markov
model may be significant for understanding how a disease
process/ for analyzing trends/ for comparing disease
distributions before and after the application of healthPLANNING FUNCTION - TECHNICAL	Page 422
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
programs, and for developing large health system models.
Reference:
Milton M. Chen and James W. Bush/
“Maximizing Health System Output with Political and
Administrative Constraints Using Mathematical Programming41
Vol.8/ No. 3, p.215-220/ (Sept./1976).
The authors first review recent mathematical
programming models (Correa/ Feldstein/ Torrance)/ and then
develop their own dichotomous integer programming model
which differs from the previous works in that:
1)	The conceptual formulation of the output function
incorporates prognoses for different patients types/
2)	The target population is disaggregated into smaller
activity modules/
3)	Empirical determinations are made for the relative
weights for different function levels/
4)	Consideration is taken of the independencies among
health activities including shared fixed-costs/
5)	Adaption is made to administrative and political
constraintsPLANNING FUNCTION - TECHNICAL	Page 42§
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
The model proposed here applies conceptually across
all target populations and health programs/ and could be
used to optimize the output of a total health system/
according to the authors- The effects of such
optimization would be appropriately reflected in the
weighted life expectancy computed as a social indicator.
Reference:
Hector Correa,
Eamilaiiaiu Haalih ami HaYalamaani/
Lexington, Mass.:	Lexington Books, 1975.
The main intent of this book, as described by the
author is '‘to study the application of the techniques of
systems analysis, operations research, or mathematical
optimization to the macro-problems of population, health
and nutrition planning.*' The idea is to use the analysis
for whole social systems, not confining it to sub-units
such as planning centers and hospitals. The initial
chapters of the book briefly present the measured
interactions of population growth, health, nutrition and
socio-economic development. These chapters provide sootePLANNING FUNCTION - TECHNICAL	Page 424
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
of the conceptual justification for the need and
possibility of using quantitative techniques in the
planning process. The second and final group of chapters
present a graded collection of operations research models
that can be used for planning population growth, health,
and nutrition, both by themselves and in combination with
socio-economic planning. Several of the models ar«
presented with actual numerical examples.
Reference:
Hector Correa,
"Health Planning Simulation Models,"
£<2£ul£li£Dx Hfialitu liJilLiiioa and Hsyslflaasai/’
Lexington, Mass.:	Lexington Books, 1975, p.117-128.
Three simulation models which are related to health
planning are presented. The author first develops a
method for forecasting population by taking account of
mortality, fertility, and the effect of changes in
morbidity on population growth, and the influence 0f
population growth on mortality. From this model,
population by age and sex can be forecasted as well as thePLANNING FUNCTION - TECHNICAL	Page 425
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
number of deaths by cause/ age and sex.
The second model is a method lor estimating the
demand for medical services. The model is based on the
assumption that morbidity and mortality rates can be
maintained constant only if the rates of medical services
are also maintained constant. Although the model is
described for the services of physicians, similar
techniques could be applied to the demand for any other
types of services or implements.
A model similar to the preceeding one is used in the
estimation of the demand for hospital services.
Reference:
Hector Correa,
"Integration of Population and Health Planning,"
H&alitu Nuttiliau. an<3 2£xslj22in.£iil*
Lexington, Mass.:	Lexington Books, 1975.
The first of three models presented by the author is
based on two assumptions: 1) infant deaths can be limited
by limiting che nuraoer of children born, or 2) by
providing care to those born. Since both of thesePLANNING FUNCTION - TECHNICAL Page 426
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
alternatives require resource expenditure/ the model seeks
to minimize the number of children's deaths by utilization
of either of these two assumptions or utiliztion of a
combination of the two/ while accepting a resource
constrain t.
An extension of the basic model is then proposed to
minimize the deaths of mothers, as well as infants and
then another is introduced to incorporate the effects of
post-partum care in the liklihood of mothers to accept
family planning services.
The author cautions that the models, in present form,
are greatly simplified and a more detailed description of
the resources needed in the health programs should be
'included in the operational version.
Reference:
Hector Correa, and Wafik A. Hassouna.
"Model for the Integration of Health and Nutrition
Planning.
development and	Vol.3, No.4, p.51-61, 1975.
The problem of choice between the prevention and curePLANNING FUNCTION - TECHNICAL	Page 427
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
of disease	is discussed.		with	an	emphasis	on	the
relationship	between the	incidence		of	disease	and	the
nutritional	conditions	of a	population. A			model	is
proposed for	integrating	health	and	nutrition		planning.	
Nutrition is introduced as an element influencing
resistance to disease and, if a person becomes sick, also
influencing the final outcome of the illness. In the
model, nutrition is considered simply as one possible May
/
to use the resources available to improve the health
conditions of a population. The model's application to
the problem of minimizing infant and child mortality in
Egypt is reported. Two nutritional levels are considered
and three diseases (bronchitis, diarrhea, and measles >
are included in the application. Better housing and
clothing are preventive measures against bronchitis, a
sanitary water supply against diarrhea, and vaccination
against measles. Data on morbidity and mortality rates,
use of resources and costs are estimated, based on
information obtained on the conditions existing in Egypt
during 1970 through 1973. It is concluded that a model
for general socioeconomic planning should have as its
objective a general social welfare function. In such a
model, the process of educating human resources ani
producing physical resources is endogenous to the model.
The capacity for education and production determine their
availability. (NTIS)PLANNING “FUNCTION - TECHNICAL	Page 428
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Reference:
Sabyasachi Dastidar,
Qeiimiiina lattmiaua in LLnnninn - A Case Sludz ni
&L&=£iiiQl2£il£Dij Esnicnnl	Elnnninn Azza*
Tallahassee:	Dept.	of Urban and Regional Planning*
Florida State Univ., Aug. 1975.
The application of optimizing techniques to the
allocation of health planning resources in the
Mid-Cumberland area of Tennessee is discussed. Linear
programming is employed in the development of a resource
allocation model, and the resource allocation process is
described and illustrated. Geographic, socioeconomic, and
health characteristics of the Mid-Cumberland area are
noted. The use of optimizing techniques in long-range
planning, short-range planning, and day-to-day planning
and operation is evaluated. The regional health planning
model based on these techniques assumes limited
substitution among hospital beds as opposed to Hill-Burton
and similar approaches. Limitations of the model are
cited, and areas for further research are suggested. It
is envisioned that data on hospital bed distribution in
the Mid-Cumberland area will aid regional health planning
agencies or health systems agencies in the conduct of bed
need studies and that the model can be applied to resourcePLANNING FUNCTION - TECHNICAL	Page 429
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
allocation in different health care institutions.
Appendixes contain the questionnaire used in the analysis
of hospitals in the Mid-Cumberland area and supporting
tabular data. (NTIS)
Reference:
Holies Milh Ihs. libai ill	in Elan Usisiosaeati
A Simulation Madsl inc ESAs*
Cambridge, Mass.:	Pugh-Roberts Associates, Inc., 1975.
A system dynamics model that predicts the effects of
various actions considered by planners on an area's health
care system was developed for the Capitol Health Systems
Agency in North Carolina. The model was also used to
project the number of additional nursing home and hospital
beds the area would need through 1982. The purpose of
this document is to describe the model, its uses at the
time of writing, and its potential usefulness to health
systems agencies. The discussion opens with a description
of the Capital Health Systems Agency and the 11 counties
it serves and an explanation of the reasons the model was
developed. The model itself is then discussed in terms ofPLANNING FUNCTION - TECHNICAL	Page 430
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
its structure and development. Attention is given to the
use of data in qunatifytng the model. Finally/ the
discussion turns to the ways in which the model has been
used to explore the effects of programs being considered
for the agency's health systems plan. These include
simulations carried out to determine the effect of an
expansion in community health centers on certain segments
of the population and on health care utilization and costs
for the population as a whole. The impact of implementing
cost control programs was also projected. (NTIS)
Reference:
Burton V. Dean and Amar J. Singh/
"Optimal Design of Prepaid Dental Plans/"
Cans QsliyiiY flannioii
Arnold Reisman and Marylou Kiley/ ed./ New ¥ork:	Breach
Science Publications/ 1974/ p.302-322.
The authors first discuss Prepaid Dental Plans/ which
have become increasing popular in the United States/ and
the problems inherent in financing them. They conclude
that in order to hold the costs of the insurers at aPLANNING FUNCTION - TECHNICAL	Page 431
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
minimum the dental plan should try to minimize the
unsatisfied dental need and thereby avoid spreading the
risk of costly dental services. The unsatisfied need
calculated for each service, when multiplied by the
respective weights, gives the weighted unsatisfied need of
each service. The total sum of unsatisfied needs of all
services can serve as a measure of performance.
The authors then utilize these performance measures
to develop a dynamic programming model in which 23
different dental services through 23 different
sub-problems are optimized. Finally a cost estimization
is developed which relates incidence, utilization, and
cost parameters to the total cost of plan operations.
Reference:
Q£¥£l£>Ein2 Maiiifl^lpaias iat Eaalib ElanaaLS. 12.
SatjfisLfis abaiasi Esa-Uk Cana QLiaali£iifltis.x
Rockville, Md.:	Health Resources Administration, 1976.
The results of a 2-year research project concerned
with the status and economic impact of shared service
arrangements among hospitals are summarized. The projectPLANNING FUNCTION - TECHNICAL	Page 432
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
involved analysis of data from a
shared services, from a special
service organizations conducted in
Administrative Services program
1971 national survey of
survey of 156 shared
1974, and from Hospital
data files for 1968
through 1976. Details on 22 specific services were
gathered on onsite visits to 19 shared service
organizations. Details on financing and operations were
obtained from six organizations. The classifications
system used to categorize shared services is described,
and terminology is defined. Findings are presented on
existing arrangements of shared services and on the
effects of the sharing arrangements. Two methods are
recommended for use by health planners in identifying and
analyzing existing arrangements for sharing services and
in assessing the potential for initiating sharing
arrangements. The economic impact of sharing arrangements
of six sites is summarized in terms of economies of
scales; capital requirements; unified strength for
pricing and negotiating; reductions in unmet health needs
and in random fluctuations of patient demands; spatial
reallocation of resources; and effects on quality,
comprehensiveness, accessibility, availability, and
acceptability of care. Supporting data are included. The
tables of contents from the two reports summarized herein
are appended. (NTIS)PLANNING FUNCTION - TECHNICAL	Page 433
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Reference:
G. Alan Dever,
£&ld&nii2l2£.Ual itadei fax iiaalUj Enlis* Analysis
Atlanta:	Atlanta Division of Physical Health, Georgia
Department of Human Resources, 1975.
An epidemiological model for use in policy analysis
of health programs is presented. The model identifies
four primary divisions: system of health care
organization; life style, i.e. self-created risks;
environment; and human biology. It is contended that
this epidemiological model provides a more balanced
approach to development of health policy than the limiting
traditional divisions of prevention/ diagnosis, therapy,
and rehabilitation, or public health, mental health, and
clinical medicine. Following a schematic presentation of
the model, each major element is considered in detail, and
the following subdivisions evolve: restorative, curative,
and preventive subdivisions of the system of health care
organization; leisure activity risks and consumption
patterns within the life style element; social, physical,
and psychological subelements of the environment and
genetic inheritance, complex internal systems, and
maturation and aging, included in the human biology
element. Application of the model involves four steps:PLANNING FUNCTION - TECHNICAL	Page 434
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
(1) selection of high risk diseases that contribute
substantially to overall mortality and morbidity? (2)
proportionate allocation of contributing factors of the
diseases to the four elements of the model; (3)
proportionate allocation of total health expenditures to
these four elements; and (4) determination of the
difference in proportions between these two allocations.
As an example/ the model is applied utilizing 13 diseases
in Georgia to ivestigate Federal expenditures for 1974
(actual) and 1975 and 1976 (estimated). Tabular data and
a bibliography are included. (NTIS)
Reference:
William L. Dowling/
“The Application of Linear Programming to Decision Making
in Hospitals/”
Uaaailal idainistLaiiaiLf p.66-75/ (1971).
After a brief introduction to the meaning of linear
programming and some of its applications in hospital
administration/ the author reviews several previously
published articles in hospital LP utilization.PLANNING FUNCTION - TECHNICAL	Page 435
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Reference
Sam A. Edwards,
A K&allb	£imulaioj:.t
San Antonio:	Health Resources Planning Unit, Texas
Hospital Association, 1973.
Modern scientific techniques for modeling and
quantifying the health care delivery system are described.
The principal result is a computer- based health services
simulator. The simulation describes the salient
characteristics of the medical care system from a macro
viewpoint and can analyze many related questions. It
forecasts the medical care demands for a given population
by level of care, duration and disposition.
Determinations which can be made by the simulators are
those such as the need for care, health status of th®
population, why people seek care, and optimum facility
location. The simulator uses regression equations to
predict entry to the health care system through initial
visits	for episodes	of	care	demand; simulates the	
movement	of patients	through		the system to	es timate
outpatient/inpatient care			need	by level, intensity, and	
duration	of care; need	by	level.	intensity, and	duration
of care,	and calculates		resource utilization		plus costs
for the s	imulated care.	(NT IS)			
>•PLANNING FUNCTION - TECHNICAL	Page 436
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Reference:
Martin S. Feldstein/
Economic Analysis 1st itealih ^styles SIlisiiaiisLi/.
i
Chicago:	Markham Publishing Co., 1968.
The book is divided into 3 sections. The first,
Chapter 1, serves as an introduction. The second,
consisting of Chapters 2 through 6, examines the hospital
as a production unit. The author addresses issues of
hospital costing, the measurement of productivity, and
input efficiency, and then develops a linear programming
model of hospital production. The third section, entitled
"Planning the Supply and Use of Health Care Resources,"
deals with the questions of hospital input care, hospital
maternity care, and planning for the health sector.
In his discussion of planning for the health sector,
the author develops a 9 equation model which allows the
user to study the inter-relationships between hospital,
local authorities, general practioner services, as well as
the effects on these health sector activities of the
social and demographic characteristics of the population.
The equations were estimated with cross-section data for
1960 with 60 observations.PLANNING FUNCTION - TECHNICAL	Page 437
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Reference:
Martin S. Feldstein,
"Health Sector Planning in Developing Countries,"
Economical Vol.37, No.146, p.139-163.
This paper describes a method of allocating th«
scarce health sector funds, manpower, and facilities of af>
underdeveloped country among different disease control
programs and individual activities in such a way which
yields the optimum feasible reductions of mortality,
morbidity and economic losses. At the core of this method
is a linear activity analysis description of the health
care sector: a vector of inputs and a vector of outputs
is associated with each health activity. This leads to afl
optimization procedure using a linear programming
algorithm.
A linear programming formulation provides a natural
framework for incorporating the multiple benefits and
costs of health care programs. In principle, although the
method has been applied in this paper to the activities
for controlling one disease, it can be extended to a wide
spectrum of diseases and be integrated into a more general
development planning model.Paqe 438
PLANNING FUNCTION - TECHNICAL
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Ret erence:
Martin S. ^eldstein/
"An Aggregate Planning Model o£ the Health Care Sector/"
MsdiC-31 £££2/ Voi. 5/ p.369-381/ (1 957).
This paper indicates the ways in which an econometric
model of the health care sector could be used to provide
monitoring and explanatory information and to make
conditional predictions of the effects of alternative
policies. These ideas are illustrated by a study of the
demand and supply of hospital inpatient care.	The
endogenous variables are the number of persons with health
insurance/ the number of general practioners/ the number
of medical specialists/ the number of available short-ters
general hospital beds/ the number of admissions/ and the
mean duration of per case stay. The predetermined
variables are of two types. The first consists of past
values of the endogenous variables. the second is the
exogenous variables:	population age structure/ income
distribution/ urban/rural residence/ percentage of married
females. All equations are assuaieu to be linear. The
author admits that the model is too crude to be of
practical use and that a more detaileu specification aiua t
be developedPLANNING FUNCTION - TECHNICAL	Page 439
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Reference:
Martin S. Feldstein,
££G02iui£ Analysis £jbi Hsaliii SamtiGS Eiiiciansyi
flcamimsitis Siudiss al	Biilisti Uaiiaaal ilaalib
Sfi£3£i££x
Cambridge/ Mass:	Harvard University/ 1967.
Economic analyses concerned with identifying and
estimating information relevant to decisionmaking in
health care and with applying optimizing methods to
improve the efficiency of the British National Service are
presented. The book is in two sections; the hospital as
a producing unit and planning the supply and use of health
care resources. The first section includes a discussion
of the measurement of cost and productivity in acute
hospitals; analysis of ways,in which hospitals ranging in
size from 72 to 1/064 beds; several models of the of the
hospital as a producing unit; estimation of the
implications and causes of interhospital variation in
capacity utilization;and an experimental application of
linear programming to the selection of an optimal mix of
cases for treatment. The second section opens with a
discussion of the supply and use of hospital inpatient
care. A decisionmaking approach is described in which
policy formation is assisted by an econometric model thatPLANNING FUNCTION - TECHNICAL	Page 440
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
provides	condit i ona l	predictions of	the effects	of
different	government	policies on	availab ility	and
utilization patterns. The way in which the British health
care system allocates maternity care resources among
individual patients is examined/ and an alternative method
for such allocation is suggested. The closing chapter
presents a simple/ nine-question aggregate model the
interrelationships among hospital/ local authority/ and
general practioner services. (NTIS)
Reference:
Paul J. Feldstein,
M£iD3E£ii!0[ Heninl	Ad aciinsmis Analysis/
Lexington, Mass.:	Lexington Books, 1973.
The book is divided into 7 chapters/ of which the
first is devoted to an attempt to delineate boundaries,
specify objective, and to develop some criteria for the
remainder of the book. This is followed by an analysis of
the demand for dental care in Chapter 2, analysis of the
supply oi dental services in Chapter 3, and an analysis of
the market for dental and auxiliary education if ChapterPLANNING FUNCTIUii - TECHNICAL	Page 441
.MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
4. In Chapter 5 the author describes the development and
application of an econometric model of the dental sector
for	use in forecasting and policy evaluation. A
simulation analysis was conducted in order to forecast the
effects of future cnanges in demand on dental prices,
visits, expenditures, and dental incomes. Using the model
the policy implications of maintaining a constant dentist
to population ratio are evaluated, as well as various
proposals to increase the supply of dental care. Chapters
5 and 7 contain a discussion of the government's role ip
the	dental	sector and	a summary with concluding
observations.
Reference:
Robert s. Fetter and John D. Thompson,
"A Planning Model for the Delivery of Health Services,”
iiSJlIL ZZLZ 0d.liy2.LY EidDDlLJ/
Arnold Reisman and Marylou Ki1ey,ed., New York:	Gordon
and Breach Science Publications, 1974, p.302-322.
After reviewing the need for patient classification
according to nospital resource utilization, the authorsPLANNING FUNCTION - TECHNICAL	Page 442
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
present a method which specifies some dependent variables
(sucn as length of stay) and examine the logical structure
of attributes^ which from a medical point of view/ might
be hypothesized as resulting in a statistically consistent
prediction of the dependent variable. This was don*
through the development of an interactive statistical
system. Once these patient classes and their paprmeters
are identified/ they are used in the development of a
facilities plan. The authors use linear programming to
plan the development of a diagnostic facility to
accomodate 5 classes of patients with 3 different kinds of
facilities for the care of such patients. The objective
function was defined in terms oi maximizing the
utilization of all facilities and with this utilization
weighted by first the relative cost of investment and
operation. Budgeting constraints were imposed on both
investment and operation.
Reference:
Merwyn R. Greenlich/ Arnold Hurtado, Clyde R. Pone,
Ernest	Saward, and Samuel S. Yoshioka,
"Determinants of Medical Care Utilization/"
Heal th	E22£2.L££1/ Vol.3, No.4/ (.Vinter/ 1963).PLANNING FUNCTION - TECHNICAL	Page 443
MODELS - GENERAL PLANNING AMD RESOURCE ALLOCATION
A multidimensional approach to the study of the
factors that determine medical care utilization is
described, based on the hypothesis tnat different sets of
social,	economic,	and situational backgroung
characteristics are significant determinants of
utilization in different disease situations. The patterns
of utilization are studied in the setting of a prepaid
group practice plan for coraphrehensive medical care with a
membership of over 100,000. Preliminary findings are
presented on the characteristics of the sample population,
the patterns of medical care utilization, and the
utilization for various types of morbidity.
Reference:
James V.Hansen
"Computer-Assisted Planning for Regional Health Care
Programs",
Vo.1.9,	Ho.!), p. 23 9-245,
1975.
A systems approach to orderiny the elements of a
regional health care program is suggested which usesPLANNING FUNCTION - TECHNICAL	Page 444
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
binary matrixes and elementary Boolean operations in a
computer-assisted operation. It is observed that the
process of synthesizing hierarchies is frequently dealt
with intuitively by planners of regional systems of health
care/ often resulting in fragmented and redundant
programs.	It is proposed that formal procedures that
relieve planners of much of the complexity in developing
programs and changing their structure can contribute to
better understanding of the system and to the
effectiveness of program design. The major challenges
that confront planners in the development of appropriate
hierarchies are the selection of a relevant set of
variables, the determination of	what elements are
subordinate to what other elements, and the designation of
subordination relations. For larger systems, this can be
an overwhelming process, one in which the computer can be
of assistance. The matrix approach suggested is applied
to a set of system elements, such as home health care,
transportation services, continuity of care, determine aqe
range of recipients, and referral mechanisms. In this
demonstration, system elements are drawn from four
programs developed by regional planners. The design that
results from the computer- assisted analysis combines the
elements in a single program, rather than in four separate
programs. It is empnasized tnat tne binary matrix-based
system for designing program models does not relieve the
PLANNING FUNCTION - TECHNICAL	Page 445
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
planner of the job of identifying all elements relevant to
the program in question. However/ once the elements are
identified/ the planner's task is reduced to assessing
pairwise relationships between elements. The discussion
is illustrated with sample matrixes and witn schematic
representations of the program plans developed manually by
planners and the program plan developed from binary raatri*
analysis. (NTIS.)
Reference:
Gary Hirsch and Martiette Howell/
ZzsdhasLk SIluslIul&s. in lh& lUalih Esliyscy .Sysl-emi &
SjLmyiylian Madfil fan £aim£atianaiy& Esallti Elaoaiaax
Cambridge/ Mass.:	Pugh-Roberts Associates/ Inc./ 1973.
The development of a simulation model for health
planning purposes is detailed. The model is designed
specifically for medical care planning at the regional
level. .It was developed by the Office of Comprehensive
Health Planning in Massachusetts and allows planners to
consider the health care system as a total system rather
than as a fragmented set of services. The model also

1PLANNING FUNCTION - TECHNICAL	Page 446
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
provides planners with an environment in which to examine
programs and resource allocations of patients into/
within, and out of health care facilities is described and
illustrated. The health care system is categorized
according to four sectors: ambulatory care, acute care
hospitals, long-term facilities, and home health services.
The health care planning model is based on a system
dynamics approach which emphasizes causal structures of a
system's behavior that are of interest to planners. Steps
in the application are outlined. Structural elements of
the model are delineated. It is pointed out that the
model focuses on interactions among ambulatory, acute
impatient, long-term, and home care sectors of the health
care system. This focus is considered to be essetial in
evaluating changes in utilization that may result from
changes in resource allocations and policy decisions.
Reference:
Daniel Horwitz, T. D. Hartweller, J. R. Batts H, and
Triangle Institute Team,
"Methods of Building a Health Manpower Simulation Model"
EiLQc&fidings Eaaati al	£aal£L£Q£fi an a Hajillb
Manpower SimulaliQQ Model# National institute of Health

rPage 4 17
PLANNING FUNCTION - TECHNICAL
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
under the Sponsorship of the 3ureau of Health Manpowec
Education, Vol.2, Aug. 31 and Sept. 1, 1970.
The purpose of this paper is to present a dynamic
microsimulation model lor projecting utilization of
general hospitals by the United States civilian,
non-institutional population. The model was developed to
provide essential inputs to a model designed to project
I
hospital manpower requirements, but may be used
independently. It attempts to meet the need for improved
methods fof analyzing the effects of changes in the
compositon of the population and of changing utilization
patterns on hospital admission rates and length of stay.
Further, the model may be used effectively in simulation
experiments to provide prior measures of the consequences
of alternative programs designed to improve personal cara
in the U.S.
The model has two components. The first, POPSIM, a
demographic simulation model which creates a population of
individuals in the computer and then projects this
computer population forward in time, generating births,
deaths, and changes of marital status for each individual
by Monte Carlo methods and on a competing risk basis. The
output of P3PSIM for a given simulation period provides
the input to H03PEP, the second component of the hospital
1
tPLANNING FUNCTION - TECHNICAL	Page 448
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
utilization simulation. HCSPEP is also a stochastic
model/ generating hospital episode histories for each
individual for a selected simulation period. The hospital
simulation model discussed in this paper is essentially
descriptive in nature. The model is not self-adaptive in
the sense of having parameters which adjust automatically
through interaction of resource constraints in the system.
Reference:
H. W. Jackson/
’"Financing Public Hospitals in Ontario:	A Case Study ill
Rationing of Capital Budgets/”
Management Science/ Vol.2C/ No. 4. (December/ 1973) Pt.
2.
A real system is described where the normal
assumptions of capital rationing are violated. A goal
programming model of the system is developed which allows
a decision maker to choose the basis upon which an
objective could be computed. The major part of this model
is a linear programming algorithm leading to selection of
the projects which optimize the system according to thePage 449
PLANNING FUNCTION - TECHNICAL
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
basis chosen/ yet can be used on a relatively simple
computer. Finally speculation on the possible use of this
tool in other public sector decision making activities is
presented.
Reference:
J. Kane/ W. Thompson/ and I. Vertinsky/
“Health Care Delivery:	A Policy Simulator/"
EiiilllliflS SclfiDSSS, Vol.6,
(1972).
p.283*293,
This paper investigates three alternative policies to
allocate medical resources. A coraoination of DELPHI and
simulation techniques are used to arrive at forecasts. To
facilitate the transfer of knowledge among the panel
members and to enhance pattern recognition, a simulation
model was constructed using a recently developed
simulation language. Whereas previous models of health
care delivery have aimed at determining and evaluating
strategies and prescriptions for action, this paper
discusses policy modeling and evaluation. In particular
three policies of health care delivery are evaluated. The
»PLANNING FUNCTION - TECHNICAL	Page 4$0
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
first focus is on maintaining existing levels of health
care through incremental strategies. The second policy
aims at supplying services to all people who demand them.
The third policy aims at providing health services to all
persons who may need them. Through DELPHI procedures the
planel derived the interaction matrices to represent the
major interactions in the British Columbia health care
system.
Reference:
Frederic D. Kennedy#
"Development of a Community Health Service System
Simulation Model#”
Health	HfiliJtfiLY flanilinS/ Arnold Reisman and Marylou
Kiley#ed.
New York:	Gordon and Breach Science Publishers# 1974#
p.266-286.
A general description of the community health service
system is given in terms of needs# demands# and resources.
This same framework is used as the basis for a simulation
model of one segment of the system. The model of a publicPLANNING FUNCTION - TECHNICAL
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Page 451
maternal and infant care program was derived from
available data augmentad by professional estimates.
Predictive ability of the model and its application to
other similar operations has been demonstrated. Several
conclusions result from this research. Additional testing
of the model is warranted. Utilization of the model in a
gaming environment should be investigated. Data
availability for certain health systems is adequate to
initiate simulation model development. Simulation can
provide a useful tool for the health planner.
Reference:
J. M. Lapatra/
Health £a££ HaliyatY. SYSlsaisi ZyLahialism Stiisti-a/
Springfield/ Illinois:	Charles C. Thomas Publishers/
1975.
The general objective of this book is to show how we
can apply systems concepts to the study of the large
organiztion known as the United State health system. In
Chapter 1 the author after a brief review of the
literature/ concludes that explanations for health issuesPLANNING FUNCTION - TECHNICAL	Page 452
MODELS — GENERAL PLANNING AND RESOURCE ALLOCATION
are: not enough doctors, poor geographic distribution of
doctors, too few general practioners, and inadequate
health care for the non-white population. He introduces
the systems approach in Chapter 2 and demonstrates its
applicability to the health care field. Chapter 3 is
dedicated to causal models availabe for use in the health
care system. Models in general are discussed and a more
detailed treatment is given to path analysis, simultaneous
equation models and linear programming. All of these
models are of a general nature. The remainder of the book
deals with health care simulations, evaluations, ways to
measure components of the health care system, health
status indicators, and health standards. The publication
is theoretical in nature, no data is presented to show
implementation of the models or concepts.
Reference:
Vicente Navarro,
"Systems Analysis in the Health Field,"
Elunning, S£ieQ££S Vol.3, p.179-189, (1969).
This paper reviews the application
of systemsPLANNING FUNCTION - TECHNICAL Page 453
MODELS - GENE'?AL PLANNING AND RESOURCE ALLOCATION
analysis to the planning of health services. Planning
models which have employed a systems analysis approach i
the health field are critically examined/ their strengths
and limitations are considered and areas where more
research is needed are indicated. New approaches which
attempt to eliminate these limitations are presented.
The use of health indices as performance indicators
of the health service system/ as social development
indicators and their use as intrinsic variables in the
models of development is also critically examined.
Reference:
Vicente Navarro,
"Planning Personal Health Care Services:	Markovian
Mode l,"
£312/ Vol.2, No. 3, ( May-June, 1969).
A Markovian planning model is presented. It takes
into account the dynamics of the health service system ani
allows health planners flexibility in a continuously
changing environment. Analysis of tne Markovian model
leads to its three applications: 1) prediction,i.e.,PLANNING FUNCTION - TECHNICAL	Page 454
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
determining future requirements tor manpower and resources
for any .population defined in terms of desired or
specified demographic and/or epidemiologic
characteristics; 2) simulation, i.e., analysis of changes
in the health service system and/or in the demographic
and/or epidemiologic variables and the repercussions of
these changes on present and future resources; 3) goal
seeking,i.e., the design of several alternative stategies
of reaching, in a given time period, specified utilization
patterns or organizational arrangements, and the choice of
the '’best" alternative according to defined constraints
such as "cost" or "minimum charges in current resources,"
etc. The three applications of the model have been used
in different situations. Empirical data from diverse
sources has been used. Within the conceptual framework of
the model the levels of care and the composition of
population groups can be changed to meet desired criteria.
Reference:
Vicente Navarro,
"A Systems Approach to Health Planning,"
Services Research, p.96, (Summer, 1969)PLANNING FUNCTION - TECHNICAL	Page 455
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
This paper describes a holistic approach to the
planning of personal health services/ considering health
services not as an aggregate of independent parts but as
interdependent groups forming a unified whole. It defines
a stochastic model, utilizing a Markov chain that
integrates the component parts involved in health service
systems for planning purposes. The three applications
described are prediction, for the ordinary statistical
problem of forecasting; parametric study or simulation,
for determining the effect on the whole system of
simulated changes in its parameters; and goal seeking,
for calculating the optimal utilization strategy to
achieve a specified goal under given constraints such as
minimization of costs or resources. Numerical examples
are given for each application.
Reference:
Vicente Navarro, Rodger Parker, and Kerr L. White,
"A Stochastic and Deterministic Model of Medical Care
Utilization,"
Health SfiLVliSa Research* Vol.5 No. 4, p343-354, (Winter,
1970).PLANNING FUNCTION - TECHNICAL	Page 456
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
A previously reported stochastic model predicting the
future distribution of a stable population in various
states of health care is here modified and expanded to
take into account the stochastic process of varying rates
of utilization among different age groups and the
stochastic and deterministic processes that determine
changes in size and age structure of the population. The
functioning of the model is described and its use
illustrated by application to a hypothetical population.
Given an adequate data base, the model offers a
quantitative tool for estimating future resources required
by each component of the health services system.
Reference:
James R. Newheiser and Milton E. F. Schoeman,
"A Stochastic Model for Health Care Resource Planning,"
£LaQniQ£ S£lan££5, Vol.6, P. 197-213,
(1972).
The need for improved management of health care in
the United States is evidenced by recent trends and the
current state of the nation's health. Many systems andPLANNING FUNCTION - TECHNICAL Pa9e 457
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
methodologies for aiding health care management have been
proposed. However* at this relatively early stage of
development* most approaches are either highly conceptual
or restricted to unique conditions* thereby having little
utility for general application.
This paper first defines a conceptual model of the
health care system and then develops a generalized
management planning model which is designed to be
applicable to a broad class of health care programs.
Following this* the described methodologies are applied to
a specified health care program* the Cervical Cancer
Detection Program of South Texas* and the general model is
used to derive a computerized resource planning model for
a major sub-system of the program.
The findings derived from this experimental
application of the methodology are discussed in terras of
1) the mechanics of the resource planning model* 2) the
use of the resource planning model as an aid to management
planning* 3) the adaptability of the resource planning
model to similar health care programs and 4) the
applicability of the systems methodology and the
generalized model to the various types of health care
programs.PLANNING FUNCTION - TECHNICAL	Page 458
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Reference:
Peter Newman
MA Conceptual Framework for the Planning of Medicine in
Developing Countries/*' mimeographed report/ Nov./1972.
After a discussion of the role which health plays in
both individual and social welfare/ the author presents an
analytical framework which contains definitions of "state
of health" and a complete planning model. The
optimization model referred to as "the production function
for health" assumes that what determines the evolution of
the state of health is 1) the current level of that state;
2)	the vector of capital gooods present in the economy;
3)	the current vector of consumption of all goods and
services/ other than the service of human wealth; 4) the
services of human wealth; 5) that part of the service of
human wealth allocated to consumption; 6) the state of
knowledge; 7) the time. The author does not attempt to
solve the optimization nor to set necessary and sufficient
conditions to achieve an optimum/ his chief concern is to
show how the state of health/ affecting and being affected
by other variables in the economic system/ fits logically
into itPLANNING FUNCTION - TECHNICAL	Page 459
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Reference:
Madelynn Oglesby, and Mary K. Carl,
"Development and Evaluation of a Health Care System:	A
Heuristic Model,"
Nyrging Res<?3£gt}/ vol.23, No.4,	p.334-341, (July-August
1974).
A heuristic model for the development of a health
care system is proposed. Various models for planning and
evaluating a health care system are noted. The proposed
model is classified as verbal rather than mathematical and
describes the interactions of health-related behaviors
exhibited by providers and recipients of health care. The
model advocates the development, implementation, and
evaluation of a health care system that is predicated upon
identified health care problems of a specific population,
an interdisciplinary approach to the solution of health
care problems, and continuous evalution to provide more
efficient health care. Three model phases are identified;
planning/ implementation, and evaluation. Six stages are
encompassed by these three phases: (1) systematic
definition of health care problems using empirical data
from a variety of sources; (2) subdivision of the health
care problems of a population into categories of
disciplinary health needs and objectives; (3)PLANNING FUNCTION - TECHNICAL
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Page 460
categorization of the objectives in stage two according to
practice	functions;	(4) development of patterns of
staffing by an interdisciplinary team; (5) implementation
of a structure for the health system defined in stage one;
and (6) evaluation of the component parts of the health
system.	An . example is given to operationalize the
conceptual description of the model. The example concern3
a paradigm showing the steps involved in planning,
/
implementing, and evaluating nursing practice. (NTIS)
Reference:
Jorge Ortiz and Rodger Parker,
"A Birth-Life -Death Model for Planning and Evauation of
Health Services Programs,"
Esallh Services RcaeaEg.il, Vol.6,No.2, (Summer, 1971).
A Markov model of the
developed to relate two
specific mortality rates by
specific fertility rates
involving life expectancy,
mortality by age and
birth-life-death process is
input decision variables
age and group of diseases and
by age — to output criteria
time dependent structure of
cause of death, and otherPLANNING FUNCTION - TECHNICAL	Page 461
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
time-dependent demographic structures. Experimentation in
the form of computer simulation is used to determine the
input of health services programs in terms of the output
criteria when the cost of the program and its estimated
alteration of the input variables are known.
Reference:
A. H. Packer/
"Applying Cost-Effectiveness Concepts to the Community
Health System/"
Operations EfiSSaLSLtlz Vol. 16/ No.2, p.239-253.
This paper investigate ways in which concepts of
-	I
model building and cost-effectiveness can be applied to
the health planning process. The problem is described and
methodological implications drawn that reccommend
large-scale digital computer simulation techniques. Study
of effectiveness measures suggest that the system's basic
purpose is to reduce the likelihood that individuals will
be in the state of ill-health. The proposed measures of
ineffectiveness is defined as the expectation of the
weighted sum of the population's expected duration of stayPLANNING FUNCTION - TECHNICAL	Page 462
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
in each of "ra" disability states. The applicability of
this and other measures to specific health problems is
also discussed. The paper deals with the problem of
estimating costs. Distinctions are made among the various
kinds of costs and among the various bearers of the costs.
Reference:
Leon S. Pocinki and Dale L. Thomas,
"Simulation of an Ambulatory Care Delivery System
Illustrated by a Pediatric Clinic,"
Uplift Cars Dsliyaiy Elating,
Arnold Reisman and Marylou Kiley, ed.. New York:	Gordon
and Breach Science Publication, 1974, p..323-349.
This paper describes several of the results of
Geomet's continuing research program sponsored by the
National Center for Health Servic Research and
Development. Goals of this program include the
development of a simulation moael to be used in evaluating
health care delivery systems. The study was limited to
those services which compare personal health care for a
community population. Initial emphasis was placed on thePLANNING FUNCTION - TECHNICAL	Page 46b
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
delivery of ambulatory
requires interaction
model/ Delivery system
model. The simulation
care. The overall model structure
of four primary models:	Population
model/ Cost model/ and Finance
is programmed in the PL-1 language.
Reference
Jeffrey A. Prussin/
’’Network Analysis:	An Innovative Approach To Health Care
Delivery System And Facilities Planning”,
filcmcilical Sciences SceceeSinasxx Voi.n (1975).
A discussion of network analysis as a logical and
systematic approach to planning new health care systems
and facilities is reprinted/ following its presentation to
the 12 annual Rocky Mountain Bioengineering Symposium and
the International Instrument Symposium. The network
analysis approach to planning is flexible in that it can
be applied to single facilities, planning regions, or
entire countries. Through network analysis, which views
health care delivery as the sura of many interrelated
activities, the interactions of demand within a given
health delivery unit can be quantified. The successfulPLANNING FUNCTION - TECHNICAL	Page 464
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
application of the network analysis approach depends on
development of the existing and pending legislation and
other exogenous factors in health delivery systems be
understood. Depending on the application for which the
network analysis approach is to be used/ various
configurations of computerized models can be employed to
manipulate and analyze the relevant data. Among the
models available are demographic/ regional demand analysis
inpatient demand/ ambulatory demand/ cost-benefit
analysis/ dynamic planning/ clinic operation and clinic
financial models. (NTIS)
Reference:
Hans Dietrich Radtke/
AlinsLaiifin 2l itealib-EnaiiiisiD'i Essaiuzsss in iiis Esdlis
Corvallis:	Oregon State University/ 1973.
The purpose of this thesis is to develop a model of
the health industry in the Northwest in order to provide a
method for estimating interrelationships among public
expenditure/ environmental and economic variables and thePLANNING FUNCTION - TECHNICAL	Page 465
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
health status of a community/ and to estimate the
interrelationships between these variables and the
availability of physicians. Specific objectives of the
study were : (1) to develop a conceptual framework
relating the health of the Oregon/ Washington/ and Idaho
region to environmental/ social/ economic/ and other
related factors; (2) to examine empirically the
contribution of those factors to the health status of the
population of this region; and (3) to identify the policy
variables in health resource allocation in this region.
Theoretical economic justifications for public
interference in public health are reviewed/ and problems
inherent in quantifying returns to health resources are
outlined. The two-stage least squares method of
estimating simultaneous relationships is used to examine
empirically the contributions of the aforementioned
factors of the health status of the northwest region.
Information derived from these estimates is then used to
identify the relevance of public policy in ascertaining
social desirability of certain proposals affecting the
availability of medical care or otherwise changing the
general health environment. The text of the thesis is
substantiated with tables and figures. Conclusions/ some
of which differ from traditional health care policy
significantly enough to warrant a reexamination of methods
for expenditures of health resources/ are drawn from thePLANNING FUNCTION - TECHNICAL	Page 466
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
statistical relationships resulting from these empirical
analyses.	Conclusions are stated in terms of marginal
products as indicators of policy/ and marginal value
products of the medical inputs relative to productivity of
/
physicians, paramedics/ and hospitals.	Policy
implications are also stated. Finally/ a bibliography and
a series of appendices are provided. (NTIS)
Reference:
Hans Jorgan Rasmussen/
"Conflicting Strategic Objectives in Hospital Design/”
Qasaa*. lh£ JaumaL 21 aaaasaieai sciancs/ voi.2.. No.2,
(1974)
This paper presents a multigoal linear programming
model designed to analyse the impact of different
strategic objectives in the planning of hospitals. The
author argues that it is necessary to adopt an overall
point of view in planning/ that it is necessary to
consider the interaction between the hospital and other
social and health institutions and the community at large
in order to attain an efficient plan. A simplifiedPLANNING FUNCTION - TECHNICAL	Page 467
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
cost-benefit analysis is suggested/ and it is demonstrated
that the opportunity costs of lost working days may be
more important(than both capital and operating costs from
a social point of view.
Reference:
Edwards b.Roberts and Gary 3.
"Strategic Modeling for Health
ti&allli Cats aaaaaamaiii. RsxLaMz.
Hirsch/
Care Managers"/
p.69-77, (1976).
Strategic modeling methods are described for
determining whether a health program will succeed or fail.
Three advantages of strategic models are noted : (1) they
help to make decisions concerning program design/ resource
allocation/ and the choice of program policies; (2) they
can be used before any resources have been committed to a
program to assess the impact of that health program on its
sociomedical environment and the effect of environmental
changes? and (3) they permit planners to study health
problems and find leverage pOints where the investment of
health care resources results in the greatest return. The
role of strategic modeling in HMQ can be useful when
iPLANNING FUNCTION - TECHNICAL	Page 468
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
initiating a strategic planning effort. It helps to
coalesce a multidisciplinary task force around a key goal,
strategy, or policy issue. Seeing interrelationships
among different functional areas of a health organization
can generate insights	into common	objectives	and
interdependencies. The application of visual modeling to
several complex health settings is	examined.	The
development of strategic health care models is discussed.
It is shown that manpower planning has become the focus of
two modeling projects that are attempting to understand
supply, demand, and impact upon care in the separate areas
of dental care and nursing. (NTIS)
Reference:
Cyril Roseman,
Lsalth Status ii£syu£c« AHocati^a Syoyaxi Slalom.*
Baltimore, Mi.:	Regional Planning Council, Aug. 1975.
work undertaken on the Ileal th Status Resource
Allocation Support System modeling effort is summarized.
The objective of the effort is the initial conceptual
development of an approach to resource allocation
iPLANNING FUNCTION - TECHNICAL	Page 4$<J
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
decisionmaking for use by health planning agencies in
reviewing the appropriateness of Federal funds
distribution in DHEW Region III ( Delaware* Maryland,
Pennsylvania* Virginia* Nest Virginia* and the District of
Columbia). This report offers a general summary of
consultants' technical reports on various aspects of the
project. The history* origins* and focus of the project
are discussed* and the division of the task into four
teams - the health economics team (HET)* the applied
epidemiology team (AET)* the planning statistics teas
(PST)* and the legal and administrative team (LAT) - is
explained. The building of the HET model is described*
and the work of the AET in identifying the relative health
needs of populations is discussed. An initial exploration
of data availability was conducted in Maryland to
determine the kinds of problems that might be met using
the model. PST's role in reviewing data capability in the
region is described* and the limits on allocative
decisionmaking are summarized by LAT. The summary deaLs
with unanswered questions* prospects for the future*
operationalizing the model* phase II efforts* and the
regional office. Tables present supplementary data*
(NTIS)
tPLANNING FUNCTION - TECHNICAL	Page 470
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Reference:
Elisabeth Schach and Siegfried Schach/
"Continuous Time Stochastic Model for the Utilization of
Health Services/"
SfifiifirssaoQmlc Elanuirm Sciences/ vol.e, p. 263-272,
(1972).
In this paper a stochastic model for health services
utilization is analyzed. The basic idea is that at any
point in time the population can be sub-divided into
mutually exclusive subpopulations depending on the type of
medical	care received.	Individuals move between
components of care according to certain probabilistic
rules.
Since the model is stochastic/ the quantities of
interest/ like the number of individuals receiving
hospital care and the number of physician hours required
on a certain day or over a certain period of time/ are
random.	The distributions and their parameters are
derived. Basically/ the model allows the prediction of
the ultimate affects of changes in health policy. Several
examples are given to illustrate the point.
IPLANNING FUNCTION - TECHNICAL
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Page 471
Reference:
David 3. Starkweather/ Louis Geluich/ and Robert Newcoma,
"Delphi Forecasting of Health Care Organizations/"
Ixmuii:*/ Vol.12/ p.37-46, (1975).
The research described in this paper originated as a
part of a master plan for redevelopment and expansion of
the services and facilities of an urban hospital in the
western United States. Hospital officials asserted that
no major change in the institution be made without first
obtaining as clear a picture as possible of the nature of
the health care organization 10 years hence; only in this
context should change be contemplated. Efforts to obtain
such a forecast relied primarily on the Delphi process/ a
technique designed to obtain consensus from a panel of
experts on future events and conditions. Results from
four realms of prediction are reported here and are an
illustration and critique of a useful planning technique
which has wide potential application. The four realms
are:	1) predominant organization patterns of health care/
2) methods of financing health care/ 3) modes of
reimbursement/ and 4) the nature and role of hospital.
(PLANNING FUNCTION - TECHNICAL	Page 471
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Reference:
Lawrence H» Stiffman,
Sam s E&allii SaalaL AaaLysls. Matiiada Ian SaYalaaiaa
iialiaasx.
Ann Arbor:	Michigan University, School of Public Health,
May 1974.
Quantitative methods and techniques for health
planning and management are described in a manual directed
to developing nations. The catalog of health sector
analysis methods has two purposes :	(1) to present a
selection of past analysis of components of the health
sector; and (2) to evaluate these analyses in terms of
their ability to identify choices in allocating scares
resources among competing objectives, activities, or
strategies;to evaluate the consequences of alternative
decisions in terms of health, economic improvement, and
cost; and to identify the preferred alternative given
available information, skills, and resources. Application
of health sector analysis techniques is described at the
national, regional, single facility, and single prograa
level. The manual opens with a discussion of the
constraints in using quantitative methods and techniques.
Program budgeting applications are then described in both
developed and developing countries, and examples of
PLANNING FUNCTION - TECHNICAL	Page 473
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
cost-effectiveness analysis are offered for cholera and
malaria. Forecasting and operations research techniques
are described at the health program management level.
Examples are presented of methods for identifying data/
organizing data into information/ and analyzing and
managing information in decision-making. Methods included
are time series analysis/ regression analysis simple
population and utilization projections/ queuing and
inventory theory/ and network analysis. Analytic or
optimizing models, including linear and dynamic
mathematical programming and Markovian analysis, are
described. Allocation models are described for
decision-making in regard to tuberculosis, allocating
personnel, moving patients, and environmental health.
Supporting data, graphs, flow diagrams, and a bibliography
are included. (NTI5)
Reference:
David Stimson,
"Utility Measurement in Public Health Decision Making,"
Management	Vol.16, No.2, (Oct. 1969).
lPLANNING FUNCTION - TECHNICAL
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Page 474
The Churchman-Ackoff approximate measure of value
method was used successfully to measure the utilities of
objectives of decision makers in a large public health
agency. The utilities thus obtained formed a part of a
model of a resource allocation problem faced by the agency
in its role as allocator of a federal grant. A comparison
of the normative solution derived from the model with the
solution already decided upon by the agency tended to
support the hypothesis that the members of the agency
chose among alternatives as if they were maximizing
expected utility.
Reference:
Jay Vora,
"Heuristics and Optimizing Techniques Applied to Long
Range	Facility	Planning	for Hospital	Ancillary
Departments/"
Management	Vol.21/ No.4/ (Dec./ 1974).
A conceptual framework for long range facility
planning of ancillary departments in hospitals is proposed
and successfully applied to a radiology department. The
iPLANNING FUNCTION - TECHNICAL	Page 475
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
frame-work involves the interaction of optimizing
techniques with heuristics for effective and efficient
achievement of an organizational objective. It uses
outputs from an optimizing technique as inputs to d
heuristic, and vice versa. This approach does fiot
guarantee an absolute optimal plan, but it does provide
the best plan relative to the alternatives developed by
following a systematic approach within the framework.
The proposed framework is adaptable to the
organization needs of health centers, hospitals and other
service organizations. It should enhance the
understanding of complex planning processes by managers
through providing means to separate vital from trivial
policy inputs.
Reference
Burton A. Weisbrod,
EconamiQs 2l Euhlisi Haallti*
Philadelphia, Pa.:	University of Pennsylvania Press,
1961.
The author presents an attempt to set forth a
tPLANNING FUNCTION - TECHNICAL	Page 476
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
procedure to aid in making rational choices among
alternative health projects (to establish a framework foe
estimating the social benefits of improved health) and to
employ the procedure, evaluating quantitatively certain of
the benefits to society of successful elimination of
cancer, tuberculosis, and poliomyelitis. The study is
broken down into 4 parts. In part 1 the rationale of the
investigation is discussed. Part 2 discusses the factors
which makes the commodity, health, unusual. In part 3, a
framework is established for determining monetary losses
resulting from any disease. The author utilizes this
framework in part 4 to estimate losses in the United
States due to cancer, tuberculosis, and polio. He then
uses marginal analysis techniques to compare these
estimates with the nation's expenditure on these diseases,
to obtain a rational basis for the allocation of health
funds.
Reference:
Guillermina Vankelevich,
•'The Use of Analysis of Factors in the Solution of
Variables of Interest in Public Health,"
Pallid EuJ2li£3 de :i£2U£2/ Sp.5, Vol. 18, No. 4, p. 641,
IPLANNING FUNCTION - TECHNICAL	Page 477
models - general planning and resource allocation
(1R7o).
A multivariate statistical analysis (factor analysis)
was performed with a list of variables currently
considered important in health studies. The analysis'
permitted the objective selection of a group of variables
and it is suggested that these variables are relevant for
the elaboration of a health profile on the Mexican
Republic.
Hierarchical arrangement of the federal states was
generated according to an index of "health accessibility"
derived from the analysis. The health phenomena is
visualized as a complex population system with multiple
elements and multiple interactions. It is suggested that
only integrated studies of this kind will eventuality
permit more rational discussions concerning the promotion
of public health.
The paper also includes in detail the extensive
correlation study required in the analysis of the 58
economic/ cultural and sanitary variables used.
Reference:
1PLANNING FUNCTION - TECHNICAL	Page 478
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
Donald E.Yett/ Leonard Orabek/ Michael D. Intriligator/
and Larry J. Kimbell,
"Macroeconometric Model for Regional Health Planning/"
it£2D2mi£ and Business Builatln/ Vol. 24 p.1-21 (1971)
An empirical model is proposed for evaluating the
economic aspects of regional health planning. The
structure and purpose of comprehensive health planning
(CHP) agencies are discussed. Features of CHP which have
implications for the econometric model are noted. It is
envisioned that the proposed econometric model will assist
CHP agencies in dealing with the supply and demand for
health services; treating health services/ manpower/ and
facilities; examining long-term and short-term impacts of
change; and permitting an analysis of alternative policy
instruments as they act upon participants/ mental health/
drugs/ and dental services. It deals primarily with
categories of health service institutions and health
manpower. Categories of health service institutions
incorporated in the model are voluntary and proprietary
and short-term hospitals/ State and local government
hospitals/ skilled nursing homes/ outpatient clinics of
nonfederal hospitals/ offices of medical specialists in
private practice/ and offices of surgical specialists in
private practice. Health manpower categories included in
XPLANNING FUNCTION - TECHNICAL	Page 479
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
the model are medical specialists in private practice,
surgical specialists in private practice, physicians
employed by hospitals, registered nurses, hospital interns
and residents, allied health professionals, and
technicians, and nonmedical labor. The structure of the
model is described and illustrated and supporting
equations are given. Appended are data on variables and
relationships of the model. (NTIS)
Reference:
Rita Zemach,
”A Model of Health Services Utilization and Resource
4
Allocation,”
Operation Research# tfol. 18, No.6, (Nov.-Dec., 1970).
This paper presents the initial basis for a
descriptive mathematical model of the total utilization of
personal health and medical utilization by the population
of the community or region, the allocation of resources
used to provide these services and the cost of health care
as derived from the prevailing costs of resources.
Simplified illustrated example is presented. The patterns
1PLANNING FUNCTION - TECHNICAL	Page 480
MODELS - GENERAL PLANNING AND RESOURCE ALLOCATION
by which resources are allocated to provide services and
the patterns by which the population groups use the total
mix of services available are identified as parameters in
the model. On the basis of data the model can be used to
predict allocation and use of services over time as a
funtion of population dynamics. Problems of
implementation are discussedPage 481
PLANNING FUNCTIONS - TECHNICAL
MODELS - HEALTH STATUS
Reference:
Jame S. Anderson/
"Causal Model of a Health Services System/"
ilejllii	Research/ Vol .7/ No.l, p.23-42, (Spring/
1972).
Path analysis is used to construct a causal model of
the health services system serving the state of New
Mexico. The model includes a network specifying the
causal relationships among a set of social/ demographic/
and economic variables hypothesized to be related to the
health status of the population; a set of mathematical
equations that permit prediction of the effects of changes
in the values of any one variable on all other variables
in the model; and estimates the path coefficients based
on the U.S. census data and vital statistics. The modal
is used to predict both direct and indirect effects on
health status changes in population structure resulting
from natural causes or from the intervention of health
programs.
Pelerence:
*PLANNING FUNCTIONS - TECHNICAL
MODELS - HEALTH STATUS
Page 482
C. L. Chiang/
"An Index of Health:	Mathematical Models/"
U.S. Center of Health Statistics Report Series 2/ No.5.
The health of a population is in part a function of
such demographic variables as age/ sex/ and possibly race.
To describe the health status adequately/ the population
should be divided into subpopulations according to the
variables. The author develops a mathematical model to
measure the frequency of illnesses occurring in a calendar
year. Although the model is not specifically developed
for a particular illness/ the general line of the approach
applies equally well for any specific disease; it also
provides an easy means of calculating incidence and
prevalence rates. A second model is also developed for
the duration of illness/ which again applies for a
particular disease or for all illnesses. Because of the
lack of data/ however/ no attempt is made to find a
specific function.
Reference:
Chin Long Chiang/PLANNING FUNCTIONS - TECHNICAL
MODELS - HEALTH STATUS
Page 483
"A Stochastic Model of Competing Risks of Illness and
Competing Risks of Death/”
g£d£ls IQ
John Gurland/ ed. Madison:	University of Wisconsin
Press/ 1964.
This paper presents a general stochastic model of
illness and death processes with which the competition and
interactions of disease and the risks of death can be
studied.
Reference:
S. Fanshel/
"Meaningful Measure of Health for Epidemiology/”
Ial££££ii£Dal ilauinai al	vol.i/ No.4/ p.
319-337/ ( 1972).
An operational definition of health is offered for
use by epidemiologists and others concerned with
allocation of resources for health services. The
definition is as follows: *A person is well if he is ablePLANNING FUNCTIONS - TECHNICAL
MODELS - HEALTH STATUS
Page 484
to carry on his usual daily activities. To the extent
that he cannot, he is in a state of dysfunction, or
deviation from well-being.' Operational definitions are
then given for each of a series of states along a scale of
dysfunction. These definitions describe the extent to
which a person in each state (e.g., well-being,
dissatisfaction, discomfort, disability, confined, and so
on). is able to carry on his usual daily activities. A
set of weights assigned to the states of dysfunction
results in a health status index. This index, based on
social-value judgments, is in turn the basis for an
operational definition of prognosis, which in conjunction
with definitions for population and time, allows
quantitative definiton of the outcome of health services,
program effectiveness, and population health status. The
application of such a health status index to the venereal
diseases control program for lew York City is
demonstrated. The illustration points up that that, in a
real-life situation, the question of the definition of
health is only one among many considerations. The
complexity of such situations requires the services of the
epidemiologist and of other disciplines, working as arc
interdisciplinary team. Diagrams and flowcharts are
included. (NTIS)PLANNING FUNCTIONS - TECHNICAL	Page 485
MODELS - HEALTH STATUS
Peierence:
*
Donald L. Patrick
"Construe ting Social Metrics for Health Status Indexes".
lDle£Di2li<2D3l JauLQ^i Q.1 MSdllll	Vo 1.6, No. 3,
p.443-453/ (1976).
A social metric for health status evaluation is
derived from methods of determining social preference or
value priorities and pooling these preferences for input
into the collective decisionmaking process. Emphasis is
placed on methods for constructing social metrics rather
than the issue of value aggregation. It is postulated
that/ like economic indicators of worth/ health status
indexes used to make collective decisions satisfying the
principles of equality and social preference must
incorporate a social metric for health. Previous
approaches to health metrics are noted/ and the future
development of health metrics is discussed. It is pointed
out that any index or indicator applied to populations for
determining health status or to health programs far
evaluating outcome must confront the questions of who
prefers which states of health under which circumstances.
Utility models/ psychometric scaling/ and empirical social
decision valuation have been usee to measure preferences
for health states. it is recommended that efforts hePage 486
PLANNING FUNCTIONS - TECHNICAL
MODELS - HEALTH STATUS
directed toward constructing metrics for health that are
pprospective,	context	independent,	relevant,
communitywiue,	ratio scaled, sensitive, empirically
validated, and applicable to program evaluation. These
efforts represent the application of normative social
theory to research. (NTIS).
Reference:
Richard M. Schiffler and Joseph Lipscomb,
"Alternative Estimations of Population Health Status:	An
Empirical Example,"
inquiry, Vol.ll, p.220-223, (Sept.,1974).
The primary purpose of the paper is to show how
sample survey data can become crucial input for two
alternative health status indices. The authors have
argued that the expected pecuniary benefits of disease
programs, which have traditionally been measured on ar>
aggregative fashion by means of cost-benefit analysis, can
be estimated in a form which makes them more comparable to
the expected physiological-emotional benefits of programs
as indexed in models by Chen and Bush, and Fanshel andPLANNING FUNCTIONS - TECHNICAL
MODELS - HEALTH STATUS
Page 487
Bush/ etc. Using data on health status and income loss
due to illness and a panel of judges to rank health
status/ they illustrate their methodology through a worked
exaraplePLANNING FUNCTIONS - TECHNICAL
XODELS - HOSPITAL OCCUPANCY
Page 488
Reference:
Mark S. Blumberg*
"DPF Concept Helps Predict Bed Needs*'
Modern Ii2.a2il.al/ Vol.97* No.6* p.75-31* (Dec. 1961).
A procedure for estimating hospital bed needs that
allows planners to use the laws of probability to
determine the optimum number of beds needed in various
hospitals and communities is presented. Bed needs are
generally determined by dividing the average hospital
census by some typical* desirable or average occupancy
figure. These methods fail to account for variations in
effective capacity resulting from either the size of
individual hospitals or the size and number of bed
facilities within the hospitals. By grouping hospital
beds into distinctive patient facilities (DPF)* it is
possible to incorporate these factors into a quantitative
approach to estimating bed needs. With this approach* a
facility is considered distinctive only if it is used by
just one correspondingly distinctive type of patient under
normal circumstances. A -system for devising a regional
hospital plan, based on the DPF concept is described.
Examples of types of these are given* and the consequences
of too many or too few hospital beds for a community are
pointed out
Guidelines are presented for planneesPLANNING FUNCTIONS - TECHNICAL	Page 489
MODELS - HOSPITAL OCCUPANCY
wishing to implement the DPr approach/ and a table is
provided to assist planners in determining bed needs for a
iven average census under a variety of DPF full occupancy
rates. Sample proolems illustrate the use of the table.
(NT IS).
Reference:
Robert D. Fetter and John D. Thompson/
"A Decision Model for the Design and Operation of a
Progressive Patient Care Hospital/”
ilefiisal £ar£/ Vol.2/ No.6/ ( Nov.-Dec/1969).
The problem of determining the number of beds
required in each type of service in a progressive
hospital/ subject to constraints of operation and
investment costs and minimum service Levels/ is approached
through computer simulation and mathematical programming.
The simulation of the progressive patient care system is
based on patient flow through the service zones in an
operating hospital/ but the program is capable of
accommodating any otner hospital's structure of facilities
or set of patient paths. The mathematical programmingPLANNING FUNCTIONS - TECHNICAL
MODELS - HOSPITAL OCCUPANCY
Page 490
approach to the solution of optimal bed allocation raises
basic questions on the formualtion oi objective function
and budgeting constraints which are open to further
invest iga tion.
Reference:
Alan J. Handyside and David Morris,
"Simulation of Emergency Bed Occupancy,"
Health Sstifiesa H&aaatch/ p-237 (Fall-Winter, 1967).
A method is described whereby data relating to the
duration of hospital bed stay and the mean admission rates
may be used	to simulate the	bed	occupancy	of	patients
admitted as	emergencies.	The	me thod may	be	used to
predict the	effects upon	bed	occupancy	of	various
rotational admission schedules.					
Reference:
John 0. McClain,PLANNING FUNCTIONS - TECHNICAL
MODELS - HOSPITAL OCCUPANCY
Page 491
"Bed Planning Using Queuing Theory Models of Hospital
Occupancy:	A Sensitivity Analysis/"
iQflUAXy/ Vol.	13/ p. 167-176/ (June 1976).
Simulation is discussed as a technique for
forecasting and scheduling patient bed use in hospitals.
Research work incorporating queuing theory models of
hospital occupancy is reviewed. The importance of
simulation and statistical analysis in queuing theory
models is examined. It is pointed out that statistics
from simulation experiments ase primarily randoj
variables. Methods for significance testing when usinj
the simulation approach are described. Simulation
experiments were carried out using 5/000 simulated
hospital days and 14/489 patient arrivals. Six different
computer simulation runs were performed and compared to
theoretical values calculated in an algorithm for a 30-bel
hospital unit. The 30-bed unit had an average length of
stay in 10 days and an average arrival rate of eraergenciei
of 1.5 per day. In accordance with queuing theory models/
daily arrivals in the simulation experiments followed tni
Poisson probability law and lengths of stay followed thi
negative exponential probability law. It was determine!
that simulated values did not always exceed theoretical
values. The results of the simulation
exper iment 3PLANNING FUNCTIONS - TECHNICAL
MODELS - HOSPITAL OCCUPANCY
Page 492
confirmed that the average rate of hospital occupancy is
sensitive to the assumption of discrete versus continuous
arrivals and departures. The average rate of hospital
occupancy and waiting lines were always significantly
higher under an early discharge assumption. The earLy
discharge assumption was made in contrast with turning
patients away who could not be given a bed. It was found
that queuing theory models did not allow beds to be
reserved 1 or more days in advance of admissions. (NTIS)
Reference:
John H. Milsom, Efraim Turban/ and Ilan Vertinsky/
"Hospital Admission Systems:	Their Evaluation and
Management/"
&j3Da.k£iB££)l	Vo 1.6/ No.6/ p.6 45/ (Feb./1973).
The paper presents a holistic analysis of hospital
✓
management admission systems. It outlines control
strategies which will facilitate a system's effectiveness
for various organizational attributes. In particular/
attention is focused on bed occupancy levels and on the
stability of flows into the hospital as interactingPLANNING FUNCTIONS - TECHNICAL
MODELS - HOSPITAL OCCUPANCY
Page 493
control variables.
The paper surveys the major available mathematical
models and evaluates their use vs. the use of simulation.
It emphasizes the potential of an	assignor)t
model which explicitly considers the alternative profiles
for preferences for service attributes held by the various
participants in the admission system. To reconcile the
fleeting objectives of these participants the DELPHI and
the Multi-attribute Reduction methods are proposed.
Reference:
Rodger D. Parker/
•'Variation of the Uccupancy of Two Medical Units with the
Amount of Shariny Between the Units/"
ES.2l.Lil S££Yi£££ Es&£3L£h/ p.214/ (Fall, 1968).
Prediction of gain in occupancy and reduction of
overflow effected by sharing beds between two previously
disjoint medical units is relatea to the number of beds in
each unit and to a number of beds that each unit makes
available to the other when not in use. The methodology,
here applied to two wards at the Johns Hopkins Hospital,PLANNING FUNCTIONS - TECHNICAL
MODELS - HOSPITAL OCCUPANCY
Page 494
is applicable wherever it is desired to estimate the
effect of making beds interchangeable between wards or
services.
Reference:
Joseph S. Pliskin, Theodore I. Steinman, Edmund G.
Lowrie, and Clyde H. Beck/
"Hemodialysis:	Projecting Future Bed Needs Deterministic
and Probabilistic Forecasting/"
sad SiamsdisLal Ufififiarsiiu voi.	9, No.	4/
p.317-336/ (August 1976).
Three methods for projecting need for hemodialysis
beds are presented/ and their application to data on the
population of Massachusetts is described.	Two of the
methods - the deterministic equations and Markov chain
analysis - supply average needs only/ while the computer
simulation technique provides estimates of the entire
probability distribution of	demand.	With the
deterministic methods/ average needs are first calculated
by solving a series of deterministic recursive difference
equations. The results are then reaffirmed by a MarkojPLANNING FUNCTIONS - TECHNICAL
MODELS - HOSPITAL OCCUPANCY
Page 495
chain analysis. Probabilistic forecasting is handled by
repeatedly simulating the possible flows in the patient
system. Sensitivity analysis of the deterministic model,
based on Massachusetts population data and stated
assumptions concerning patients requiring dialysis,
reveals that final projections of inpatient hemodialysis
bed needs are heavily influenced by the percentage e£
patients receiving home dialysis treatment. It is noted,
that although specific assumptions are employed in the
development of the methods, the appropriate numbers and
assumptions for any given community or region can be used
with any of the methods to obtain projections of need. In
addition, the methods described are general and thus are
applicable to other types of patient services or dynamic
medical systems. Supporting data and mathematica l
formulations are included. (NTIS)
Ref erence:
William ShonicK,
"A Stochastic Model lor Occupancy-Related Random Variables
in General Acute Hospitals,”
i2fl.UID.cil fll JLb£ AUlflliCflO SiflliS-Lical ASSflfliaJLiflD, Vol.65,
p.1474, (Dec.,1970).PLANNING FUNCTIONS - TECHNICAL
MODELS - HOSPITAL OCCUPANCY
Page 496
A stochastic model for the behavior of the daily
census in general-acute hospital is presented. For any
mix of elective and emergency patient day demand this mix
permits the computation of a complete set of measures of
operating efficiently including expected overfill rate,
percentage occupancy, waiting time for admissions, waitinq
list length, and loss of emergency patients.
This model extends previously developed models irt
important ways such as including the measurement of
previously unquantified criteria and the inclusion of the
elective-emergency patient-mix as a parameter.
With one exception published results of empirical
field studies of the behavior of the daily census can be
explained by this model and in no case are these results
in contradiction of the model.
keference:
William Shonick and James K. Jackson,
"An Improved Stochastic Model for Occupancy-Relatted
Random Variables in General Acute Hospitals,"
Jll2£L^tiaas RiiiiSiaLC.il/ Vol.21, p.9I>2-9o5, (1973).PLANNING FUNCTIONS - TECHNICAL
MODELS - HOSPITAL OCCUPANCY
Page 497
This paper presents an improved stochastic model for
the behavior of the daily census and associated waiting
variables in general-acute hospitals. The development and
the form of the distributions derived follow the general
approach of a previous paper by Shonick CjJflULIial ai the
Ainfiiican Siaiistical AssaAiaiioiu voi.65, p.1474-1500,
(1970)1, but greater flexibility is provided for the
health services planner by increasing the number of
decision choices available for achieving given outcomes.
This increased flexibility is attained via a
generalization of the queing discipline, permitting
admissions of elective patients to be suspended when the
number of occupied beds reaches a predetermined level
(which may be less than the total bed complement). For
any emergency-elective mix of the demand for
hospitalization, this model permits the computation of
many measures of operating efficiency, including expected
overfill rate, percentage occupancy, waiting list length,
and loss of emergency patients. A variant of the model
permits computation of the expected number of patient days
that will be served in "non-approved” facilities when
emergencies arriving during "full" periods are
accommodated therein, rather than turned
awayPLANNING FUNCTIONS - TECHNICAL
MODELS - HOSPITAL OCCUPANCY
Page 498
Pelerence:
John D. Thompson and Robert B. Fetter/
"Economics ol Occupancy with Varying Mixes of Private and
Other Patient Accomodations:	A Simulation/"
iisallfc S£U£i££S E£5££L£h/ P»42/ (Spring/ 1969).
The economic implications of all-single room patient
units were explored through an inpatient simulation
operated under three different loads and with five
combinations of room arrangements. Only a slight
difference in percentage occupancy for the various
accommodation mixes was found. Although the optimal mix
of private and multiple-bed accomodations cannot be
expressed as a universal percentage because of its
dependence on medical/ social and economic factors/ the
influence of these factors can be determined in specific
situations and the results of various inpatient unit
arrangements predicted by the Simula tor.PLANNING FUNCTIONS - TECHNICAL
MODELS - HOSPITAL INVENTORIES
Page 499
Reference:
Iain B. Duncan and Hew S. Norwich,
"Opportunity Costs and Elementary Inventory Theory in the
Hospital Service,"
0£££aliaaal Efissdicb QuaLietlY/ Vol.24, No.i, p.27,
(1973).
The concept of the holding cost is one which is
standard in inventory theory. In this note it is shown
that, due to the nature of the decision-making and
financial structure of the hospital service in so far as
it affects the officers who are responsible for the
organization of hospital stores, this concept is
inappropriate. A simple ordering policy which is based on
the rules of the present accounting system is devised.
Reference:
Kerry E. Kilpatrick and Louis F. Freund,
"A Simulation of Tank (Jxygen Inventories at a Community
General Hospital,"
tie a) th	Vol.2, No. 3, p.29R-305,
( Fal 1-i* in ter, 1967).PLANNING FUNCTIONS - TECHNICAL
MODELS - HOSPITAL INVENTORIES
Page 500
The authors were interested in developing a
simulation model of an oxygen tank inventory system for a
general hospital which would take one type of tank fro*
inventory/ use gas at many locations simultaneously
according to specific flow rates/ replace empty tanks/ put
partially full tanks into inventory/ and order replacement
tanks according to some policy. The model is an attempt
to simulate only that porion of the total system that had
a significant effect on the movement of tanks into and out
of inventory. The elements considered were: demand/
nature of the physicians' orders and the type and length
of treatment.
Reference:
C. Carl Pegels and Edward L. Wallace/
"A Computerized Management Information System for Human
blood Utilization/"
£lanniD2 Arnold Reisraan and Marylou
Kiley, ed.,
New York:	Gordon and Breach Science Publishers, 1974.
p.201-212.PLANNING FUNCTIONS - TECHNICAL
MODFLS - HOSPITAL INVENTORIES
Pa9e 501
Human blood is a perishable product with a short li^e
span of twenty-one days. As a result of the above, it ^
either in short supply, or it outdates beyond the useful
twenty-one day period. The study discussed in this paper
reports on a computerized instant access blood bank
information system consisting of:	1) an inventory systeg
which keeps track of each unit of blood in a large region,
including the age of each unit and flags it when it is due
to outdate; 2) a short-term inventory level forecasting
system which forecasts the system inventory level on a
daily basis for the next two weeks on the basis of current
inventory, forecasted demand and forecasted supply; and
3) an aiooc	ation	model which		allocates the	bllod in	the
system in	such	a way	as	to minimize	shortages	and
transpor tat	ion c	os ts.	The	system is	operations 1	and
actual oper	a t i n g	results	a re	presented.		
Reference:
Manus kaoinowitz,
"blood bank Inventory Policies:
tisalitl	P-271,
A Computer Simulation,
(Winter, 1973).
iPLANNING FUNCTION? - TECHNICAL
MODELS - HOSPITAL INVENTORIES
Page 502
A Computer model of a complete blood bank inventory
system was constructed in order to determine the effects
of three inventory policies on blood wastage and on work
load while using inventory level to control shortages.
The three policies were double crossmatching/ use of older
blood for patients more likely to use blood reserved for
them/ and use of Rh-negative blood for compatible
Rh-positive patients under limited conditions. Results of
the simulation indicate that all three policies would be
useful for reducing blood wastage within the constraints
of increased work load/ limited community supply of rarer
blood types/ and need of some patients for freshly drawn
blood.
Reference:
Gustave J. Rath, Jose M. Alvarez balbos, Takiehio
Ikeda/ and 0. George Kennedy/
"Simulation of a Hematology Department/"
MSdlifc RfilXiCfiS Rsssaic!}/ P»25, (Spring/1970).
The model describes the standard hematological tests
elementary steps composing them and permits study
by thePLANNING FUNCTIONS - TECHNICAL
MODELS - HOSPITAL INVENTORIES
Page 503
of the time required to process blood samples und
various modes of laboratory organization and sample inp
schedules. The model was validated by use of of one day
data from the hematology section of the clinical patholo
at Passavant Hospital; different laboratories may
simulated by changing the relevant parameters. The bas
purpose of the simulation is to generate a transformati
function representing the clinical pathology laboratory
part of a general model of a complete hospital.
er
ut
9 _
gy
be
ic
oo
3 S
Reference:
Iain B. Duncan and Hew S. Norwich/
‘•Gpportunity Costs and Elementary Inventory Theory in the
Hospital Service/”
ESSSdtch SuatiSLlY/ Vo 1.24/ No.l/ p.27/
(1973).
The concept of the holding cost is one which is
standard in inventory theory. In this note it is sho^n
that, due to the nature of the decision-making and
financial structure of the hospital service in so far as
it aflects the officers who are responsible for the
tPLANNING FUNCTIONS - TECHNICAL
MODELS - HOSPITAL INVENTORIES
Page 504
organization of hospital stores, this concept is
inappropriate. A simple ordering policy which is based on
the rules of the present accounting system is devised.
Reference:
A.G. Smith, K. Gregory, and J. D. Maguire,
'•Operational Research for the Hospital Service,"
Qkstaiiaiial tassanah	Voi.26, No.2,	p.375-388,
(1975).
This article discusses work carried out by the
Operational Research Execurive of tne National Coal Board
for the Department of Health and Social Secutity on
Hospital Supply Problems. Two case studies are presented
here, one concerned with stock control and the other with
stores centralization. There is a discussion of the
models usea and the approach adopted. The work has
assisted in bringing about desirable changes in hospital
supply. One of the keys to success has been the
considerable post-research work carried out, and this is
described.
iPLANNING FUNCTIONS - TECHNICAL
MODELS - LOCATION OF FACILITIES
Page 505
Reterence:
William J. Abernathy and John C. Hershey/
"A Spatial Allocation Model for Regional Health Services
Planning^"
Operations Research/ Vol.20, No.3/ (May-June, 1972).
In p	lanning for heal	th services the need		ar is	es	to
deterni ine	the locations/	capacity and the number		of	he	al th
centers f	or a geographica	lly defined region	. Th	e p	re	sent
paper fo	rmulates this	problem in a form	conv	enie	nt	for
solution	and presents res	ults from the mod	el to c		la	rify
some imp	ortant aspects	of this allocation	dec i	sion	•	The
planning	region is assume	d to consist of	geog	raph	ic	ally
defined/	subdefined sub	regions or census	blocks of		known	
location.	The population	is stratified in	such	a wa	y	that
each str	atum exibits r	elativeiy homogenous p		atte	rns of	
health-ca	re utilization.	The model cha	racte	rize	s	the
efiects	of center loca	tions upon aggrega	te ut	il iz	at	ion/
and gives	optimal locations of centers wi		th r	espe	ct	to
several	alternatives cr	iteria. An examp	le il	lust	ra	tinq
computati	onal feasiibility and the imp!icat		ions	of V	ar	ious
criteria	for the location	decision is prese	nted.			
tPLANNING FUNCTIONS - TECHNICAL
MODELS - LOCATION OF FACILITIES
Page 505
Reference:
P.D.Mahadev,and K.R. Rao,
"Model for Location of Service Facilities in a Non-Western
Urban Environment",
Vol.	40, No. 240, p. 323-333, (Nov. 1975).
A model for determining the accessibility of
community service facilities in a nonwestern city is
described and applied to neighborhoods in Mysore, India, a
city of 350,000. The model does the following! 1) aims
to be descriptive by delineating the existing distribution
of service facilities occurring throughout an area; 2)
attempts to pinpoint at a neighborhool or community level
any deficiency caused by the lack of facilities; 3)
indicates a remedial measure to overcome any deficiencies
by suggesting areas for the location of additional
facilites; and 4) evaluates possible priorties for
location of public facilities. Mysore is divided into 28
neighborhood units, each consisting of 12,500 people. The
city is characterized by the absence of widespread use ot
automobiles for commuting, with most people walking to
uork and to community facilities. Data used to
demonstrate the analytic model represent a 10 percent
sample of the households of the city. Respondents were
asxed to estimate the distances traveled to reach each
1PLANNING FUNCTIONS - TECHNICAL
MODELS - LOCATION OF FACILITIES
Page 507
existing facility for education, health, recreation, and
shopping. The model is used to assess the overall
accessibility of community facilitiess for each
neighborhood as well as the accessibility of each kind of
facility. Results of the analysis are discussed and
i 1lustrated	in maps. It is c	oneluded	that, as	a
supplemen t	to human judgment,	the model	can help	to
overcome pi	anning oversights with	regard to	the needs	o f
residential	neighborhoods in	a nonwestern urban		
environment	. Supporting data are	included.	(NT IS)	
Reference:
Richard R. Vorril and Robert Earickson,
"Locational Efficiency of Chicago Hospitals:	An
Experimental yodel,"
heaiiti	Eeseatch, p.128, (Summer, 1969).
An experimental simulation model is described by
which imbalances in the distribution of hospitals may be
A
evaluated and the location shifts suggested to meet future
needs. The model, partly deterministic and partly
probabilistic, is here used to project the effects ofPLANNING FUNCTIONS - TECHNICAL
MODELS - LOCATION OF FACILITIES
Page 508
patient travel of shifting capacity and shifting demand.
Applied to the metropolitan Chicago hospital system, the
model results indicate that relocation of hospital beds
would considerably decrease patient travel, but that tne
same improvement in patient travel and in hospital
utilization could be achieved with a far less radical and
costly shift of beds, by relaxing existing constraints of
income and race.
Reference:
George P. Schultz,
"The Logic of Health Care Facility Planning,"
Sfi£io-££2nfiffiic ElaDQina SciSDfifiS/ Vo 1.4, p383-393.
This study presents a logical model for the planning
of health care facilities. The objective is an optimal
facility pattern, that is, one which maximizes net social
benefit for the population of a metropolitan region.
Several orders of service are defined and a successfully
inclusive facility hierarchy assumed for the provision of
these services. A social benefit is computed from a set
of basic functions which describe the demand for services,PLANNING FUNCTIONS - TECHNICAL
MODELS - LOCATION OF FACILITIES
the unit cost of services/ travel cost and benefits
derived. The geometry of location and a region-wide view
of the system are described.
Feference:
Larry J. Shuman/ C. Patrick	Hardwick/	and George A.
Huner/		
•’Location of Ambulatory Care	Centers in	a Metropolitan
Area/'*		
Vol	8/ No.2/ p.	121-138/ (June,
1973).		
A	mathematical	mode 1	is dev	eloped for	deter	mini	ng the
best	locations f	or	prepaid	group p	ractic	e o	r HMQ
ambu1 a	tory car cli	nics	within	a aetr	opoli t	an	area.
Severa	1 possible f	orms	of a	function	for	esti	ma ting
enroll	meat are inves	t igat	ed on	the basi	s of	ava	ilable
data.	and the mode	1 is	app1ied	to metrop	olitan	All	egheny
Coun ty	in Pennsylvan	ia to	deterra	ine clinic	locat	ions	under
uncert	ainty in e	nr oil	ment estimates/		using	ex	is t irig
ambuia	tory care faci	1 i tie	s as po	tential si	tes.	Both	fixed
and variable costs		are	consi	dered in	the model/		whichPLANNING FUNCTIONS - TECHNICAL
MODELS - LOCATION OF FACILITIES
Page 513
projects the unit cost per plan subscriber
combinations of constraints and ennrollraent
with various
functions.
Reference:
Larry J. Shuman, C. Patrick Hardwick, and George A.
Huber,
L££2li£D a iislMfliJs at Aubulataix Uaaliii Cat£ Genista
LE£G£ZliMQi wiihia a Eaitflanliian Ataa*
Pittsburgh:	Blue Cross of Western Pennsiyvania, Research
Department, 1972.
Two models for locating prepaid health plan clinics
in urban-settings are developed and tested. The major
elements of the prepaid group practice (PPGP) and the
health maintenance organization - prepayment, a group of
physicians, a medical center base, voluntary enrollment,
capitation, and comprehensive benefits - are discussed and
related to a specific metropolitan area health care
delivery system. Empirical health and socioderaographic
data are then used to develop mathematical models which
are applied to the selection of the best site for PPGP
network in an urban area with a population of 1.7 million.PLANNING FUNCTIONS - TECHNICAL
MODELS - LOCATION OF FACILITIES
Page 511
Two approaches were taken to develop the models: 1) site
selection, in which a specified number of clinic locations
are selected from a number of alternatives, and
populations are assigned to these sites; and 2) equal
population units are assigned involving the division of a
region into a specified number of equal population
subregions with a center located in each subregion. The
site selection model can be used to determine clinic
locations from a set of potential or existing facilities
in such a way as to maximize overall enrollment within a
PPGP network. This model is constructed to limit the
number oi clinics, insure that each clinic will attract a
specified minimum enrollment, and restrict net
expenditures. The equal population model divides the
region into a prescribed number oi equal population
districts which are both compact and continguous. Unlike
the site selection model, the equal population model does
not require specification of an enrollment estimating
function by planners. Upon test applications in Allegheny
County, Pennsylvania, the equal population model failed to
provide better solutions for specified input parameters
and required considerably more computer time than did the
site selection model. The site selection model is
described as providing planners with a simple, effective*
flexible means of objectively selecting clinic sites for
prepaid plans in urban settings. Supporting data*PLANNING FUNCTIONS - TECHNICAL
MODELS - LOCATION OF FACILITIES
Page 512
mathematical formulations, and maps are included. (NTIS)
Reference:
Constantine Toregas, Ralph Swain, et.ai,
"The Location of Emergency Service Facilities,"
OafiLSiifiQS S£S£2LC.il/- Vol.19, No.6, p.1363, (Oct.,1961).
This paper views the location of emergency facilities
as a set covering problem with equal costs in the
objective. The sets are composed of the potential
iacility points within a specified time or distance of
each demand point. Une constraint in written for each
demand point requiring a "cover* and linear programming is
applied to solve the covering problem, a single-cut
constraint being added as necessary to resolve fractional
solutions.
Peterence:
Andrew Wong,
and Tung Au,PLANKING FUNCTIONS - TECHNICAL
MODELS - LOCATION OF FACILITIES
Page 513
"Regional Planning of Health Care Facilities*"
I££E l£2Qsa$Ll.isms. an Snalams*. Man*, and Cybernetics# Voi.
SML-3# No.5# (Sept. 1973).
Procedures are outlined for determining the most
suitable locations and types of health care facilities in
a regional comprehensive health care system. A conceptual
model for determining the location and extent of services
provided by a health care facility is illustrated-
Consideration in the model is given to goals and
constraints associated with facility planning# regional
comprehensive health care system organization# and
information and dec isionmaxing aspects in planning for
regional health care facilities. Data representation is
discussed in relation to three categories of health care
demands and services for a proposed facility or hospital:
(1) outpatients per day; (2) general beds; and (3)
obstetric beds. Criteria and priorities of services can
be based on fulfillment of these demand categories.
Special data manipulation functions that the model can
perform in facility planning are discussed# and computer
programming techniques are described for implementing the
model. Such techniques include integrating# screening#
matching# evaluating# and selecting health care facility
locations and types which are the most suitable for thePLANNING FUNCTIONS - TECHNICAL
MODELS - LOCATION OF FACILITIES
Page 514
physical and
facilities are
socioeconomic environment of a region where
to be constructed. (NTIS)PLANNING FUNCTIONS - TECHNICAL
MODELS - MARKETING AND CONSUMER PREFERENCE
Page 515
Reference:
Robert L. Kane/
"Vector Resolution:	A New Tool in Health Planning/"
M£j3i£3l Cai£/ Vol.13/ No.2/ p.126-136/ (Feb./1975).
Vect
analyzing
services,
frequency
origin of
the data
survey of
may be
services.
or resolution represents a new method for
consumer data and comparing patterns of consumer
The vectors are derived from a measurement o£
of use and a geographic direction from the
the group to the point of the service. Although
presented were drawn from a probability sample
southern Utah rural households/ the methodology
readily applied to data derived from a variety of
Reference:
Gary Hirsch
"Evaluating
Model/"
and Sutherland Miller/
H HO Policies with a
Computer
Simulation
M£di£3l £&££, Vo 1.12/
No.8/ (1974)PLANNING FUNCTIONS - TECHNICAL	Page 515
MODELS - MARKETING AND CONSUMER PREFERENCE
The development and design of a computer simulation
model of a health maintenance organization (HMO) is
described. Simulation models permit experimenting with
policy changes without the risk of actually making major
alterations. The data for this model came from applying
it to the issues facing a Children and Youth Project
conversion to an HVO. To illustrate the model's
usefulness/ simulations are presented/ showing the impact
of different marketing approaches/ benefit packages/ and
fitness programs.
Reference:
Bennet P. Parker/
"Consumer Preference Approach to the Planning of Rural
health Care Facilities/"
0££££iifl£S R£5£2££H* Vol.24, No.5/ {Sept-Oct./1976).
A problem in planning the expansion of a rural
primary health care delivery system is to determine the
set of facilities to be added to an existing system so as
to maximize the iD£££ffl£Di£i benefit to the community
subject to a cost constraint.PLANNING FUNCTIONS - TECHNICAL	Page 517
MODELS - MARKETING AND CONSUMER PREFERENCE
The proposed approach involves the following five
steps:
1)	Identification of facility attributes relevant to
the patients in their choice of health-care facilities;
2)	modeling of an individual's overall preference for
alternative facilities as a weighted linear function of
tfjese facility attributes;
3)	transformation of each consumer's preference model
into a benefit function expressing the individual's
benefit in dollars/year for an existing or potential
facility;
4)	provision of a method for determining the total
incremental benefit to the community from a set of
proposed health-care facilities; and
5)	use of a heuristic procedure to determine a set of
facilities that yields near-optimum total incremental
benefit subject to the cost constraint.	A practical
application of the	proposed	approach reveals that	the
consumer preference	has subs	tantial reliability	and
predictive validity.			
Re f erence:
Yoram hind and Lawrence K. Spitz,PLANNING FUNCTIONS - TECHNICAL
MODELS - MARKETING AND CONSUMER PREFERENCE
Page 518
"An Analytical Approach to Marketing Decisions in Health
Care Organization,"
Operations Eassatcti, Vol.24, No.5, (Sept-Oct .,1976 ).
The authors discuss the potential applicability of a
new choice model and scaling procedure to the marketing
»
decisions of health-care organizations. After a brief
exposition of this analytical procedure the paper focuses
on an illustrative application to the hospital selection
decision under two scenarios — surgery with a rapid
recovery period and serious surgery that requires a long
hospitalization period. The paper concludes with some
suggestions for future use of conjoint measurement and
related techniques in marketing studies of health care
organizations.PLANKING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 519
Reference:
William J. Abernathy/ Nicholas Baloff/ John C. Hershey/
and Sten Wandel,
"A Three-stage Manpower Planning and Scheduling Model:	*
Service-Sector Example/11
E-fiSfiateil/ Vol.21, p.693-711/(1973).
This paper presents a staff planning and scheduling
model that has specific application in the nurse-staffing
process in acute hospitals/ and more general application
in many other service organizations in which demand and
production characteristics are similar. The aggregate
planning models that have been developed far
goods-producing organizations are not appropriate for
these types of service organizations. In this paper/ the
process for staffing services into three decision levels:
(a)	policy decisions/ including the operating procedures
for service centers and the staff-control process itself;
(b)	staff planning/ including hiring/ firing, discharge,
training, and reallocation decisions; and (c) short-teroi
scheduling of available staff within the constraints
determined by the two previous levels. These three
planning levels are used at decomposition stages in
developing a general staffing model. The paper formulates
the planning and scheduling procedures and servicePLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 520
criteria, and permits including statistically dependent
demands. The discussion includes an example application
of the model and illustrations of its potential users in
the nurse-staffing process.
Pe f erence:
T. Doyle, and J. Naigus,
iteslih MaimaMSL MaJeiius*
Ann Arbor, Mich.:	Vector Research, Inc., 1974.
The
evaluate
models in
The proj
problem a
and na
compilati
per iphe ra
and asses
summary o
which tr
col lectiv
methods and findings of a project undertaken to
the potential utility of various healtn manpowgr
analysis and planning activities are summarized,
ect involved three tasks:	identification of
reas and policy issues confronting local. State*
tional health manpower planning	agencies;
on of an inventory of models directly or
lly related to these problems and and issues;
sment of the applicability of the models. In a
f the attributes of the 56 models studied, models
eat similar subject material are	discussed
ely to facilitate understanding of the frameworkPLANNING FUNCTIONS
MODELS - PERSONNEL
TECHNICAL
Page 521
within which the inventory (presented in a separate volume
) was constructed. Following this overview* the
applicability of the models to specific health manpower
analysis problems is evaluated. A comparison between
model input-output variables and analysis factors is used
to isolate the group of models most relevant to each of
several areas of analysis. The relative concentration of
modeling effort in each area of analysis is examined* and
areas of analysis requiring further modeling activity are
identified. Major conclusions and recommendations of the
study are summarized. The three principal recommendations
are (l) health manpower modeling efforts should place
greater emphasis on manpower systems; (2) more modeling
efforts should be concentrated on describing the effects
of programs aimed at increasing the supplies of health
manpower services and improving the distribution of these
services; and (3) major health manpower planning agencies
should attempt to employ models as operational tools.
Included in the report are schematic diagrams and tabular
summaries of the verification status and level of
generality or specificity of the models studied. Portions
of this document are not fully legible. (NTIS)PLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 522
Reference:
Aurura Fernandez, G. Gregory, A Hindle and A. C. Lee,
"A Model of Community Nursing in a Rural Community,"
OE££atiai]al EesfidLUh fluatlSEli# Vol.25, P-231-239, (1974).
The model for the working day of the community nurse
is proposed. This takes into account the attendance of
the nurse to the patients registered with assigned general
practices and the effect that this will have on her
traveling time, visiting time, and administrative duties.
It also leads to a method of dividing the country into
nursing team regions, assessing nursing services thereby
provided.
Reference:
Nancy L. Geller and Michael G. Yochomitz,
"Regional Planning of Maternity Services,"
Vo 1.10, No.l, p.67-75.
Analysis of the utilization data from maternity units
in a ten county region in New York indicates that morePLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 523
small rural maternity units
needed. A mathematical mo
is used to ascertain optimal
developed by which units
efficient use of facilities.
exist in that region than are
del/ using queueing techniques
unit sizes/ and criteria are
could be combined for more
Reference:
Marsha Geier Goldfarb/
fil Lhe. iisaliii wane2*£r Elannina LitsEaluifiz.
New Haven/ Conn.:	Dept. of Economics/ Yale University/
1972.
The development of a manpower information forecasting
and development (MIFD) system is described. It is
envisioned that/ when fully operational/ the MIFD system
will be computerized and capble of examining and
forecasting the determinants of health manpower training
for a region. Four major objectives of the MIFD systen
are iden	tified:	(1)	to catalog	health	training	and
education	eff or ts	f	including continuing		educ at	ion /
graduate	medical	education/ basic		medical	educat	ion/
allied	health/	and	nursing;	(2) to	analyze	thePLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 524
curriculums of health manpower training and education
programs? (3) to evaluate manpower training supply
constraints such as clinical facilities, faculty
resources, patients, and licensure? and (4) to match
health manpower resources with demands and needs for
health care services. A critique of health manpower
planning literature was performed in the development of
the MIFD system. The critique is concerned with
nonstochastic manpower planning models and econometric
models. The applicability of the models for the New Havei
Region in Connecticut is assessed. It is concluded that
fixed coefficient manpower planning models ani
multivariate regression models are inadequate for tna
development of a manpower planning model in New Haven
region. The recommendation is made that additional study
be conducted in the areas of demand functions for medical
services, production functions for physicians anj
hospitals, and medical personnel followup. A bibliography
is provided. (NTIS)
Ref erence:
F.L. Golladay, M.F. Hansen, W.L. Hansen, and K.R.
Smith,PLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 525
EsaJLili	HLamiina and EXXisLiani tUalih Mananast
UlillzalinnA
Madison, His.:	Health Economics Research Center/
Wisconsin University/ July/ 1972-
Research is proposed which would develop a health
manpower planning model by providing a link between a
microanalytic model of the efficient production of medical
services and a model of the regional and national demands
for medical care. The purpose of the model will be to
evaluate the implications of new categories of health
manpower for the productivity of the primary care
physician, thereby determining requirements for new
physicians and other health workers. The proposal
includes : a review of motivation for research into the
economic/ educational, and manpower implications of the
introduction of new categories of health manpower for the
productivity of the primary care physician, therby
determining requirements for new physicians and other
health workers; a survey of literature on health manpower
requirement projects, on opportunities for substitution
among medical personnel, and on the use of physician
extenders? a description of the analytical framework and
data requirements of the proposed research; an outline of
procedural methods and a time frame for the study:PLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 526
consideration of the policy implications of the study;
and consideration of the policy implications of the study;
and a description of the project's organization and
budget. The study will be particularly concerned with
efficient task delegation. Duties assigned to optimally
utilized health workers will be identified/ thus
contributing to the educational planning process. The
model itself will include two modules: (1) an analysis of
efficient manpower utilization under a variety of
organizational schemes and demand conditions; and (2) a
description of the demands for detailed medical services
as they relate to the demographic benefits of the study's
output for those who must make manpower planning decisions
are pointed out. (NTIS)
Ref erence:
Frederick L. Golladay/
•'Substituting Allied Health Personnel for physicians:	\
Survey of Methods and Results/"
Report prepared for the Pan American Conference on Health
Manpower Planning/ Ottawa/ Canada/ Sept. 10-14/ 197J.
This paper examines the methods for explicitlyPLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 527
analyzing the opportunities for intersubstitution of
health manpower. The goal of these methods of analysis is
to insure that programs of health manpower development are
premised on the economically efficient use of manpower and
equipment in the delivery of care. The research surveyed
has focused specifically on ambulatory care office
practices. The methods of analysis are more general. One
could apply them to the study of multi-specialty clinics*
hospitals and other units. The article reviews 3 major
studies in health manpower utilization. The first by Joel
Kovner entitled* "A Production Function for Outpatient
Medical Facilities" (unpublished dissertation)* limited
analysis of the substitutability of inputs in the context
of the Kaiser Permanganate Health Plan of Los Angeles.
Kovner made no effort to develop an algebraic form that
would comply with the common notions of how substitution
depends upon relative quantities of specific types of
manpower being employed.
The second study by Uwe and Miller entitled* "A
Production Function for Physician Services" (Jhg JtexitM
and Stdt.iat.itax Feb.* 1972)* developed the
Kovner approach to include a very careful analysis of tne
theoretically correct definition of the algebraic
relationship between inputs and outputs.
The third study by Golladay* Smith and Miller*
entitled "Analysis of the Optimal Use of Inputs in thePLANKING FUNCTIONS
MODELS - PERSONNEL
TECHNICAL
Page 528
Production of Medical Services" utilizes an activity
analysis model which is described in detail in the
article. (This article appears later in the
bibliography).
Finnaly, Golladay summarizes the limitations of all
of these approaches.
Le	f erence:					
F r	ederick	L. Golladay,	Ma	rilyn E.	Manser,	and Kenneth 9.
Sin	i th.					
"S	cale Economics in the		De	livery of	Medical	Care: A Mixed
In	teger	Programming	An	alysis	of Efficient Manpower	
ut	il izatio	in,”				
1D£ Ucutaal human Easautcss, Vol.9, No.l, p.5i.
This paper presents an activity analysis model of
primary medical care which/ through the use of integer
constants, captures both the technology of ambulatory care
and the institutional restriction that labor inputs must
be employed in discrete units. The result is that
staffing patterns and optimal choice of techniques depend
on the scale of practice. Empirical experimentsPLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 529
demonstrate this relationslip and# furthermore/ reveal
that introduction of physician extenders into the medical
care system	increases	the	scale	at which economies	of
staffing are	obtained	and	raises	the diseconomies	o £
suboptimal pr	actice.				
Reference:		
Frederick L.	Golladay/ Kenneth P.	Smith/ Esther J.
Davenport/ Marc	F. Hansen/ and A Mead	Over/ Jr./
"Policy Plannin	g for Mid-level Health	Workers: Economic
Potentials and	Barriers to Change/"	
inaiiiLix Voi.	13/ (March/ 1976).	
The authors first anal
which utilize the production
out three objections. They
fixed-integer model/ which
three objections. The object
as to minimize the cost
precisely/ in the short run/
labor inputs. The model is r
vector of service outputs/ an
yze health planning models
funtion construct/ and point
then introduce their own
attempts to deal with their
ive function may be specified
of providing care/ or more
the cost of hiring varialg
equird to produce a specified
d to select that staff whichPLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 530
minimizes costs of producin
all persons hired must be
recognize the need to map
services and require that
satisfied, and insure that
exceed availability. Empiric
upon the experimental model
and 1,171 patients are then d
g the services required, when
full-time. The constraints
production by techniques into
service requirements be
the total use of manpower not
al studies which were based
using data from 14 practices
iscussed.
Reference:
Ishwar Gupta, Juan Zoreda, and Nathan Kramer,
•‘Hospital Manpower Planning by Use of Queuing Theory,"
Ices Efiaegtcll/ Vo 1.6, p.72, (Spring, 1971).
The present study illustrates the practical
appliation of queuing theory to a simple problem in
manpower planning: how large a staff is required to give
adequate service from a hospital messenger unit. The
problem is simple enough to be amenable to an analytic
solution, and the optimal solution arrived at by the use
of queueing theory resulted in considerable saving to the
hospital studied. From data collection, it was assumedPLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 531
that the system operates in a steady-state condition,i.e.,
that the current state is independent of initial
conditions. Under these circumstances it was assumed that
simple queueing model described the service adequately.
Reference:
Richard C. Jelinek,
"A Structural Model for the Patient Care Operation"
ttealih SS£Hi£L«£ Research# Vol.2, No.2/ p.226,
(Fall-fcinter,1967).
This paper describes a conceptual model for the total
patient care system, and indicates some of the
considerations involved in selecting factors for, and in
constructing a model capable of quantifying the system.
An example of the development of such a model for the
nursing unit is presented, introducing the methodology of
econometrics (interrelated series of regression equations)
to achieve this purpose. Both the variables representing
the output of the system and those affecting such output
were limited in number for the sake of clarity. Thij
sample model provides additional understanding of thePLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 532
behavior of the nursing unit system/ and demonstrates the
possibility for extending this approach to obtain an
understanding of broader components of the patient care
system.
Reference:
Fredric D. Kennedy/
A££ Iteallti tfaapQuat Rlamiiaa tiadali I&ls.ism UXc.
Atlanta/ Ga.:	Atlanta Regional Commission/ Feb. 1972.
\
A technical description is presented to the health
manpower planning model developed by the Atlanta Regional
Commission. The ARC model (version HT estimates personnel
in 13 health categories needed in a hospital setting.
These categories are in five basic hospital functions:
nursing, pharmacy/ physical theraphy/ clinical laboratory/
and radiology. Physicians needeo for house staff have
been omitted because the complexity of their operations
has not been adequately modeled to allow similar
estimates. Five factors are considered in the estimates
of manpower needs: (1) demand for services/ (2) carg
requirements/ (3) personnel performance/ (4) personnelPLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 533
utilization, and (5) hospital size effects on the other
four factors. Demand for services, determined by numbers
of hospital admissions and patient days for each hospital
size category, is input to the model. Care requirements
are defined by the average number of basic work units
required by each patient, e.g., the average number of
pharmacy orders. Personnel performance is the measure of
time required to perform a given work unit. Personnel
utilization indicates the allocation among manpower
categories of total man-hours required, and converts the
allocated man-hours into personnel equivalents. The
development of the model, and its computer implementation
are described in detail. Examples of model uses (e.g.
determining the effects on required manpower of variation
in admissions, distribution of patients, variation in
manpower mix, or introduction of automation) are given.
Supporting data and computer materials are included,
together with operation instructions for implementation of
the model. (NTIS)
Reference:
Kerry E. Kilpatrick, Richard S. Mackenzie, and Allen G.
Delaney,PLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 53*
"Expanded-function Auxiliaries in General Dentistry:	a
Computer Simulation/"
Health Seryjges E£S&ai.£ii, Vo 1.7, p.283-300, (1972).
A simulation model of private dental practice has
been developed to evaluate the effects of introducing
expanded-function auxiliary personnel. The model permits
the experimental investigation of a variety of staffing
patterns and facility configurations. Results indicate
that a solo practice can expand its patient volume 169
percent and increase net revenue 233 percent by added
expanded-function auxiliaries, while simultaneouslY
reducing patient waiting time and the time spent at
chairside by the dentist. Field validations of the
simulation results are described.
Reference:
Judith S. Liebraan, John P. Young and Mandell Bellmore,
"Allocation of Nursing Personnel in an Extended Care
Facility,"
ES2fi2££iLt Vol.7, p.209, (Fall, 1972)PLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 535
A model of the assignment of direct-care tasks to
nursing personnel, based on nurses' concepts of effective
personnel use is described. Using an ordinal scale of
perceived effectiveness, the model generates daily task
assignments indistinguishable from or superior to those
used by nursing team leaders. Modification of the model
has potential use in long-range planning of personnel
needs, allowing comparison of alternative staffing
patterns by their relative effectiveness profiles and
facilitating cost/effectiveness comparisons.
Reference:
Joseph Lipscomb and Richard M. Scheffler,
•’Impact of Expanded-duty Assistants on Costs and
Productivity in Dental Care Delivery,”
Esseatsb, Vo 1.10, p.14, (Spring, 1975).
Data from an experimental dental program are used to
develop a linear programming model of dental care delivery
that the authors use to examine the economic implications
of introducing expanded-duty dental assistants (EDDAs) ir»
three types of dental practices. The authors examine the
1PLANNING FUNCTIONS
MODELS - PERSONNEL
TECHNICAL
Page 536
changes in productivity and profitability that result from
hiring one or more EDOAs and conclude that a dentist in
solo practice can double his net revenue by hiring one
EDDA but will not increase his productivity by hiring
additional EDDAs. Two-and three-dentist groups also can
increase revenue by hiring EDDAs, but/ beyond a certain
point, an inverse relationship exists between the number
of auxiliaries hired and the revenue generated.
Ref erenc e:
Daniel J. Schneider, and Robert Bilgrad,
"Prospective for Health Manpower Planning,"
ixsaU.il SSEilSSS Rgpgrts, Vol.87, No.5, p. 399-405, (May,
1972).
A comprehensive perspective for health manpower
planning is proposed which holds tnat such planning must
be:	(1) population based; (2) outcome-oriented rather
than input-oriented; (3) integrated as an essential
element in health services planning that is inextricably
joined with other major planning functions such as
organization, sociopolitical legislation, science,PLANNING FUNCTIONS
MODELS - PERSONNEL
TECHNICAL
Page 537
technology/ and economic and .financial planning; and
responsive to a host of direct and variable influences
that shape the career development process and define some
orderly distribution of all health manpower into a
deployment matrix. An outcome-oriented approach first
defines the desired results of health services and then
translates these into the functional criteria and
organizational arrangements best able to deliver them.
The model depicts a perspective for health manpower
planning within the more general scope of planning for
health services. The many factors that must be integrated
in an outcome-oriented appraoch are structured into the
model which is described in the article. (NILS)
Reference:
Donald P. Schneider and Kerry E. Kirkpatrick/
"An Optimum Manpower Utilization Model for Health
Maintenance Organization/"
EsSSSICil/ Vol. 23/ No. 5,
p.369/(Sept-0ct./1969).
This paper describes the development and validationTECHNICAL
Page 538
PLANNING
MODELS -
FUNCTIONS -
PERSONNEL
of a set of mathematical programming models directed at
optimal manpower utilization in Health Maintenance
Organization (HMD). An application of the models in
planning context for an emergency HMQ is presented and the
results compared to those of actual staffing patterns.
Two basic models are discussed in detail: an overall
planning model and a subscriber maximization model. Each
model treats the interaction between effective manpower
utilization, facility requirements, and available capital.
The objectives used in the models pertain to either
minimum cost or minimum feasible use of physicians through
the substitution of physician extenders. Field trials
indicate that the models accurately represent the actual
system and can be used effectively as planning aids.
Reference:
Larry J. Shuman, John P. Young, and Elizer Maddor,
"Manpower Mix for Health Services:	A Prescriptive
RegionaL Planning Model,"
Hea 1th	V0I.2, No. 2, p. 103-119,
(Summer,1971).
#TECHNICAL
Page 539
PLANNING FUNCTIONS -
MODELS - PERSONNEL
A model is formulated to determine the mix of
manpower and technology needed to provide health services
of acceptable quality at a minimum total cost to the
community. Total costs include both the direct costs
associated with providing the services and with developing
additional manpower and the indirect costs (shortage
costs) resulting from not providing needed services. The
model is applied to a hypothetical neighborhood health
center/ and its sensitivity to alternative policies is
investigated by cost-benefit analyses. Possible
extensions of the model to include dynamic elements in
health delivery systems are discussed/ as is its adaption
for use in hospital planning/ with a changed objective
tunc tion.
Reference:
Frank A. Sloan/
"Effects of Incentive on Physician Performance/"
itS-allil :iiiC£2V££ sioj P£a£U£iiyiiy/John Rafferty, ed./
Lexington/ ^ass.:	Lexington Books, 1974, p.53-84.
The autnor's major objective is to suggest fruitful
i
Page 540
PLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
directions for research on the question of the effects of
incentive	on	the performance of physicians.
Decision-making models in the context of cost-sharing and
revenue-cost sharing practices are developed. One set of
models assume that the physician behaves as a profit
maximizer in decisions affecting output, and that each
physician member of a group excercises a substantial
degree of individual discretion in making these decisions.
The models incorporate a terra to represent the value the
physician imputes to his foregone leisure. Thus, profits
represent the difference between total revenue and total
cost that includes the physician's imputed wage. The
models are then modified for analysis of groups sharing
net income on an unequal share basis. The implications of
these physician decision-making models, and present
institutional evidence on group management structure and
revenue cost-sharing arrangements.
Reference:
R.D. Smallwood, Edward J. Sondik, and Fred L.
Offensend,
"Toward an Integrated Methodology for the Analysis of
Health Care Systems,"

\Page 543
PLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
1972).
The purpose of this paper is to explore the
implications of employing physicians assistants in
delivering primary care. It seeks to identify the optimal
role of paramedical personnel and to assess the impact of
efficient delegation of tasks on the productivity of the
physician/ his opportunities for leisure, and the cost of
care. The technical opportunities for delegation and the
specific demands for medical services imposed on the
primary care practice are identified. These data are then
analyzed in an activity analysis model of the practice to
identify and assess the implications of efficient patterns
of delegation.
Reference:
"The Supply of Services/"
Health Economics Symposium:	Proceedings of the First
Canadian Conference., R.D. Fraser,ed. Sept.4-6,1974.
The purpose of
this
paper is to examine severalTECHNICAL
Page 544
PLANNING FUNCTIONS -
MODELS - PERSONNEL
alternative models of physician supply behavior and ta
suggest a modified approach. After reviewing models of
Feldstein, and Robert Evans, and the traditional mark
model, the author presents his own version of the
Feldstein utility maximization model. The utility
function contains five arguments:	income, leisure, excess
demand, quality of care, and independence. The author
admits that the model is not truly operational. It
contains too many variables which unduly complicate the
model. The intention of the model was rather, to develop
a theoretical framework.
Reference:
warren H. Thomas,
"A Model for Predicting Recovery Progress of Coronary
Patients,"
EiiSSUHCtl/ p.135, (Fa 11,1968).
A method is described by which the aemand for nursing
services may be predicted by analysis of information
already existing in the hospital's information system. A
Markoff predictive model was constructed, using the

PLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 545
various stages in the recovery process of coronary
patients; future short-term demand can be estimated from
this model without the intervention of time-consuming and
subjective judgments by medical or nursing staff. The
method is applicable to the prediction of demand for other
hospital resources related to the patient's recovery
process and has potential for use in units of progressive
patient care programs and in concurrent utilization
review.
Reference:
Dean H. Uyeno,
’’Health Manpower Systems:	An Applicaiton of Simulation to
the Demand of Primary Care Teams,”
Management	7ol.20, No.6, (Feb.,1974).
A method was developed for the	evaluation	of
alternative health care team composition and for the
examination of skill levels for new	categories	of
personnel. The procedure determines the appropriate
composition of primary health care teams for differing
demand levels and facility availability. A simulationPLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 546
model of a general primary health care delivery unit was
developed as part of this procedure. This simulation
model/ given demand schedules/ team composition/ and
facility levels/ produces information relating to the
efficiency and the effectiveness of the alternative.
Reference:
Thomas R. Willemain and Gordon T. Moore/
"Planning a Medical Practice Using Paramedical Personnel/’*
Haailh	ilas.£ilL£il/ Vol.9, No.l, p.53-61, (Spring,
1974).
The authors present a planning model to be used in
planning a medical practice with paramedical personnel.
Their linear programming model is based on the assumption
that in order to calculate the visit capacity and cost per
visit of a team practice comprised of one physician and
several paramedical personnel, the optimal combination of
physician visits and paramedic visits must be determined,
subject to the constraint that personnel utilization not
exceed desired levels. The final objective function is
subject to these constraints, and requires minimum data
TECHNICAL
Page 547
PLANNING FUNCTIONS -
MODELS - PERSONNEL
ana is suitable for hand computation.
Reference:
Donald Yett, Leonard Drabek/ Larry Kimbell, and Michael
Intriligator,
"Development of a Microsimulation Model of Health Manpower
Supply and Demand,"
Proceedings and Report of the Conference on A Health
Manpower Simulation Model at the National Institute of
Health, Aug.l and Sept.l, 1970.
The basic model described in the paper is a
large-scale micro-simulation of the health care system,
with particular emphasis on the demand for, and supply of
health manpower. The work on this project was limited to
the formulation and conceptualization of the model, and
hence, no quantitative results are available. Two models
are reported. The first, referred to as "Mark I",
represents the conceptualization of the model that would
be close to "ideal" in analyzing and forecasting the
demanGs for and the supply of health manpower. At this
time, however, 1) the data required to estimate certainTECHNICAL
Page 548
PLANNING FUNCTIONS -
MODELS - PERSONNEL
relationships in the Mark I are not availaole, and 2) soma
technical modeling problems must be resolved.
Ref erenc e:
Donald F. Yett, Larry Drabek, Michael D. Intriligator,
and Larry J. Kimbell,
“Health Manpower Planning:	An Econometric Approach,"
Research/ Vol.7, No. 2, p.134-147, (Summer,
1972).
Two econometric models that can be used to study
health manpower policies are described. Doth are models
of the entire health care system, treating both demand for
and supply of health services and health manpower. The
first is a macroeconometric model utilizing aggregate data
to investigate issues in comprehensive health planning at
the national, state and substate levels. The second is a
microsimulation model treating the interactions of
individuals, health manpower personnel, health service
institutions and health professions education institutions
in the analysis of health manpower policies for the nation
as a whole. The current conceptualization of Doth modelsPLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 541
Qasn-atians Rsssatcii aiunJLsil^/ voi.19, No. 6.,
(Oct.,1971).
This paper introduces patient state and physician
state of information as two unifying concepts for the
analysis of health care systems. The concepts are
presented in the context of four specific problem areas.
As a demonstration of the utility of these concepts, a
technique for evaluating alternative facility macroplans
is described and some results from an actual application
are presented and reviewed.
Reference:
Kenneth 8. Smith, A. Mead Over, Jr, Marc F. Hansen,
Frederick L. Golladay, and Esther J. Davenport,
"Analytic Framework and Measurement Strategies for
Investigating Optimal Staff in Medical Practice,"
Qoqrations R£S£2L£il, Vol.24, No.5, p.815,
(Sept.-Oct.,1976).
This paper presents the application of a mixed
i
>PLANNING FUNCTIONS - TECHNICAL
MODELS - PERSONNEL
Page 542
integer programming model to the choice of an optimal
staff for an ambulatory medical care practice. Instead of
adding further institutional constraints to earlier
models/ this paper describes a	strategy for the
measurement of the key empirical constructs on which such
analysis must rest. The analysis illustrates the use of
the models for selecting the optimal staff and shows the
relationships of this staff to the types of problems
presented to the practice and the scale of activity. The
effects of scale and patient mix on average cost per
encounter are examined and the dual solution is used to
determine the relative costs of producing encounters in
the various groups. Finally the allocation of
\
responsibilites for different types of patient problems
among the various members of the medical team is presented
I
as part of the optimal solution.
Reference:
Kenneth R. Smith/ Marianne Miller/ and Frederick L.
Golladay,
"An Analysis of the Optimal Use of Inputs in the
Production of Medical Services/"
The Jsujrnal al ftUSdll E£.S21II£,£.2/ Vol.7/ No.2/ (Spring,
*
»PLANNING FUNCTIONS - TECHNICAL	Page 549
MODELS - PERSONNEL
is presented and their current implementation status is
discussedPLANNING FUNCTIONS - TECHNICAL
MODELS - SCHEDULING
Page 550
Reference:
Shlomo Barnoon and Harry Wolfe/
"Scheduling a Multiple Operating Room System:	Simulation
Approach/"
He?}th	K2£e.2L£.tl/ p.273 (Winter/ 1968).
The advantages and disadvantages of various schedules
for operating rooms are determined by the use of a
Simscript simulation program. Input variables consist of
actual data or are generated from their probability
distributions by the Monte Carlo technique. The simulator
assigns operating rooms# anesthetists# and nurses for each
case when they are available. A report of the performance
of the system/ which may be obtained at any desired
i
periodic cycle/ included the ideal time and waiting time
for facilities and personnel. The simulator/ applied here
to a suite of operating rooms in a specialty hospital for
elective surgery# can# with minor modifications/ be used
to describe a general system of operating rooms.
Reference:
J
F
Bithe 11/TECHNICAL
Page 551
PLANNING FUNCTIONS -
MODELS - SCHEDULING
"A Class Discrete-time Model for the Study of Hospital
Admission Syteros/"
B£S£SL£hr Jo 1.17/ p. 48-69, (1969).
This paper presents a class of discrete-time models
for the study of the control of hospital in-patient
admissions. It coftends that the use on non-homogenous
Markov chains is appropriate to the problem and allows a
wide choice of possibilities to suit many different
situations. The restriciton imposed by the Markoj
property are discussed and methods of generalizing the
process are suggested. In particular/ the way is openel
for models based on a length of stay with Pascal
distribution and on scheduling patients with several days
no t ice.
Reference:
Michael M. Connors/
"A Stochastic Elective Admissions Scheduling Algorithm/"
ii£3ila ^e£vic£2 Eesadish/ P.3 07/ (Winter/ 1970)PLANNING FUNCTIONS - TECHNICAL
MODELS - SCHEDULING
Page 552
An admission scheduling algorithm that can function
with various scheduling criteria is described. It employs
probabilistic and deterministic constraints constructed
from the hospital's current status and the individual
requirements and characteristics of the proposed admittee.
The constraints identify feasible combinations of
admission date and accomodation; choice among these
feasible combinations is based on minimizing the value of
a composite function of patient inconvenience and hospital
inefficiency.
Reference;
Augustine M. 0. Esogbue/
"Mathematical and Computational Approaches to Some Queuing
Processes Arising in Surgery/"
EifiSCiSDCfiiU vo'1.4, p.531-542/ (1969).
Queuing theory has been applied to study congestion
problems arising in the industrial and econometric
systems. The method can be profitably used to analyze
similar problems in hospital systems. To apply queuing
theory to the study of and design of allocation processesPage 5o3
PLANNING FUNCTIONS - TECHNICAL
MODELS - SCHEDULING
arising in surgery/ we resort to some mathematical
artifices. Recursive equations are developed for the
generation/ via the digital computer/ of transition
probabilities of a service facility within service
channels. Cases considered include a system with no
waiting tolerated (emergencies)/ a finite waiting line
”ln/ and a parallel input stream consisting of both
emergencies ana scheduled cases. The development is
independent of the type of input and output distribution
functions.
Reference:
Robert B. Fetter and John D. Thompson/
"Patients' Waiting Time and Doctors' Idle Time in the
Outpatient Setting/"
llegj th Soj^yi^ea	Voi.l/ p.66-69, ( 1966).
If outpatient care is to be made acceptable to the
patient and still remain efficient/ some balance between
the patients' waiting time and the doctors' idle time must
be achieved. Examination of tne literature on the sublect
and of three specific waiting-time studies revealed thatTECHNICAL
Page 551
PLANNING FUNCTIONS -
MODELS - SCHEDULING
there are at least seven variables affecting this
relationship:	appointment intervals, service time,
patients' arrival pattern, number of no-shows, number of
walk-ins, physicians' arrival pattern, and interruptions
in patient services. An outpatient department simulator
was constructed so that each of these variables could be
manipulated, and its effect on doctors' idle
time—patients' waiting time relation assessed. Specific
experiments were conducted to determine the effect of
patient loads, patients' early and late arrival times,
physicians' promptness and	a combination of these
variables on the operation of the clinic. Results of the
simulation runs are presented.
Re ference:
J. Goldman, H. A. Knappenberger, ana 2.W. Moore,
"An Evaluation of Uperating Room Scheduling Policies,"
Vol.40-51, ( Apr i 1,1969) .
In light of the high cost of operation and the
possibility of the operating suite becoming a bottleneck
to the flow of patients, it is nandatory that thisPLANNING FUNCTIONS - TECHNICAL
MODELS - SCHEDULING
Page 555
facility be operated at a high level of effectiveness.
Scheduling problems may result in decreased effectiveness
if adequate scheduling and expediting policies are not
applied. In order to investigate the impact of scheduling
and expediting poliices, a computer simulation study was
conducted.
Reference:
David H. Gustafson,
"Length of Stay:	Prediction and Explanation,"
fl£Jltii	P-12, (Spring, 1968).
Five methodologies for predicting hospital length of
stay were developed and compared. Two techniques - a
subjective Bayesian forecaster and a regression forecaster
- also measured the relative importance of the symptomatic
and demographic factors in predicting length of stay. The
performance of the methodologies was evaluated with
several criteria of effectiveness and one of cost. The
results should provide encouragement for those interested
in computer application to utilization review and
scheduling inpatient admissions.PLANNING FUNCTIONS - TECHNICAL	Page 555
MODELS - SCHEDULING
Reference:
Claire E. Gutkin,
at a iduitiaia RoaLas^ion nads.1 to. ELadiai liosaital
Qiitaatieni visit a*
New York City:	Center for Community Health Systems,
Columbia University, 1973.
A regression analysis model is described for
predicting outpatient visits at a rural hospital, the Mary
Imogene Bassett Hospital in Coopers town, New York. the
growth and increased utilization of the hospital are
notea. Multiple linear regression was used to develop a
mathematical model to predict increases in outpatient
visits to trie hospital. Data on variables potentially
influencing the growth of outpatient departments wore
collected retrospectively for the years 1953 to 1971.
Independent variables incorporated in the model were:	the
estimated total population of Otsego County where the
hospital was located and its surrounding counties, t.ne
number o£	visits at Bassett Hospital, full-tine
equivalents of house staff working in in out-patient
departments at the hospital, the numoer of physicians in
Ctsego County and its surrounding counties who were not on
the Bassett Hospital staff, and the number of Bassett
Hospital admissions. A predictive equation was derive!PLANNING FUNCTIONS - TECHNICAL
MODELS - SCHEDULING
Page 557
from the application of stepwise regression to outpatient
visits in 1972 and 1973- The model allows hospital
administrators and planners to predict the utilization of
medical services and plan for the delivery of primary
care. Statistical data and graphical illustrations
supporting the model's application are provided- (NTIS)
Reference:
R.K. Dieter Hausman/
"Waitng Time as an Index of Quality of Nursing Care,"
SfiOticsa Esssarsfc/ P.93, (Summer/1970).
A model of the patient care process/ based on
queueing theory/ is described and its parameters defined
empirically for application to a burn unit. For the
particular case/ the model is shown to provide a close
approximation to observed data. The model is descriptive/
with an output of expected waiting times for various
priorities of patient demand. The waiting times so
estimated constitute an index of the quality of nursing
care and afford a aieans of predicting changes in quality
with changes in staffing or inpatient load. The modelTECHNICAL
Page 55d
PLANNING FUNCTIONS -
MODELS - SCHEDULING
facilitates investigation of the re lationships of three
factors:	patient condition, nurses' activity priorities,
and patient load per nurse.
Reference:
Birger Jansson,
"Choosing a Good Appointment System:	A Study of Queues of
the Type (D.M.l),"
OHSOiiflBS	Vol. 14, p. 292-312, (1966).
A queueing system with exponentially distributed
service times and constant interarrival time is studied
for the case with one service station.	The
characteristics of the queue are determined both in its
transient part and in its steady part. The cost of the
system is defined as a linear sum of the cost of keepinj
the customers waiting for service and the cost of having
the service station idle. The statistical distribution of
this cost is derived and it is also shown how its mean may
be minimized by proper choices of the constant arrival
time and the initial numbers of customers in the queue.TECHNICAL
Page 559
PLANNING FUNCTIONS -
MODELS - SCHEDULING
ReferencG:
Peter Kolesar,
"A Markovian Model for Hospital Admission Scheduling,"
Macail£IlI2Qi	Vol.16, No. 6, (Feb.,1970).
Several queueing methods suggested for modeling
hospital admissions scheduling are reviewed and a
Markovian decision model is presented. The mathematical
models discussed make it possible to evaluate the effects
of various admission scheduling systems and policies on
patient services and hospital utilization. The models,
themselves, may suggest new policies which may be
attractive to management. The suggested Markovian model
takes advantages from both analytic queueing and
simulation models. The model allows a great deal of
flexibility in the types of services and arrival
distributions used, and also permits rather general types
of decision rules be used. The model enables one to
obtain optimal general or at least "good" rules by using
linear programming.
Reference:TECHNICAL
Page 560
PLANNING FUNCTIONS -
MODELS - SCHEDULING
Robert F« Rikkers,
"Effect of Spoke Design on Occupancy:	A Simulation
Model/"
ile^lii!	Esse^££il/ Vol.5, p233-247., (1970).
The flow of patients into and through a hospital is
simulated to determine the effect of flexible care-unit
boundaries on hospital performance. Using empirical
admissions data as input/ the moael depicts the variations
in occupancy level/ waiting time for admission/ and number
of admisssion requests not accomodated under various
operating .policies. A policy that allows maximum
flexibility, with boundaries permitted to vary over a wide
range for all admission requests, is found to offer i
possibility of increasing the occupancy level of a 99-bei
hospital by nearly 6 percent. The potential applicabi1it/
of the model to scheduling and other administrative
problems is discussed.
Reference:
Edward J. Rising, Robert Baron, and Harry Averill,
"A Si stems Analysis of a University Health CenterPLANNING FUNCTIONS - TECHNICAL
MODELS - SCHEDULING
Page 551
Outpatient Clinic,"
Li2£Lilian,5	Vol.21, p.1030-1047, ( 1973).
This paper presents a case study on the use of
mathematical computer models in developing operating
policies for a university health service outpatient
clinic. Based on results predicted by the models, actual
policy changes were made in the system; the paper
compares the subsequent real-world results with those
predicted by the model. The comparison demonstrated the
validity of the models, and significant improvements were
realized in the changes system. An analysis of daily
arrival patterns was used during periods of low walk-ii
demand in order to smooth the overall daily arrivals. A
Monte Carlo simulation model shows the effects of
alternative decision rules for scheduling appointment
periods during the day to increase patient throughput and
physician utilization.
Ref erence:
Gordon Robinson, '"haul */ing, and Louis E. Davis,
"Computer Simulation of Hospital Scheduling Systems,"PLANNING FUNCTIONS - TECHNICAL
MODELS - SCHEDULING
Page 562
iisalU 2SI.JI.U2S S£S£.aE£fc/ (Summer, 1968).
A method of analyzing alternative systems of
scheduling hospital admissions by means of computer
simulation is descrioed. The simulation is divided into
three programs, dealing sequentially with requests for
admission, scheduling, and evaluation of costs of three
basic scheduling systems and using the output of each
phase of the simulation as input to the following phase.
The feasibility of using the scheduling program in a
real-time automated patient-scheduling system is
discussed, with indications of adaptations required and
additional functions that could be handled by the system.
He f erence:
A. Soriano,
"Comparison of Two Scheduling Systems,"
lUSEUUCS 2252aL£ll HuaEifiElY/ Vol.l l, p.388-397, (1966).
The
de
lays
that outpatients have to underyo before
medical treatment are often excessively
getting
theirPLANNING FUNCTIONS - TECHNICAL
MODELS - SCHEDULING
Page 563
long. The most commonly used patterns of scheduling
appointments are classified into three categories: 1)
Pure Block Appointment Systems/ 2) Individual Appointment
Systems/ and 3) Mixed Block-Individual Appointment
r
Systems. Several analytical appointment systems and their
highlights are described briefly. There are many othec
possible ways of assigning appointments to patients. One
such way/ * referred to as the Two at a Time Appointment
System/ is described. The advantages of the Two at a Time
system over any of the commonly used ones are discussed.
Finally/ the steady-state waiting time distribution
functions that will correspond to the Two at a Time System
and the Individual Appointment System/ as applied to the
Wilmer Outpatient Clinic have been obtained and are
compared.
Reference:
Gordon Swartzman/
"The Patient Arrival Process in Hospitals:	Statistical
Analysis/"
ilS-ai-Lil	Vol.5/ No. 1/ p. 320/( 1970).Page 564
PLANNING FUSCTIONS - TECHNICAL
MODELS - SCHEDULING
The arrival process for emergency patients,
inpatients, and scheduled and unscheduled outpatients is
closely studied by time-series analysis. The hourly
variation in weekday arrival rates is examined and a model
describing the processes with a considerable degree of
predictive accuracy is developed. The model is tested by
comparing predicted values with data from a follow-up
survey•PLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIAL FACILITIES AND HOSPITALS
Page 565
Reference:
David L. Anderson,
"Economic Aspects of Clinical Laboratory Functions,"
A paper presented at the Health Economics Symposium
Proceedings of the First Canadian Conference, R.D.
Fraser, ed.
The primary objective of this paper is to scrutinize
the underlying cost structure of the clinical laboratory
with emphasis on scale and utilization characteristics.
The secondary objective is to explore the impact of
alternative scalar output measures on the variables
subject to management control. The author presents an
economic model of a clinical laboratories of small scale
general hospitals. The proposed cost function may be
interpreted as a reduced form equation of an unspecified
utility-maximization model. The hypothesized average cost
function is stated in terms of the exogenous variable
output, price, and institutional characteristics. The
final model contains 6 dependent variables and four
exogenous explanatory variables. The model is then tested
with data collected in a survey of 50 Saskatchewan puolic
general hospitals. A final 44 responses were used. From
the results, the author proposes policy reccommendations
for reorganization of clinical laboratory
f aci l i tiesPLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIAL FACILITIES AND HOSPITALS
Page 566
Reference:
Henry H. flaligh and Danny J. Laughhunn/
MThe Economic and Linear Model of the Hospital/"
Health SfiOidS Research# Vo 1.4/ No.4/ p.293-303.
The hospital is examined as an economic entity in
terms of inputs/ constraints/ and intermediate outputs/
and a linear economic model for planning admissions is
constructed. The model is based on the concept of patient
equivalence classses which are defined by requirements for
goods and services and by sets of weights assigned by the
hospital to fulfilling those requirements. The hospital's
terminal output is defined by the model as the weighted
sum of patients treated in all equivalence classes. The
*
optimal solution of the objective function defines the
hospital's output capacity. The data requirements of the
model are discussed.
Reference:
F. Blewett/ D.M. Grove/ A Massinas/ J. M. Norman and
K.M. Southern/
"Computer Simulation Models for Multi-Specialty isards/"Page 567
PLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIAL FACILITIES AND HOSPITALS
QH£Eili.inil£ E£5i£j2££il Quarterly/ Vol.23, p.139-142, (1972).
This paper describes computer simulation models of
the utilization of shared resources by two E.N.T.
consultants and two opthalmology consultants in an English
hospital. The resources in question are the hospital beds
used by their patients, which are in the same wards, and
the operating theatre, whose use they share. The validity
of the models in relation to the actual system studied is
assessed and experiments are described which evaluate
alternative arrangements for the use of these resources.
The models are discussed botn as part of a continuing
programme of research into hospital decision-making and as
tools aiding the evaluation of the options open ta
hospital staff faced with a specific problem.
Reference:
Rachael Floersheim 3oaz,
’’Manpower Utilization by Subsidized Family Planning
Clinics:	An Economic Criterion for Determining the
Professional Skill-mix,”
lil£ Journal of Human S£SflH££££/ Vol.7,No.2, y.191.Page 568
PLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIAL‘FACILITIES AND HOSPITALS
Rapid expansion of publicly subsidized family
personnel. but
services was mucn
cannot be ignored.
has i	ncreas	ed	their demand for qua	lif	ied
e the	clin	ics	employing the fe	asib ie	
s econoraica		11 y	justifiable? The a	nsw	er ,
of 19	cl ini	CS,	has been negative.	In	17
linal	cost p	er	patient of the physi	cian's	
lower	than	the corresponding co		st	o £
1 by	the c	linic's other personnel		•	The
on a	sma 1	1	sample, should no	t	be
tive,	but	in	view of the rising c	ost	o £
by me	dical	and	paramedical personnel,		i t
id. A	more	eff	icient organization	of	the
; is 1	ikely	to	reduce the cost of s	er v	ice
incre	as ing	the	number of patients	ser	ved
i in the cli		nic	's expenditure.		
Reference:
».erner Frederick Daechsel/
Geoorob Model:, A p£2bal>ililY ilQiifil £2S2iidl ElaQQiQd.1
New York City:	Columbia University, 1970.
The purpose of the Ceoprob study was to improve th>PLANNING FUNCTION'S - TECHNICAL	Page 569
MODELS - SPECIAL FACILITIES AID HOSPITALS
precision of tools used by both planners and
decisionmakers in predicting the distribution flow from a
given subregion to four or more hospitals whose size,
beo-to-population-served ratios, and distance frra the
subregion all vary. The study was based on the total
hospitalization experience of residents in Saskatchewan,
Canada during 1961 and 1966. The dependent variable in
the study was the proportion of patients from a subregion
who received service in a specific hospital. Independent
variables included the number of beds in all hospitals in
the province of Saskatchewan, the population of all
subregions within the province, and the distance between
each subregion and all hospitals. An additional variable
used in the study was the sum of hospital patients from a
subregion who received care at a specific hospital or
other hospitals as far as or farther from the subregion.
It was concluded that the closer of two hospitals which
are approximately equal in size will be chosen more often
than more distant hospitals, and that the larger of twin
hospitals which are equidistant from a subregion will be
chosen more often than a smaller hospital. Using the
Geoprob model, it was determined that hospital planners
can calculate the predicted number of aumissions by using
an estimate of the number of patients from each subregion,
within the limitations of the simulation capability of the
Geoprob model, it was also determined that hospitalPLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIAL FACILITIES AND HOSPITALS
Page 570
planners can set goals and simulate a normative mode to
create a system of hospitals that will provide a supply of
facilities in accordance with that requisite to desired
goals. Appendices provide information on date processing
for the Geoprob model/ and a bibliography is included
(NTIS).
Reference:
Catherine Rhys Hearn and J.M. Bishop/
"Computer Model Simulating Medical Care in Hospital/"
British	Journal/ Vol.3/ p.396-399/ (1970).
A computer model has been constructed to simulate the
activities and events concerned in the care of patients in
hospital. After validation of the model it has been used
to examine the consequences of certain changes in the mode
of working in the hospital/ including the scheduling of
items of service and a system of progressive care. It is
concluded that computer models of this kind are likely to
prove of value in the management of hospital resources.PLANNING FUNCTIONS - TECHNICAL	Page 571
MODELS - SPECIAL FACILITIES AND HOSPITALS
Peference:
Ulysses S. Knotts,
LinejiL EtajgLajEiQd Analysis ai a caatiunlii:	Haimital za
Qaiiiauia	LUilizaliaa*.
Lincoln:	Dept. of Economics, Nebraska University, July
1971.
Linear programming is discussed as a management tool
that will enable hospital decisionmakers to determine the
optimum output of patient types attainable in a give**
period of time with an existing mix of resources.
Consideration is given to planning in a community
hospital, role of linear programming analysis in a
hospital, and tests using data from a community hospital
in Omaha,Nebraska. Twelve patient types are used as
variables in a linear programming model, with profit per
visit tor each type of patient representing the parameters
for each variable. The model is used to identify the most
profitable mix of patients for a hospital, given the
hospital's price structure for patient care, treatment
patterns of the medical staff, nursing philosophy,
physical facilities, and supply of personnel resources.
The introduction of a set of general hospital policy
constraints into the model draws attention to the cost or
reduction in potential profit of treating a specific mix
/PLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIAL FACILITIES AND HOSPITALS
Page 572
of patient types. It is felt that/ after appropriate
refinements have been made to data in the model/ it will
be possible to pinpoint areas where economy measures can
be taice to eliminate excess capacity where it exists. An
alternative might be to use the model in order to
experiment with specialty loads if a hospital wishes to
consider becoming a regional center for a particular kind
of patient care. Profit maximization is used in the model
as the objective for a nonprofit institution. Major
shortcomings of the study are noted/ and implications of
study results are discussed. Information is appended on
study procedures and linear programming model data. A
bibliography is provided. (NTIS)
Reference:
Sang M. Lee/
"Aggregative Resources Allocation Model for Hospital
Administration/"
Elannifigi Sciences/ Vo.1.7/ p- 381-395,
(1973).
The application of a goal programming appraoch to the
PLANNING FUNCTIONS - TECHNICAL	Page 57?>
MODELS - SPECIAL FACILITIES AND HOSPITALS
design of an aggregative budget planning model for
hospitals	is described.	A	small	city in	southeas tern
Virginia	was selected	for	mode 1	design.	A community
hospital	in the study	area	serves	predominantly rural	
residents within a radius of 20 miles. With no resident
physicians in the community hospital patients are
generally admitted by their personal physicians or through
the hospitals emergency room which is staffed by local
doctors on a rotation basis. It is noted that most
management science models developed for health care
delivery systems have focused upon the analysis of input
(resource) requirements and demand forecasts. They have
generally ignored system output/ unique organizational
characteristics/ and behavioral aspects of decision
processes. However/ these variables are considered to be
important in the goal-programming model which allows the
optimization of goal attainments while permitting an
explicit consideration of the existing decision
environment. The goal programming model demonstrates that
some goals cannot be achieved under desired constraints
and conditions and/ hence/ tradeoffs must occur due to
management policies or limited resources. The model
allows a hospital administrator to review critically the
priority structure of his institution in view of the
solution derived by the model. the goal programming
approach requires that an administrator be capable of
PLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIAL FACILITIES AND HOSPITALS
Page 57<q
defining, quantifying/ and ordering objectives. it is
suggested that such an approach has a wide area of
application for the scientific operation of health care
organizations. Equations and tabular data are included to
illustrate stayes in model development. (NTIS)
Reference:
Franklin S. Robeson/
All££<2iiQ3
Logan, Utah:	Utah State University, 1973.
A model that may be used by hospital administrators
as a tool for analyzing alternative resource allocations
is based on behavioral characteristics of the hospital
market, the hospital as a multiple-goal organization, and
the measurement of allocation criteria in terms of regret
costs ( what it costs not to do something). The influence
of the hospital market structure on administrative
decisionmaking is discussed, and the results of a survey
of existing models describe the allocational process for
hospitals. Models in the survey range from utility theory
models to institutional surveys. Hospital .market
iPLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIAL FACILITIES AND HOSPITALS
Page 575
characteristics are analyzed in relation to market
structure and important groups that participate in
decisionmaking. Economic causes of the existing hospital
market structure are examined, as is the influence of that
structure on the allocation of resources. Consideration
is given to potential contributions from the theory of the
firm, and the multiple-goal theory of the firms for
building a hospital allocation model is explored.
Implications of the hospital resource allocation model are
discussed, as well as possible expansions to the model and
its specific application in decisionmaking. (NTIS)
Reference:
Homer H. Schmitz and N.K. Kwak,
’’Monte-Carlo Simulation of Operating Room and Recovery
Room Usage,”
Operations Ssseatcil/ Vol.20, p.1171-1100, (1972).
The purpose of this paper is to provide an insight
into the increased need for operating-room and
recovery-room facilities and space, based on an increased
bad complement. The problem is formulated into three
I
tPLANNING FUNCTIONS - TECHNICAL	t-age 576
MODELS - SPECIAL FACILITIES AND HOSPITALS
primary questions:	I) How many more surgical procedures
will ba performed because of the increased bed capacity?
2) How much more operating-room time and space will tne
surgical procedures require? 3) How much recovery-room
time and space will the surgical procedures require? To
answer these questions, a simulation model of the lengths
of stay in the operating room and the recovery-room is
constructed by the Monte-Carlo method, it is tested
statistically and its results interpreted. This
simulation model can facilitate planning, dec is ion-making,
and managerial control by providing management
inf ormat ion.
Rei erence:
Atnar J. Singh,
fl£timjl SJt£at£3ie.s £oi B^d AHog^ifiD afld Patieaj;
XL£Dlci£ni in a llasiitiai^.
Cleveland, Ohio:	Case Western Reserve University, 1972.
Three problems encountered in allocating hospital
resources and alleviating shortages of skilled medical
personnel in a hospital are identified, and solution
■l
iPLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIAL FACILITIES AND HOSPITALS
Page 577
strategies are developed. The problems are the
distribution of beds among wards/ the allocation of beds
to seriously ill and nonseriouslly ill patients within a
ward/ and patients within a ward/ and patient treatment
problems. The technique of dynamic programming is used to
solve the optimal allocation problems and to obtain
near-optimal policies for patient treatment. In the first
part of the research/ two cases of bed distribution among
hospital wards are studied by using both deterministic and
stochastic demand rates for admissions. Dynamic
programming models are developed to determine the optimal
allocation of Deds to wards. The cost of denying a
patient a	bed	in	a given ward	is	analyzed/	and
consideration	is	given	to the alternatives		available	to
the patient	in	order	to determine	the	value of	this
shortage cost. The results of this analysis are extended
to include tne cost of suffering to the patient due to an
unavoidable stay at home. Interviews are conducted with
healthy/ sick/ and nearly recovered persons to determine
tradeoffs values for different levels of suffering/ but no
conclusions are drawn regarding such tradeoff patterns for
the general population. The second part of the study
examined the ward as a subsystem of the hospital. The
optimum distribution of beds in the ward is determined by
assuming that patients are arbitrarily classified as
serious or nonserious/ that admissions follow Poisson
lPLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIAL FACILITIES AMD HOSPITALS
Page 579
distribution, and tnat length of stay in the ward follows
negative exponential distribution. A cut-off level is
defined as the number of beds beyond which nonserious
patient are not admitted, and a system of birth and death
equations is developed. The objective function, made up
of shortage and holding costs, is optimized for various
values of the cutoff level. The third part of the study
considers the patient as a subsystem of the ward and
focuses on	the	use of	automated	methods of	patient
treatment.	The	met hod	of state	increment	dynamic
programming for determining optimal treatment policies is
tested for a patient with a pulmonary disease. Supporting
data and calculations are included. (NTIS)
Ref erence:
Amar J. Singh,
"Transportation Systems for Maternal and Infant Care
Project Patients,"
ii.2i5.llh Cd££ h£liy«ry SlimciiLj , Arnoll Reisman and Marylou
Ki ley,ed.
Gordon and Breach Science Publishers,
N e u York:
1974,PLANNING FUNCTIONS - TECHNICAL	Page 579
MODELS - SPECIAL FACILITIES AND HOSPITALS
A Maternal and Infant Care Project was establised in
Cleveland in 1965 in an attempt to improve the quality,
quantity/ and accessibility of obstetrics and pediatric
care in low income mothers and newborn infants. Of the
estimated 4500 patients expected to utilize the clinic
yearly/ only 1500 did so. The author feels that poor
transportation for patients is a major reason for the
failure to obtain optimal utilization. In order to
support this hypothsiss/ he analyzes the delinquent
patient reports through use of a least squares technique
and oiscovers that delinquency is higher in the winter
than in the summer and that a linear relationship exists
between delinquency and traveling time to reach the
clinics. He then compares the costs of the three methods
to minimize the transportation problem/ patient pick-up
service/ and a mobile medical system with the present
system and determines that the mobile medical system would
bo the most economical alternative.
Re rerence:
Andrew T. Sumner and Richard X. C. -Hsieh/
"Long-range Prediction or Examining Room Requirements/."
Health i&£yi£es iiesea££.liy Vo 1.7/ p.22l/ (Fall/1972).Page 580
PLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIAL FACILITIES AND HOSPITALS
A quantitative methodology for predicting long-range
examining requirements of an orthopedic outpatient clinic
is described. A simulation model of the clinic is used in
an analysis of the sensitivity of four performance
measures to changes in the clinic components/ providing
upper and lower boundaries for the component values and
ranking the components by their importance. Regression
equations relate the number of examining rooms to the
performance measures/ and an overall equation is
constructed to predict examining room requirements as a
function of weights assigned to the four measures.
iFUNCTIONS - TECHNICAL
SPECIFIC DISEASES
Page 581
PLANNING
MODELS -
Baierence:
Robin Barlow,
"The Economic Effects ol Malaria Eradication,"
AUi£li£.aIi EiZonauiiSL Re^iei:, Vo 1.57, No. 2, p.130-143,
(vay,1967) .
In this paper a method is presented for measuring the
economic effects of malaria eradication, in particular,
the effects of eradication on per capita income in the
long run. The method, which involves specifying a fairly
detailed model of the entire economy, has been applied to
the case of Ceylon and some preliminary results are
presented on what course Ceylon per capita income would
have been after 1947 if the successful eradiction campaign
of that year had not been undertaken.
The inquiries may be revelant to the decision-maker
in government who must choose between alternative
expenditure proposals in the context of a budget
constraint. Consideration of the economic payoff of the
alternative projects may properly influence the decisions
which are made in those circumstances.PLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIFIC DISEASES
Page S82
Reference:
Wilton H. 3unch and Gary M. Andrew,
"Use of Decision Theory in Treatment Selection,"
Clinical ££tii££»edics 2alalcd Ecscaccii/ No.80,
(Oct.,1970) .
Decision theory applied to medical diagnosis allows
the physician to separate the variables which go into the
decision process. For the purpose of illustration, the
authors study the problem of the choice of treatment of a
mid-shaft fracture of the femur in a young, healthy, adult
male, based upon the probable results of different modes
of treatment and their effect upon a patient whose
occupation miynt involve sedentary or heavy physical work.
27 possible outcomes of the treatment of a fractured femuc
were chosen, and the probability of each event was
computed. The author admit that their decision model roust
be considered a "first-generation" one. It has both
advantages and disadvantages. One advantage being that it
allows the physician and the patient to evaluate the
expected returns from different strategies and trade-off
one return for another. Another advantage is that it
focuses attention on areas in which additional information
and study is needed. One of the dangers is that explicit
statement of possibilities ana decisions may stillsPLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIFIC DISEASES
Page 583
experimentation and research by uninformed persons.
Reference:
Bush/ S. Fanshel/ and M.M. Chen/
"Analysis of a Tuberculosis Testing Program Using a Health
Status Index/"
Socioreconpiaig Planning &£i.£H££/ Vol.6/ p49-68/ (197 2).
A function status index and health status index are
defined and a county-wide tuberculin testing program is
analyzed to illustrate their uses in health planning.
Each member of a target population belongs to one of
several levels of function/ from well-being to death. The
distribution of the population cohort among the various
levels over time corresponds to a stochastic process where
group prognoses make up the transistion probability
matrices. Using a set of function weights/ the function
status of a person or population can be computed for each
point over time/ with or without a program. Output/ the
expected difference between the two function-histories
with or without the program, is measured in function-time
units that are independent of disease form/ permittingPLANNING
MODELS -
FUNCTIONS - TECHNICAL
SPECIFIC DISEASES
Page 584
comparison amonq health programs for different diseases-
The output measure can be used in cost-effectiveness/
mathematical programming and other optimization models/- as
wall as in other areas of health services research.
Reference:
Fonald W. Chorba/
•'Planning Models for Tuberculosis Control Programs/"
Heal th Sstiises Pe£e.a££h/ Vol .6/ No. 2/ p.144.
Discrete-state/ discrete-time simulation model of
tuberculosis is presented with submodels of preventive
interventions. The model allows prediction of the
prevalence of the disease over the simulation period-
preventive and control programs and their optimal budgets
may be planned by using the modal for cost-benefit
analysis: costs are assigned to tha program components
and disease outcomes to determine the ratio of program
expenditures to future savings on medical and
socioeconomic costs of tubercu 1 os is. Optimization is
achieved by allocating funds it: successive increments to
alternative program components in simulation andPLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIFIC DISEASES
Page 585
identifying these components that lead to the greatest
reduction in prevalence for the given level of
expenditure. The method is applied to four hypothetical
disease prevalence situation.
Reference:
Richard J. Coffey,
"Model of a Communicable Disease Spread in a Rural
Population,"
Health	UsliyaLX Planning# Arnold Reisman and Marylou
Kiley,ed.
New York:	Gordon Breach Science Publishers, 1974#
p.237-301.
This paper investigtes the application of
mathematical simulation to the modeling of communicable
disease spread. A general simulation model and program
have been developed for communicable disease spread in a
rural population. The model is organized around a
population description matrix, wherein each member of the
population is described by six characteristics. The
program is composed of a basic program and ninePage 586
PLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIFIC DISEASES
subroutines, all are written in Fortran Extended.	The
basic program alternately considers	day-time	and
night-time centers, determines disease category changes,
updates disease	categories, presents output	when
appropriate, and calls the desired subroutine.	The
complete simulation program has been tested quantitatively
to verify the model. From the various quantitative test?
done, the model apears to be operating correctly.
kef erence:
Hector Correa and Judith Sangl,
"Mathematical Models for Decision-making in Planning Drug
Abuse Control Programs,"
£££ifi::££i2D£:JLLi: ElDDD-LDd 2£i2L£.£.2/ Vol.ll, No. 5, p. 27 3-290 ,
(1977).
Agencies charged with the control of drug abuse face
the problem of making the most efficient use of tne
resources available to them. Thus it is possible that
mathematical models for decision making might be useful to
them. After a review of previous works, the authors
indicate gaps tnat need to be filled. Then, some of thesePage 587
PLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIFIC DISEASES
existing gaps arc filled by a detailed presentation of a
linear programming model to maximize the number of addicts
abstaining from the use of heroin/ and a dynamic model to
specify the optimum policies for the control of heroin
supply.
Reference:
Hector Correa and Joseph D. Beasley/
"Mathematical Models for Decision Making in Population and
Family Planning/"
American iLaurniil Euhlis iisaliii/ voL.61, No.l,
(Jan.,1971).
In the present paper, the methods of mathematical
programming, linear and quadratic, are applied to the
problem of optimum choice techniques for polulation and
family planning. The authors first present a simple
mathematical model for decision-making in this area,
together with a numerical example. Then several possible
modifications of this simple model are described. The use
of these methous in an actual program would suggest ways
to improve the utilization of resources available in suchPLANNING FUNCTIONS - TECHNICAL	Page 583
MODELS - SPECIFIC DISEASES
programs, adding to the substantial increase in size of
the population served. The authors caution, however, that
direct application of the analytical results could create
conflicts	with the	preferences	and	attitudes of	the
population	that should receive		the	most benefit	from
population	p 1 arming	programs.	Therefore, the models		
should be	considered	as only	one of	the criteria	to be
taken into consideration in the planning of the actual
program.
Reference:
K. Dietz, L. Molineaux and A. Thomas,
"A Malaria Model Tested in the African Savannah,"
aa-Lld ilsiilla CtaanizjiiflD Sullsiin^ tfoi.50, p.347-357,
(1974).
A new simulation model of malaria has been developed
for comparing the effects of alterantive control measures.
It describes both the temporal change of the infection
rate and the immunity level of the population as 3
function of the dynamics and characteristics of the vector
populations. Critical vectorial capacity is specified,PLANKING
MODELS -
FUNCTIONS - TECHNICAL
SPECIFIC DISEASES
Page 539
below which malaria cannot maintain itself at an endemic
level. The model has been tested with epidemiological
data collected in the African savannah.
Reference:
Lila R. Elveback, John P. Fox/ and Eugene Ackerman,
"Immunization Strategies via a Stochastic Simulation
.Vode 1, "
.Sinm E£vi£.W/ Vol.18, No.l, p.52-61, (Jan., 1976).
The authors present two stochastic simulation models.
The first for influenza, has a random variable, the length
of the latent and infectivity periods. Because the
authors wish to make the model general for use with all
infections spread by person to parson contact, the
parameters of the model are several and allow foe
variations in susceptibility, response to vaccination,
etc.
The second model presented involves the use of live
polio virus vaccine to stop an epidemic. The authors also
discuss the model as compared to analytical ones. They
conclude that the models are complex as compared to thePLANNING FUNCTIONS - TECHNICAL	Page 590
MODELS - SPECIFIC DISEASES
over-simplified analytical ones.
Ret erence:
Martin S. Feldstein, M.A.Piot, and r.X. Sundaresan,
Effluxes Alla^iioQ i3od£i iai £uali£ Usaliii ElaDaioai A
Ellidy fll	ZZUlLQlu.
Cambridge/ Mass:	Ue?t. of Economics/ Harvard University/
1973.
A model of linear programming is presented that is
specifically applied to tuberculosis control in the
Republic of Korea. Important features of the approach
exist in the feasibility of separating the requisite
informational	inputs so that	they can	be	provided b/
medical and	epidemiological	exper ts.	and	in the clear
differentiation of the separate roles of value judgement
and technical information. Seven types of health care
benefits are considered in the analysis: reduction of
temporary disability during the acute phase of
tuberculosis; reduction of permanent impairment;
reduction of the risk of dying in four different age
groups; and the resulting effects on income. The healthPLANNING FUNCTIONS - TECHNICAL	Page 591
MODELS - SPECIFIC DISEASES
planning model that is formulated involves a number of
demographic, epidemiological, technical, and economic
parameters. Solutions for the optimum allocation of one
year's resources for tuberculosis control have proved
relatively insensitive to moderate changes in assumptions.
The results of the study suggest that the traditional
allocation of resources in tuberculosis control may be
inappropriate. (NTIS)
Reference:
Brian E. Forst,
"Decison Analysis and Medical Malpractice,"
Cpepattg qos EsseDIHil/ Vol.22, p.1-12, (1974).
Decision theory has been applied to the problem of
evaluating alternative diagnosis-treatment strategies.
The courts rely on a different set of values in performinj
the same sort oi evaluation. This paper investigates tne
differences. It is suggested that the "alleged
malpractice crisis" results from the application of a set
of ambiguous and mutually inconsistent medical-legal
principles such as "reasonable medical certainty",PLANNING FUNCTIONS - TECHNICAL	Page 592
MODELS - SPECIFIC DISEASES
standards of medical practice in the community and
"proximate cause." The expected utility criterion or
decision analysis is proposed as an alterantive to this,
both for the purposes of establishing the existence of
negligence and de ter ruining the proper amount of
compensation.
Ref erence:
Ralph Fredicks and Juan Frauda,
"A Computer Simulation Model for the Control of Rabies in
an Urban Area of Colombia,"
Management Science, Vol.22, No.4, (Dec, 1975).
A simulation model is developed describing the
transmission of canine rabies within and between 116
spatially distributed barrios (ncighborhoods) in Cali,
Colombia. The discrete-time, dynamic model considers both
discrete rbndom variables, (incubation, infection periods,
appearances, and movement oi rabid dogs through the city)
and deterministic variables (demographic components of the
barrio canine population). Value for the input variables
were acquired through field observations, other ColombianPLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIFIC DISEASES
Page 593
sources and a review of the literature. Various canine
vaccination strategies were tested in the modeL over a ten
year planning horizon for cost-effectiveness with regard
to the prevention of canine rabies. The model is
recommended by PAHC to be used as an interactive gaming
model to aid health system managers in Latin American
cities.
Reference:
Robert Marshall Gurfield,
£ixat£<ii£ Elannioa Lqi Hsaliii Estitisasi An Aaalitaliou la
Eaaclial Unices tsiL Hsaxl filseass EallanUz.
Los Angeles:	California University, 1972.
The demand for hospital services by heart patients in
California is projected through 1990 to illustrate the
application of strategic planning models. Fogr
interrelated models for exploring alternative futures are
proposed. The first model is used to compute the expected
number of patients in California with heart disease at any
time up to 1990* given certain assumptions about
population growth, incidence rate,
and prevalence ofPLANNING FUNCTIONS - TECHNICAL
MODELS - SPECIFIC DISEASES
Page 594
various kinds of heart disease/ social conditions/ medical
practices, and hospital saervices. A second model
converts that demand into resources (i.e. physicians,
beds, operating rooms, laboratories, etc.). Coronary care
unit bed requirements to handle the random occurrence of
acute myrocardial infarctions and of arrythmias are each
analyzed through the use of a model. Assumptions and
forecasts are then combined to create scenarios for the
late 1930 's. It is concluded that technical innovations
affecting resource use per heart patient have a
potentially greater effect on resource demand than do the
social or medical variables. A literature review, tables,
and notes accompany the text. (NTIS)
Reference:
Charles S. Revelle, Walter R. Lynn and Floyd Feldman,
"Mathematical Models for the Economic Allocation of
Tuberculosis Control Activities in Developing Nations,"
Management SsiSQCS/’ Vol.16, p.l90-B211, (1969).
Two models are presented in the article. The first,
a descriptive model, includes nine classes of tuberculosisPLANNING FUNCTIONS - TECHNICAL	Page 595
MODELS - SPECIFIC DISEASES
with and without various predetermined forms of controL.
The second^ an optimization model oerived from the
descriptive model is used to establish the forms of
control that will achieve specified numbers or active
cases at least cost. Optimization is achieved by linear
programming. The optimization model is currently adapted
only to the developing nations. In order to find optimal
patterns of control in other settings, a new optimization
model would have to be derived from a descriptive model/
since the tuberculosis problem in advanced nations is of a
much different nature.
Reference:
Stuart Q. Schweitzer,
"Cost Effectiveness of Early Detection of Disease,"
Lilith	ii&il&aiLSb., Vol.9, p.22, (Spring, 1974).
A methodological framework for cost-effectiveness
evaluation of diagnostic tests for inass screening is
presented.	The decision rule is based	on disease
incidence, probabilites of test error, the cost of the
test and of the treatment for found cases, and the
PLANNING FUNCTIONS - TECHNICAL	Page 596
MODELS - SPECIFIC DISEASES
economic value (expected lifetime earnings or equivalent)
of additional length or quality of life for those cured of
the disease. The decision rule is applied to the Pap test
for cervical cancer/ with results showing that as a
one-time screening device the test is cost-effective from
society's standpoint. Extensions of the method would
permit estimation of the disease incidence at which a
given test or treatment would be cost-effective? would
permit estimation of the break-even price of the test and
treatment with given disease incidence; and would allow
determination of optimal testing frequency.Page 597
PLANNING FUNCTIONS
IMPLEMENTATION - GENERAL
Reference:
E. Dean Conley and Linda Gray,
iisalili Elacdan InElfiifinialiimi Eimnnals iaaa ilie spiral
sciences nmJ Sacks-tina ailii a Ihsnmlcial Enamaaai:]!/.
Washington/ D.C.:	Dept, of Health Care Administration/
George Washington Univ./ Nov. 1975.
Baseline information relevant to constructing and
evaluating health planning implementation strategies is
presented. The report is based on a review of areawide
comprehensive health planning operations/ relevant
legislation/ and academic research/ and applied social
science and marketing materials published in the early
1970's. The major components of the report are two
narrative sections on the social sciences and marketing/ a
conceptual framework/ and a 428-entry annotated
bibliography. Supplementary sections include *sn
introduction/ a preliminary discussion of health planning
and implementation/ recommendations for further research
and technical assistance on implementation/ conclusions/
and a research note. The theoretical framework contains a
dual model of the health planning implementation process
at an abstract level. The model is then filled in with 54
'idea and concept' components/ each keyed to entries in
the bibliography. Among the conclusions reached by the
tPLANNING FUNCTIONS
IMPLEMENTATION - GENERAL
Page 598
researchers are the following: little information is
available on health planning implementation per se; there
is a great deal of social science information on change,
most of which requries substantial transformation to be
applicable in health plan implementation; the
implementation process is by its nature problematic and
precarious; most success in implementation is
fundamentally negotiative; idealism in planning should
not be abandoned in the face of demands for realism; and
health planning implementation is closely aligned with
political and economic factors. (NTIS)PLANNING FUNCTIONS
IMPLEMENTATION - NATIONAL
Page 599
Reference:
Roger Battistella and Theodore Chester/
"Reorganization of the National Health Service:
Background and Issues in England's Quest for a
Comprehensive-Integrated Planning and Delivery System"/
Milbank idfiJDQLial Fund Quarterly# Vol.51, No.4/	p.489-530/
(Fall 1973).
The first major reorganization of the National Health
Service since its founding in 1948 took place in April 1#
1974. Three major objectives were involved: the
consolidation of the tripartite structure into a single
unified system/ the strengthening of management processes#
and the expansion of machinery for making health services
more responsive to local needs. While generally
supportive of the reorganization/ this assessment of the
changes in policy and structure identifies a number of
constraints in the form of political realities and
organizational-administrative capabilities which may limit
the attainment of objectives. In particular/ the bias in
modern medicine for hospital-based specialization/ the
uneven power relationships among competing professional
interests, and the continued separation of health from
social services are seen as restricting policy aimed at
altering the balance between primary, secondary, andPLANNING FUNCTIONS
IMPLEMENTATION - NATIONAL
Page 600
tertiary levels of care and between curative and
"carative" services.
Reference:
C.C. Edwards/
"Sounding Board:	Form and Function in the Federal Health
Effort"/
a&M finalaud JaiilQSl fll ^sdicine, Vo 1.295/ No. 12/ p. 674-6/
(Sept. 16, 1976).
The author believes the function of the US federal
health effort and the form to carry out that function need
to be defined and established in an atmosphere unhindered
by political bias and philosophical cart. The first step
of restructuring is to separate two prime functions
regulation/and program management and support. The
federal health effort should be realigned under three
separate structures:	(1) an agency that would continue
the management and support functions; (2) a regulatory
agency concerned with the safety and effectiveness of
products whose use directly affect health/health care?
and (3) a separate regulatory agency empowered to control
>Page 601
PLANNING FUNCTIONS
IMPLEMENTATION - NATIONAL
health care costs. For the last, creation of a National
Health Authority is proposed. This rearrangement of the
form of the federal health effort along lines dictated by
functional responsibilities is a critical next step toward
bringing order to the federal health enterprise and
stability to the national health system.
Reference:
"Health Services in Europe:	(1) Administrative and
Preventive Services",
iiHQ Chronicle, Vol.30, p. 407-412, (1976).
Three articles describing different aspects of the health
services (administration, preventive services, and health
legislation) in the countries of WHO's European Region
were published in the WHO Chronicle in 1965. They were
based on a monograph entitled Health Services in Europe,
which has recently been revised and brought up to data by
the WHO Regional Office for Europe. The second edition is
in three parts - the first describes new trends in puolic
health administration and progress in prevention,
organization of medical care, and training of healthPage 602
PLANNING FUNCTIONS
IMPLEMENTATION - NATIONAL
personnel; the second describes the health system in each
Member State ot the Region on the basis of a questionnaire
sent to governments; and the third, mainly statistical,
consists of a series of comparative tables summarizing the
main features of the health situation and services in the
various countries. The following is the first of t«:
articles prepared on the basis of the new edition.
Reference:
R.M. Lapr,
"A Short Outline of Health Services Planning at Central
Level in the Netherlands”,
Mfllld Ufl-SS-i-LalS/ Vol.12, No.2, p. 114-6, (1976).
The article deals with the theoretical and practical
aspects of health care planning, as well as with hospital
facilities planning in the Netherlands. It considers four
elements which comprise health services planning at the
central level in the Netherlands separately: (1) health
services; (2) planning; (3) central level; and (4)
practice of planningPLANNING FUNCTIONS
IMPLEMENTATION - NATIONAL
Page 603
Reference:
A.L. Levin/
'•Health Planning and the U.S. Federal Government"/
Inie£]i2iionai Jauusal al iteaLLh SexxiSL&S/ voi.2. No.3/
p.367-376, (1972).
The history of health planning efforts' within the
federal government is summarized/ starting with enactment
of the Hill-Burton legislation in 1946. Shortcomings in
planning by the central government and in its guidance of
the states are noted. The recent development of certain
federal health planning techniques - a program structure/
the five-year program and financial plan/ and program
analyses - is summarized. Political and administrative
constraints on planners/ within the system of
federal-state-local relationships/ are explored. The
degree to which planning is applicable to current health
programs/ including those of rising prices and misuse of
resources/ and future federal reactions to these problems/
are commented upon.
ReferencePage 6f)4
PLANNING FUNCTIONS
IMPLEMENTATION - NATIONAL
R.F.L. Logan,
'•National Health Planning - An Appraisal of the State ot
the Art",
inisiLimiifliisi Jaunn^i q.l Haallh	voi.i, No.i/
p.6-17, (1971).
Despite the increase in planning activities, there
have been few reports on what happened in practice. After
22 years of the National Health Service in Britain, there
has been little change in the old inequalities in the
distribution of health resources, hospital beds, manpower,
and the budget to finance these. A critical examination
of these failures suggests the complex difficulties in
trying to implement theoretical planning. The changes in
medicine from being a professional art to a technical
science have been too big and too fast. The very
successes of these new advances often lead to survival on
maintenance therapy or to an even more critical and
expensive relapse to a larger geriatic burden. With
little pay-off or benefit in chronic disease, the limited
resources are over-strained in even the most affluent
countries, but neither the profession nor the public is
willing to face the decision of which age sector of the
population to neglect. At the same time, most clinical
decisions involve the use of a limited resource so everyPage 605
PLANNING FUNCTIONS
IMPLEMENTATION - NATIONAL
clinician
the lack
a useful
creating
is the
administr
is a manager* Rather than
of implementation of the plann
purpose as a declaration
a forum for discussion. For m
beginning of the beginning
ation of medical care.
be	disappoin	ted in
ing	process#	it has
of	intent	and in
ost	countries	this
in	the eff	ective
Reference:
Daniel Zwick#
"Health Policy Guidelines and Holistic Care",
Awerican J<2U£ii3l of Health planning# Vol.l, No.l# p.49-51#
(July 1976).
This article notes the purposes# timetable# and
processes connected to the development of National Healtji
Policy Guidelines mandated by P.L. 93-641. It identifies
six dimensions selected by an HEW Task Force as the basis
for analyzing goals and standards and the criteria for the
review of proposed policy statements. The unifying theme
of wellness is developed# and support for the concept is
highlighted. The role of HSA boards and staffs in
defining and implementing national goals and standards is













PLANNING FUNCTIONS
IMPLEMENTATION - NATIONAL
emphas iz ed.





Page 606










Page 607
PLANNING FUNCTIONS
IMPLEMENTATION - STATE AND CITY
Reference:
Helen Kerscnner and Robert Myrtle,
lai Ihs. ImaXeabeoIaJULQii al Arsaalds Haailb
Plans*.
Los Angeles:	School of Public Administration, University
of Southern California, 15 Nov. 1975.
The
areawide
conduc ted
initial
health p
implement
was devis
focused
both org
institut i
issues 1
interview
implement
founaatio
variables
for area
or ientat i
development and implementation str
health plans was considered in
by the University of California in
ob	jecti	ves	of the project were to sel	
la	ns a	nd	to deve	lop strategies
a t	ion.	A	theoreti	cal foundation for
ed	, bas	ed on a lite		rature review. At
on	an	ins	ti tution	aI building model
an	izati	onal	as we	11 as exchange
on	ai	and	linkage	variables, and
ea	ding	to	the de	velopment of a
	guide	on	str ate	gies for areawide
at	ion.	The centr		al theme wnich
n	of	the	project	was that there
a	ssoci	a ter]	with th	e development of
wi	da h	ealth plan		implementation:
on	and	its	use of p	ower and influence
ategie	s for
a p	roject
1975.	The
ect tw	o good
for	their
the p	roject
tentio	n was
e ncomp	assing
const	ructs,
theor	etica l
structured
health plan
formed the
are two key
stra tegies
(1) agency
; and (2)
exchange
of energy between an areawide health planningPage 608
PLANNING FUNCTIONS
IMPLEMENTATION - STATE AND CITY
agency and its environmental linkages. A description o£
the research methodology used in the project is presented.
Data analyses and data summaries from eight agencies in
California are provided. Included in these analyses and
summaries is information on the strategies used, the
implications of these strategies for agency
institutionality and implementation, and the relationship
of the findings to the Kermer implementation approach.
Two agency technical assistance activites where elements
of the Kermer model were tested and reviewed are
described. The Kermer model is described and its
relationship to agency institutionality and health plan
implementation is discussed. (NTIS)
Reference:
Dorothy Lane and Gerald Mazzola,
"The Community Hospital as a Focus for Health Planning",
American Jautaal al Eufiiic Eeallli/ voi.66,	No. 5,
p.465-463, (May 1976).
A community focus for health planning has been
developed by a Department of Community Medicine in aPLANNING FUNCTIONS
IMPLEMENTATION - STATE AND CITY
Page 609
"non-teaching'* voluntary hospital. Results of three years
of planning experience have included: descriptions of
service area populations and utilizer populations;
implementation of neighborhood based health centers with
transportation and outreach programs; integration of
emergency services with other ambulatory care resources;
and proposal for geriatri' '.ay-oare, ambulatory surgery/
and patient education. Working relationships have been
developed between the hospital department and local
planning bodies/ among them the Comprehensive Health
Planning agency/ the County Health Services Department/
consumer groups/ voluntary agencies and a University
Health Services Center.
Reference:
v
Leslie Taylor and John Fitzpatrick/
implementation of lbs haallti Sxslsms AasncY in Hnnianaz.
Helena:	Office of Budget and Program Planning/ Montana
State Office of the Governor/ April 1/ 1976.
/
The history of health planning in Montana is
reviewed/ and options available to the State forPage 610
PLANNING FUNCTIONS
IMPLEMENTATION - STATE AND CITY
implementing the National Health Planning and Resources
Development Act of 1974 (P.L.	93-641) are set forth in a
report directed to the State's consumers, legislators,
service providers, and government officials. A background
discussion of the system for health planning and resource
development existing in Montana prior to passage of P.L.
93-641 covers comprehensive health planning, regional
medical program, and Hill-Burton program activities in the
State. The legislative background of each program is
reviewed briefly, implementation in Montana is described,
and accomplishments and shortcomings are assessed. The
major provisions of P.L. 93-641 are then discussed, with
a view toward implications for Montana. P.l. 93-641 is
compared with legislation creating the comprehensive
health planning and regional medical programs. A
discussion of potential duplication of effort by State
agencies and health systems agencies (HSAs) in States with
just one HSA points out that the program outlined under
P.L. 93-641 appears to be patterned for urban rather than
rural areas.	Four options available to Montana for
implementing P.L. 93-641 are identified, each providing
for a slightly different organizational structure and/oc
delineation of responsibilities between the HSA and the
State agency.	The options pertain to the period of
conditional designation and are directed to eliminating
potential for duplication in such areas as health dataPLANNING FUNCTIONS
IMPLEMENTATION - STATE AND CITY
Page 611
management/ plan preparation/ and review. Supporting
materials are appended. (NTIS)
References:
Robert Myrtle/
Health Elan LfflElefflsnlalLQD - iLansasilflual AsR&zis. ill
Sa^lal £b£Q2£x
Los Angeles:	School of Public Administration/ University
of Southern California/ Aug. 1975.
The strategies used by eight California comprehensive
health planning 'b' agencies to implement their health
plans are examined/ with particular attention to
conditions and factors which either promote or hinder
successful implementation. An institution-building model
of influence transactions within the agency/ from the
agency to the environment/ and from the environment to the
agency is presented/ together with a power and influence
framework for categorizing the transactions. In gathering
data/ a structured interview guide based on the
transactional model and power and influence framework was
employed; the guide is appended. The findings that thePLANNING FUNCTIONS
IMPLEMENTATION - STATE AND CITY
Page 612
agencies rely significantly on power-coercive strategic
rather than on strategies emphasizing normative or
utilitarian dimensions is unexpected in light of the
relatively little power mandated in the planning
legislation. Most of the agencies did not plan
systematically for implementation, could not identify
activities associated with successful implementation, and
failed to employ environmental linkages beyond those
involving the focal organization or actor. Positive
implementation and institutionalization outcomes were
suprisingly low for rural agencies. The key role of the
executive director in developing implementation strategies
is noted. Supporting data, tables, graphs, and
documentation, a bibliography, and an assessment of the
analytical framework are included. It was felt that the
institution-building model was shown to be a useful tool
and that the theory of the interdependence of
institutionalization and implementation power and
influence activators was proven in relation to health plan
implementations. (NTIS)PLANNING FUNCTIONS
CONTROL
Page 6L3
Reference:
Ai-saaiilfi Health Elannias A^no.1 EetXatiDaii£S
Rockville:	Comprehensive Health Planning Service, Oct.
1973.
Agency performance standards for Section 314(b)
comprehensive areawide health planning agencies, developed
by the Comprehensive Health Planning Service, Bureau of
Health Resources Development, U.S. Dept. of Health,
Education, and Welfare, are presented. The standards are
intended to define the role and responsibilities of these
agencies in the following functional areas: health plan
development and implementation, studies, public issue
involvement, project review, agency management, community
participation and education, planning coordination, and
data management. Each function is described and broken
down into elements which identify the specific components
necessary to perform the function satisfactorily. The
standards were developed with consultation from both staff
and council members of State and areaaide health planning
agencies, and were influenced by the development of a
resource allocation model in DREW Region IX, by the final
report of the Expectations Study, and by the development
of the agency assessment process and training. The
standards will be used as
criteria in the agencyPLANNING FUNCTIONS
CONTROL
Page 614
assessment process. (NTIS)
Reference:
Katherine Bauer,
cost caniiiirmenl nnilai. £*Lx	2 Is Mil	SitsasLilifiniiia ihe
£axlE££5Lii£ hst^aen iiftaliii Plaanica Ead RaaulaiiflOx
Cambridge, Mass.:	Center for Community Health and Medical
Care, Harvard Univ., Jan. 1978.
The report describes
issues that surround the
certain types of health regu
Health Planning and Fesou
search for cost containment,
such linkages could be f
present summary has two par
major conclusions, and
recommendations. The 1974
ambitious reform of the
Although it aoes not directl
higher priority than equit
care, the entire structure c
a study which clarifies the
linking of health planning to
lation under the 1974 National
rces Development Act in the
and explores ways in which
orged or strengthened. The
ts:	a general overview of
a listing of more specific
Planning Act calls for
U.S. health care system,
y assign cost containment Q
able access to quality medicsL
an be - and is - interpretedPLANNING FUNCTIONS
CONTROL
Page 615
as providing an overall context of concern with rising
expenditures for health care within which the myriad
planning and review activities it prescribes should take
place. (NTIS)
Reference:
Paul Guptill and Charles Cameron/
EnflSLSiuniis. 1q.l LziLujilinz il&allh Sian Esitslaaiasiii and
Ininlaffinniation Slsaanis in AtaaMias Eaallii Elannina
l£j:lniaan££ 5iandaid£x
Grand Island:	Central Nebraska Comprehensive Health
Planning Council/ Dec. 1974.
Procedures for evaluating the performance of a
comorehensive health planning agency/ based on the agency
performance standards published by DHEW in 1973/ are
presented. The comprehensive health planning agency's
plan development and implementation is broken down into 14
elements: planning framework; description of process and
timetable; identification of area health needs?
projection of future health needs; inventory of health
resources? analysis of health resources? statement ofplanning functions
CONTROL
Page 616
health goals; development of objectives; formulation of
specific methods and activities; development of agency
recommendations; implementation strategy and schedule;
use of the plan for project review; publication and
dissemination of the plan; and evaluation and revision of
the plan; Each element is described briefly/ and related
procedures for agency self-evaluation are stated. A
general description of health plan development and
implementation is included/ as is a discussion of the
assignment of tasks and responsibilities to staff/ board
members/ and others. A self-evaluation checklist is
provided. Exhibits include the following; a framework
for planning developed by the Georgia Office of
Comprehensive Health Planning; health planning
definitions; an outline for a comprehensive health plan;
a step-by-step description of the planning process; 3
schematic diagram of the plan development process; an
outline of the data needed to describe the health status
of an area; guidelines for describing the health systens
in an area; guidelines for assessing community health
services; and an outline of a preliminary study of
community health needs/ problems/ and resources. (NTIS)PLANNING FUNCTIONS
CONTROL
Page 611
Reference:
Margaret Jordon and Larry Siegel,
£££££££ Ql 2SJU2M JEld £flUU3£I]-£i A Syi-LCJH ffl£ H23JLQD IX Ctf2
Sliial £Qd Uliiiil liifinciasx
San Francisco:	Comprehensive Health Planning Service, 14
August 1972.
The review and comment function of comprehensive
health planning agencies (314a and 314b) is discussed.
This function evolved from the reasoning that health
expenditures allocated in accordance with the needs and
priorities identified by State and areawide comprehensive
health planning (CMP) agencies will result in improved
health status through better coordination	and	more
effective use of health resources. It is felt that an
overall system with specified stages and steps from
minimum to maximum reviews is needed. A study of the
status of review and comment as practiced by 314b CHP
agencies in Region IX as of July 1972 is reported. This
study forms the basis for a suggested series of stages
containing the minimum steps necessary for the review and
comment process. In the study, the objective was ta
assess and analyze the review and comment process for ?
sample group of CUP agencies most closely reflecting
differences in agency maturation, population and location.PLANNING FUNCTIONS
CONTROL
Page 618
Interviews were conducted with directors and st
agencies in California and Arizona using a qu
developed to elicit review and comment informa
following stages in the review and comment p
observed:	(1) establishment of a base of re
internal control mechanisms; (3) instituti
formalized review process? and (4) followup
Steps associated with each of these stages are
explained, and additional information on the
comment study is appended. (NTIS)
aff of	nine
estionnaire	
tion.	The
rocess	were
view?	(2)
on of	the
procedures.	
listed	and
review	and
Reference:
Socrates Litsios,
’’The Principles and Methods of Evaluation of National
Health Plans,"
daunnal o£ iisalili Ssisicss voi.i, no.i,
p.7 9-85, (19711.
A set of seven questions is used to define the nature
of "plan evaluation." These questions identify what are to
be the major desirable attributes of a well-conceived
"plan of action" and of the planning process thatPLANNING FUNCTIONS
CONTROL
Page 619
generates the plans of action. The self-generative and
renewal natures of planning and evaluation are noted?
they cannot exist alone and actual iinprovement in one can
only follow either actual or conceptual improvement in the
other. It is proposed that the seven questions preferred
might form a useful conceptual basis for using evaluation
as the means for initiating the improvement of the
planning process.
Ref erence:
Socrates Litsios/
••Developing A Cost And Outcome Evaluation System/1'
international jiaumal aX. iisaliii	Vo.1.6/ No.2/
p.345-360/ (1976).
This paper is concerned with the problem of
introducing an evaluative capability in the administration
of the health services of developing countries. The
scarcity of resources available for evaluation is taken
for granted; as a consequence/ the approach to evaluation
must be simple and straightforward. A strategy foe
developing such an approach is presented. The strategy isPLANNING FUNCTIONS
CONTROL
Page 620
characterized by a gradual build-up of an evaluative
capabili ty.
Relerence:
SJtalsi iisalHi Elauuiim Assiisji Z£LlsiL&m£.s. SiaadaLds-t
Rockville, Md.:	Comprehensive Health Planning Service,
1977.
Performance standards developed by the Comprehensive
Planning Service to define the roles and responsibilities
of State Health Planning Agencies (SHPA) are presented.
These responsibilities are categorized in nine areas:
health plan development and implementation, studies,
health policy involvement, project review, program
management, public information and education, planning
cooruir.ation, areawide development and assistance, and
data base management. Each agency function is described
and arranged into elements which identify specific
components necessary to perform the function. These
performance standards will be used in evaluations to
assess the effectiveness of State agencies. (NTIS)CONSEQUENCES OF PLANNING
Page 62L
Ref erenc e:
R.M. 3attistella/
"Rationalization of Health Services:	Political and Social
Assumptions/"
Inlsjcnaiiaual JautD^I ai ilaallii SfiiJtiass/ Voi. 2, No.3,
(1972).
Confronted with deep-seated problems of spiralling
health care costs/ the United States is actively-
considering rationalization as a means for improving
efficiency and effectiveness in the operation of health
services. The application of managerial and
organizational principles characteristic of large-scale
business and industry/ i.e./ quantification of
decision-making/ consolidation of production/ money
rewards for cost savings/ and economies of scale/ is
increasingly seen as the key to successful control of the
health economy. The drive for rationalization is assessed
in terms of its probable impact on the following issues:
(a) the scope of	health-field	boundaries	and	program
responsibilities;	(b) the	influence	of	health
professionals in policy and planning; (c) the role of
altruistic ideals as compared to market values in
conditioning provider behavior; and (d) the relationship
of health services to larger social and philosophic aims.CONSEQUENCES Of PLANNING
Page 622
Because of the tendency toward convergence in
governments face in the financing and aeliv
care, it is suggested that developments in
States may be relevant to other countries
advanced stages of economic growth.
the problems
ery of health
the United
in similarlyPUBLISHED PLANS
Page 523
Reference:
Annual lanlaajsnlaiinn Elan nl lim ALsauissi Hnallti 2E£-t£ffls
Elan lot Enlntaln Elanniaa aal Maaaifiiaaai E^gion l«s
lLa£ini££ anl ialii Qannlisnlz.
Fort Collins, Colo.:	North Central Comprehensive Health
Planning Association/ Inc./ Aug. 1975.
The 1575-1976 Annual Implementation Plan (A IP) for
Larimer and Weld Counties, Colorado, is presented by North
Central Comprehensive Health Planning Association, Inc.,
as Chapter VI of the region's first health systems plan.
The A1P is basically a summary of the detailed health
system	plan	sec	tions,		and is	intended for		wide
distribut	ion to	hea	1th	care	providers	and	for use	as a
reference	guidi	e f	or	hea It	h care planning		in the r	egion.
An overvi	ew of	the	A IP	is	provided,	and	the pi	anning
process,	goals	and	objective		s, and purpose		of the do	cument
are summa	r ized.	Th	e he	al th	systems	plan	sec tions	that
have been	comp L	eted	by	the a	gency and	the 5	tate duri	ng the
current year, and areas that are to be worked on in the
next phases	are identified.	Several	exhibits	p rovide
reference to	specific service	providers	and to	various
plan sections and action recommendations. The progress
ana achievements of the agency during the past year aod
the impact that the National Health Planning and ResourcesPUBLISHED PLANS
Page 624
Development Act of 1974 will have on the area are
explained. The agency work program identifies the work
schedule for the coming year and relates the schedule to
manpower availability. Appendices summarize service goals
and action recommendations for the following service
areas: primary care/ including freestanding ambulatory
care centers; intermediate care/ includinmg acut-e
inpatient services/ long-term nursing care, emergency
services, chronic renal dialysis, alcohol abuse, drug
abuse, and mental health; and tertiary care, including
oncology and radiation therapy services. Action
recommendations and/or commitments are also summarized by
service provider and/or appropriate agency. (NTIS)
Kef erence:
A22a±azhLaL Maiyiac-j Ziis. 'Lzil H&alili &£X£l&£Jfi£n£ E-Ua
12I2=li2$A
Cumberland:	Health Planning Council of Appalachia
Maryland, Inc., 1972.
A five-year regional health plan for the three-county
Appalachian region of Maryland is presented by the HealthPage 625
PUBLISHED PLANS
Planning Council of Appalachia Maryland/ Inc. The region
is both urban and rural/ with diverse topography, climate,
population density, and economic base. Death rates in the
three counties are higher than in the State as a whole,
but infant mortality is lower. The area is served by five
general care hospitals, 18 nursing homes, and one chronic
disease hospital. While health care facilities are
sufficient, there is a shortage of physicians and
dentists. The organization of the Health Planning Council
is described, including the composition of the Executive
Council and working committees. Job descriptions of staff
members are included. A chronological progress report
details all decisions of the Council and all planning
activities. Relationships within the Council and with
allied agencies are explored. The objectives and
activities of the Council from 1972 to 1976 are outlined,
beginning with the establishment of community needs,
goals, and priorities. Plans are presented for ambulatory
health services, environmental health, mental health,
health manpower, a health profile, health education, and
agency functions. Appendices contain the Council's
Articles of Incorporation and Bylaws and demographic data
in tabular form. Portions of this document are not fully
legibile. (NTIS)PUBLISHED PLANS
Page 626
Reference:
SLaaaistisosixs Hsallii El^u ISdt 21+
Asheville, N.C.:	Mountain Ramparts Health Planing, Inc.,
1975.
An areawide comprehenisve health plan for a
four-county rural area in the mountains of North Carolina
is provided. Parts of the area are isolated from needed
services and are characterized by a poor transportation
system. Demographic data are displayed in charts and
tables. A regional health profile lists 65 health-related
services, as well as health facilities and health manpower
available within the region. Major problems, in order of
priority, are: availability and accessibility of
physicians, need for additional long-term care facilities,
shortage of paramedical personnel, care for the medically
indigent, and acuta care hospital facilities. Planning
and project goals are enumerated for the following
components of the health care system: primary care,
hospitals, services for the aged, long-term care, mental
health services, the mentally retarded and handicapped,
emergency medical services, and environmental health. The
need for skilled and intermediate care nursing beds is
forecast for 1930 based on a 1975 survey of nursing
facilities in the region. Recommendations for action arePUBLISHED PLAN'S
Page 627
suggested for each of the system components. Reports of
the hospital/ long-term care, and physician access
committees are included. Portions of this document are
not fully legible. (NTIS)
Reference:
AJLeiUiida ifaaitii Elan*.
Omaha,Nebr.:	Health Planning Council of the Midlands,
Dec. 1974.
The areaaide health plan prepared by the Health
Planning Council of the Midlands in Omaha, Nebraska, is
discussed. The plan was developed through the effforts of
volunteers representing a cross-section of providers and
consumers of health in an 11-county area. The formative
stages of plan development identified existent community
health agencies and programs. Plan development task
forces related those health programs and services which
are in operation to ideal conditions. It was then
possible to identify strengths and weaknesses in the
community health care system for the 11-county area in
Nebraska and correlate identified problems with possiblePUBLISHED PLANS
Page 628
solutions. Each phase of development was reviewed by
health agencies and organizations in the community. By
following this method of development/ the areawide health
plan was broadly based so that all interested citizens had
an opportunity to make a contribution. The plan addresses
the following topics: education (coordinated health
education/ institutions/ and health and long ter®
educational costs); services (rural ambulatory care/
rural preventive services, fragmentation of health
services, environmental health, ambulatory care,
availability and accessibility of care to the elderly,
detoxification accessibility, treatment of drug problems,
chemical dependency and alcoholism, home health care
services, recuperative care services, and pharmaceutical
services), data and studies on health and long term care
services; potential problem areas in health care
delivery; and standards and criteria for health services.
(NTIS)
Reference:
£££a4i£e Hsallh E-U&t
woos ter, Ohio:	Seven County Health Planning Council/’ Feb.
1975PUBLISHED PLAMS
Page 62 9
An areawide health plan is described that is intended
to provide a flexible framework for the improvement of
health care in Ashland, Carroll, Homes, Richland, Stark,
Tuscarawas, and '^ayne Counties, Ohio. Six major sections
of the plan focus on the status and future development of
acute inpatient services, long-term care, home health
services, ambulatory health services, emergency medical
services, and environmental health services. Each section
of the plan includes a discussion on general issues,
problems, and concerns, as well as an evaluation of
existing resources for providing services.
Recommendations, criteria, and guidelines are included in
each section of the plan which will be used by the
Seven-County Health Planning Council in its consideration
of health facilities and service projects which come under
its review responsibilities. Consuaiers, health
professionals, and representatives of local government
participated in the plan's development to ensure its
relevance and acceptibi1ity throughout the seven-county
area. It is noted that the plan is designed to be
flexible and subject to continuing review and revision in
order to meet changing healtn care neeus. (NTIS)PUBLISHED PLANS
Page 630
Reference:
Ar-saaiils Healiii Elan/
Kansas City:	Mid-America Comprehensive Health Planning
Agency, Nov. 1974.
The areawide health plan of the Mid-America
Comprehensive Health Planning Agency (MACHPA) is detailed.
MACHPA was established through the combined efforts of
several regional groups in the Kansas City, Missouri area:
Mid-America Council of Governments; Regional Health and
Welfare Council; and the Health Planning Council. MACHPA
is comprised of consumers, health care providers,
governmental representatives, and a professional staff.
Provider directors include physicians, dentists, nurses,
hospital administrators, health educators, and
representatives of volunteer health agencies and other
health disciplines. Consumer directors represent
geographic areas and socioeconomic and minority groups
within the region. The jurisdiction of MACHPA is firmlT
rooted in P.L. 89-749 at the Federal level. The purpose
of the agency is to promote and assist in the extension
and improvement of comprehensive health planning and
public health services through providing for the more
effective use of available Federal funds for such planning
and services and for other purposes. The effect of otherPUBLISHED PLANS
Page 631
legislation (P.L. 92-603, Kansas certificate of need
legislation, and 1122 reviews) on the development of
MACHPA's areawide health plan is examined. Major programs
requiring comprehensive health planning review are noted.
Basic issues relating to the areawide health plan are
identified, including the primary orientation of the
health delivery system, the distribution of health
services in relation to the population, and
decentralization versus centralization. Four major
components of the areawide health plan are detailed: (1)
ambulatory services; (2) emergency medical services; (3)
inpatient services; and (4) long-term care services.
(NT IS)
Reference:
Hejlih Elan,
Baton Rouge:	Louisiana Capital Area Health Planning
Council, Dec. 1975.
An areawide health plan is presented for the
Louisiana Capital area which outlines a desired health
care system and documents needs and ■ priorities asPUBLISHED PLANS
Page 632
perceived by members of the community. The purpose of the
plan is to provide a base of information and
recoramendations for improving the health care system and
health status of residents of 11 parishes in the Capital
area. The planning effort is based on an influence
structure study of providers/ consumers/ and government
officials. The following health priorities were
identified in the study: emergency medical services/
health manpower/ environmental health/ health services for
the aged/ alcohol and drug abuse services, school health,
ambulatory care, consumer health information, nonemergency
transportation, developmental and handicapping
disabilities, health care costs, acute care hospital
services, dental care, disease detection and control,
mental health, and health services for the medically
indigent. A summary is provided for each of these
priority areas, and goals and recommendations for each
problem are delineated. Appendices, which comprise the
bulk of the document, contain tabular and narrative data
concerning regional characteristics, perceived health
needs. health status indicators, the health care delivery
system, and project review. A glossary of terms is
included. (NTIS)PUBLISHED PLANS
Page 633
Reference:
A-LeaMidf*	E!j3D/
Little ^ock:	Central Arkansas Planning and Development
District/ Inc., May 1975.
A comprehensive health care plan is presented for the
six counties included			in	the	Centr
Planning	Program	Area.	The	area	inc
largest	city,	Little	Rock,	and	is
density	compared	to the	State	and	the
the area also includes more sparsely populated sections.
The population is served by a health care	system
consisting of four large medical centers in Little Rock,
12 hospitals, 32 nursing homes, and two State mental
hospitals. Part A of the plan document discusses the
purposes and goals of the plan and the plan/uork program
!
concept. Part 8 presents a description of the planning
area, including geographic, population, and employment
characteristics?	area-wide	and individual	county
profiles? and area-county health indicator profiles.
Part C describes the health delivery system of the area,
including primary,	secondary.	and	tertiary	care
facilities; manpower	supply and education; and services.			
Part D examines the health status of		the	population,	and
Part S ranks health	priorities for	the	area, stating	thePUBLISHED PLANS
Page 634
nature of the problem/ goals/ objectives and
recommendations/ and resources for each priority itej
drawn from an areawide survey. The top 10 priority items/
in order/ are: consumer health information/ hospital
costs/ lack of community mental health services,
inadequate public school health education programs,
emergency medical service, health care for the poor,
health manpower, inaccessibility of health care services,
day care services for the aged, and physical therapy
services. A summary of the 1976 work program is provided.
Tabular data are included. Portions of this document are
not fully legible. (NTIS)
Reference:
Lacrosses:	Western	Wisconsin	Health	Planni ng
Organization,	Inc., Mar.	1975.		
An	areawide		health plan is presented for		a sevn
county	area	of	western Wisconsin,	including	a brief
history	of	the	Western Wisconsin	Health	PIanning
Organization (WWHPfJ) and a descriotion of demographic,PUBLISHED PLANS
Page 635
economic/ and governmental characteristics. Planning
terminology and definitions are given/ and objectives are
delineated. The objectives represent a corapre hensive
blueprint for thehealth care system and its functional and
component parts. The blueprint deals with inpatient/
outpatient/ and emergency levels of care; it considers
the educational requirements of the general public and of
patients for maximum benefits; and it addresses issues of
cost/ coordination/ sharing of services/ management and
financing/ and utilization of resources. In addition/ the
manpower/ facilities/ and services aspects of each subject
area are considered. Finally/ the public/private health
education portion of the blueprint addresses preventice
health issues/ self-vare/ and utilization of the health
care system. A framework for achieving these objectives
is provided and includes:	setting of objectives; data
collection and analysis; areawide demographic and health
systems forecasts and estimates; identification of
problem issues; preparation of planning program designs
and plans; and adoption of plans by the WWHPG board of
directors. The final phase of the plans offers the
methodology to be used for evaluation/ monitoring/ and
revision of the plan and its functional and component
parts. Graphics present supplementary and supporting
. (NT IS)
dataPUBLISHED PLANS
Page 636
Reference:
Heuliii Elaui Elan iiniLelajmsn-t lnilaD£.e imi-sclnl,
Omaha, Nebr.: Heaith Planning Council of the Midlands,
1974.
Purposes and scope of the areawide health plan
developed by the Health Planning Council of the Midlands
in Craaha, Nebraska are discussed. The areauide health
plan is defined as a document that presents the desired
health care system for a community and recommends specific
actions to ensure that the desired system is attained.
The plan contains specific statements that direct the
development of a community's health care system. It is
pointed out that the areawide health plan must be based on
realistic expectations and that it aiust be continuously
revised and updated. Three objectives of the plan are
identified: (1) describe the desired health care system
for communities in an 11-county area of Nebraska; (2)
note deficiencies and gaps in the health care system; and
(3) provide planning guidelines for decisions and actions
designed to enhance the health care system. Content of
the areawide health plan is related to the desired health
system, status of the system, and recommendations for
improvement. Plan development guidance material is
provided, and phases of plan development are delineated.PUBLISHED PLANS
Page 637
Appendices provide additional information on planning
terminology/ standards/ and format protocols for an ideal
health care system. (NTIS)
Reference:
Arkansas Elsn 1st Erimso Essllti Cans* lalims 1*
Little Rock:	Arkansas Dept. of Planning/ Jan. 1973.
A plan for improving the delivery of Arkansas primary
care services which builds on existing health cats
personnel and facilities is presented. Environmental
health, mental health, and aspects of physical health
beyond the primary care objective are not considered. Tvio
basic problems impeding the delivery of primary health
care are recognized:	shortages and maldistribution of
primary care personnel/ and the inability of a sizeable
portion of the population to have ready access to primary
health services. Criteria for solutions are developed/
and immediate priorities are proposed to make better use
of personnel and facilities. One change is an increase in
the production of family practitioners at the University
Medical College (UAMC) through improved and
of ArkansasPUBLISHED PLANS
Page 638
expanded recrui tment* education and training* using
hospitals throughout the State. Priorities are to: (1)
establish area healtn education centers to develop
training and continuing education programs? (2) develop
training programs for physician extenders through the
university* and clarify the Medical Practices Act to allo\»
their use and the use of emergency service personnel; (3)
increase the capability of UAMC to meet needs of primary
care delivery system; (4) develop and implement art
effective emergency medical system; (5) increase the
capabilities of the Arkansas Health Department; and (6)
extend the scope of Title XIX. (NTIS)
Ref erence:
calilpxnia	£iah iai iisalJLlix
Sacramento:	Office of Comprehensive Health Planning*
California State Dept. of Public Health, 1971.
The Task Force of the First California State Plan for
health sought to identify major barriers in improvement of
environemtnal health and personal health care delivery and
to suggest directions and mechanisms to overcome tnaPUBLISHED PLANS
Page 639
barriers. A profile of the current situation details
health status; health services and facilities and their
cost; and the distribution of health services.
Population factors are also in the profile. The fields of
environmental and personal health and those health
problems with significant social implications are analyzed
according to background and current status.
Recommendations for immediate and future action are
included. Such specific problem areas as the needs of the
poor and the aging, venereal disease, drugs and alcoholism
are dealt with in individual sections. A comprehensive
glossary defines terms used in the report and the
publication contains many summary charts and graphs
related to the materials covered. (NTIS)
Reference:
Mha Samian	HfLalJLii .2130 itsyisaiixlSIilx
Rock Hill, S.C.:	Catawba Regional Planning Council, June
1974.
The 1974 revision of a comprehensive health plan for
the four rural counties of north central South CarolinaPUBLISHED PLANS
Page 610
comprising the Catawba region is presented. Chapter One
describes the region (geographic and population
characteristics, economic indicators). The Catawba Health
Advisory Council — membership composition,
responsibilities, structure, committees — is discussed in
Chapter Two. Health facility and manpower resources are
described, including inventories of hospitals, inpatient
psychiatric facilities, inpatient rehabilitation
facilities, outpatient rehabilitation facilities,
ambulatory care facilities, hospital emergency services,
ambulance services, long-term nursing facilities,
intermediate care facilities, public health department
services, and health-related agencies in the region. A
critical shortage of health manpower, particularly with
regard to physicians, is noted. Shortages of registered
and licensed pratical nurses also exist. Vital statistics
are presented. Health goals and Council recommendations
are stated in the areas of health facilities, health
manpower, personal health, mental health, environmental
health, and emergency medical services. Appendices
present the Council^ bylaws and membership roster.
Fifty-two tables are included in the text. Portions of
this document are not fully legible. (NTIS)PUBLISHED PLANS
Page 641
Reference:
Claris CsunlY Elaa I21 ttsalliu
Las Vegas; Advisory Council/ Ciark Council Areawid0
Comprehensive Health Planning Association/ Dec. 1974.
Health needs and resources of Clark County/ Nevada
are identified and a plan for achieving priority health
goals is described. A demographic background of the
county is also provided. Each component of the health
care system is examined in terras of the present situation/
community needs/ goals and objectives. The components
discussed include; emergency medical services/ acute and
long-term care facilities/ specialty facilities/ health
manpower/ mental health services/ public and environmental
health systems/ treatment for the retarded/ and substance
abuse care. Particular attention is given to several
rural areas which lack access to most health care
services. The development of adequate ambulance and
communications networks and possbiie visiting doctor and
paramedical services is discussed. A section describing
the ideal characteristics of and barriers to health system
planning is included. This section discusses the need for
planning input from health providers and consumers/ as
well as public information practices. Recommendations foe
particular health service groups are presented/ and thePUBLISHED PLANS
Page 642
development of a task force to examine health exonomics is
suggested. Portions of this document are not fully
legible. (NTIS)
Reference:
ElsDz.
Highland:	N.W. Indiana Comprehensive Health Planning
Council/ Inc./ 1973.
A plan is presented for the future development of the
i
health delivery system and improvement of environmental
conditions in the seven county northwestern Indiana
region. The counties include:	Lake Porter/ Laporte/
Newton/ Jasper/ Starke/ and Pulaski. The comprehensive
health	plan is discussed with regard to:	consumer
participation; health goals and priorities; the region
and its people; health status and problems; hosptials/
nursing homes/ and home care agencies; ambulatory carg
ana health services; health education and manpower; and
mental health (alcoholism and drug abuse) and development
of statistical and summary data on health care in the
region. Portions of this document are not fully legible.PUBLISHED PLANS
Page 643
(NTIS)
Reference:
CarntfibaDsiya Hsaliii £lai) Xai las Cammaiiasallli flf
Mass^iiusaliS/
Boston:	Massachusetts Office of Comprehensive Health
Planning/ 1970.
This document is concerned with the proper allocation
of health care resources (manpower/ equipment/ facilities/
information/ and funds) by both the Commonwealth oF
Massachusetts and the Federal government. Information is
presented in a series of task force reports. The first
deals with statewide comprehensive objectives; special
statewide program/ administration/ and resource
objectives; and regional objectives. A task force on
health facilities reports on health care trends/ issues/
and problems. Health information systems are discussed in
terms of purpose and relationship with ongoing and planned
activities of various organizations. The goals of the
task force on health services were to understand the
health needs ot the population/ to have information onPUBLISHED PLANS
Page 644
available health service resources, and to develop new
patterns of service delivery. The manpower task force
report details		the growth in		demand	for	health se	rv ices
and the	difficulties		encountered		in	obtaining	these
services,	the	supply	and	demand	for	specif ic	heal th
professions in Massachusetts, and the problems in meeting
the manpopwer needs. Solutions include up-to-date
information on distribution and needs, inventories of
educational facilities and programs, restructuring of
staff organizational patterns in health institutions,
redefining job levels, and developing new professions to
bridge the gaps in continuity of health care. (NTIS)
Reference:
iifialiii Plan* Siais g£ Quassia,
Salem:	Oregon Health Planning Committee, Jan. 1971.
Several alternative mechanisms for developing plans
and recommendations have been utilized in developing the
Oregon Comprehensive Health Plan (CHP) presented by the
CHP Advisory Council. The composite plan incorporates
reports by the CHP staff, ad hoc committees, professionalPUBLISHED PLA'IS
Paye 645"
and voluntary organizations/ and State agencies who
administer a wide variety of health and health-related
programs. Elements of the format include: title of study
or problem area, programming goal/ statement of
condition/problem/ current programs and activities/
authorities, objectives, recommendations and methods,
operational problems, evaluation criteria, and priority
assigned to problem area/recommendations. Reports are
included for: health delivery system problems; health
services; target groups; personal health problems
including mental health, communicable and non-communicable
diseases; and environmental health problems. Appended
are: the executive order 67-14 manda ting the creation of
the CUP system; the organizational chart; Oregon's CHP
goals and objectives; the planning process; and
classification of health problems. Charts, graphs and
maps present supplemental data, and listings are presented
of members of the Governor's Committee and the Governor's
Ad Hoc Committee. A table lists organizational
responsibility by agency. The document is indexed by
organization and by subject. Portions of this document
are not fully legible. (NTIS)PUBLISHED PLAMS
Page 646
Reference:
H&BILLJliiSIlsiltfi id£Il£3l Usaliil £Ian Ifit i£Si Vitallliax
Charleston:	Governor's Advisory Committee for MentaL
Health Planning, West Virginia State Dept, of Mental
Health, Sept. 1966.
A long-range plan for mental health in West Virginia,
representing two years' efforts by more than 800 citizens
of that State, is presented. As part of the planning
effort, an extensive survey of neads and resources was
accomplished through questionnaires, public hearings,
reviews of literature, interviews, and related activities.
Findings, goals, priorities, conclusions, and
recommendations compiled by the Governor's Advisory
Committee for Mental Health Planning through its several
task forces and regional, county, and local committees
were coordinated through the planning division of the
State Department of Mental Health and recast into the
basic long-range plan. Part I traces the history of
mental health in West Virginia, briefly outlines the
background of the planning effort, and sets fmrth
long-range and immediate goals for the State in mental
health. Part .11 identifies mental health resources and
needs in the State, and presents recommendations for
alleviating need in the special proolem areas, thePUBLISHED FLANS
Page 647
following groups: the actively mentally ill, both acute
and chronic; children; the mentally retarded;
alcoholics; and the aged. Part III presents an overview
of existing mental health facilities and programs in the
State and projects plans for these facilities and programs
in the future. In Part IV, recommendations for
iraplemen tation	of	the mental	health plan are	presented
relative to	admin	istrative and	consultative	services,
consultation	and	education,	research, manpower and	
training, legislation and financing, 3nd coordination and
planning. Individual task force reports, supporting
tabular data, and documentation of the procedures and
organization of the planning effort are appended.
Portions of this document are not f.ully legible. (NTIS).
Reference:
A	E.l^n f0£ £2J22£eji£QS.U£ ilSdllli £a££ in £ll£
IQ-liUDJl li	D3ii£li22n]£Ql	iQQ
health £a££x
San Francisco, calif.:	Arthur D.	Little, Inc., Oct.
1972.PUBLISHED PLANS
Page 648
The report/ in both English and the native text/
presents the issues and lays out the recommended mission
goals/ and objectives that are necessary for promotion of
a healthy population/ and the consequences of these goals
and objectives	for health	resource		requirements.	The
changing health status		of	the	population of	the
V'ukon-Kuskokwim	area in Alas	ka is	a	major issue in	the
study. The mortality rate in this area has fallen/ while
incidence of communicable diseases has risen/ as well as
the incidence of accidents/ and mental health problems.
The community is moving from life threatening problems to
chronic disabilities/ and questions relating to the
quality of life. Portions of this document are not fully
legible. (NT IS)
Reference:
Eaateiu Montana	Hfidiiii Elaac
Sidneys Economic Development Association of pastern
Montana, May 1975.
This plan presents a view of health resources, goals,
and objectives for a 17-county area of eastern Montana.PUBLISHED PLANS
Page 64<3
along with strategies for its implementation. Economic
and demographic character is tics of the sparsely populated
region are provided with projections of growth patterns to
1985. The health care system is described in terras of
three major categories of manpower, facilities, and
services. For each category, an inventory is made, and
standards or goals are set. Needs based on these
standards or goals are determined, and then long-terra
objectives are proposed through 1985. The services
discussed include public health, emergency medical
services, alcoholism and drug abuse care, and mental
health services. Historical costs of nursing homes and
hospitals in the region are discussed, and data indicating
various inodes of payment for health care services are
examined. Potential developments of health maintenance
organizations and national health insurance are also
analyzed. Groups and agencies responsible for
implementing objectives of the plan are identified. A
multi-media community education program is being initiated
to inform the public about the plan's objectives.
Planning needs and goals are listed, and appendices ar«
provided. (NTIS)PUBLISHED PL AMS
Page 650
Ref erenc e:
EijlsI Elat 1q£	lot tfje ZzqzIs qL Manl^tfiZx £aa
££HiItx 5ant.a £ruz QniiQliSJijL Izhms. Il Ettsanal Health
Ss£ni££sZEt3£i£oninsQlal Usalliix
Salinas, Calif.:	Mid-Coast Comprehensive Health Planning
Association, 1974.
The pers
components o
midcoast are
agriculture-o
greatest sour
population 1
utilized is
problem anal
demographic c
Goals and o
personal heal
are set f
identi fie d:
related negat
of health car
mechanisms;
inappropriate
servi
onal health service and environmental health
f a health services plan for the three-county
a of California are presented. Although
riented activities provided the single
ce of income in the area, 73 percent of the
ives in urban settings. The planning process
described briefly, and a six-step health
ysis model is presented. Geographical and
haracteristics of the area are described,
bjectives for reducing barriers to adequate
th care, and implementation recommendations
orth. The following problem areas are
lack of knowledge of resources and culturally
ive attitudes toward medical care; high cost
e coupled with inadequate income or insurance
and quantity of services insufficient or
to meet needs. The following personal
ces elements are considered:	rehabilitation,
healthPUBLISHED PLAM3
Page 651
home health services, dental health services, primary
health care services, vision care, geriatic care, mental
health services, mental retardation and developmental
disabilities. Legislative proposals for national health
insurance are discussed. Goals and objectives are also
stated with regard to air quality, water quality, and land
use. It is noted that dysentery and infectious hepatitis
are still major waterborne health problems in the area. A
potential issue — unhealthful effects of excessive sulfqr
oxide emissions into the atmosphere — is traced through
an environmental health analysis model. A nine-page
health planning resource glossary is included. (NTIS)
Reference:
£Lani£waLi£ lat £ami>Le.lis.flsiys M&aliii Elan EfiJifilaimjini/
Peabody:	North Shore Health Planning Council Inc., 1974.
Principles, goals and criteria for plan components
are outlined for the comprehensive health planning (CHP)
effort of the North Shore Health Planning Council,
Peabody, Massachusetts. A diagram depicting the
relationship between values,
goals.
objectives, standards,PUBLISHED PLANS
Page 652
policies, plans, and programs is included. The role of
the planning committee is discussed, and the background
for goal development Dy the Council is described. Twelve
principles are stated, the first of which emphasizes the
promotion of good health through prevention of unnecessary
illness, disease, disability, and premature death. It is
also noted that every citizen should have a right to
choose from two or more systems of primary care from among
multiple providers. Goals in the areas of accessibility./
acceptability, comprehensiveness, and efficiency are set
forth. Three dimensions of CHP development — the health
problems, the consumer or patient, and the service
subsystems — are defined. The parameters of a plan
component or subsystem are described, and criteria for
measuring the rate of progress toward the stated goals are
listed. Data necessary for evaluating the extent to which
existing services meet the stated goals are listed. The
final step in plan development — specification of
objectives and consideration of alternative means of
achieving objectives (Action Plan) — is outlined. (MtI3>
Reference:PUBLISHED
PLANS
Page 653
Sacramento:	Golden Empire Comprehensive Health Council,
Inc., 1973.
The	re	port singles out	
problems		in th	e areas
Sacr amen	to,	Sierra	, and Yo
Areawide		health	prioriti
headings	ern	er gency	medical
services	,	the	consumers*'
environm	ent	al heal	th, health
transpor	tat	ion,	mental he
rehabi1i	tat	i ion.	The major
discusse	d.	Each	of these
with the	re	1evant	data solu
report	als	o includes severa	
of health problems			listed ac
the	major
(SI	Dora
lo	count
es	are
services
role,
manpowe
alth/ment
problems
problems
tions ar
1 maps of
cording t
health care planning	
do, Nevada	, Placer,
ies in California).	
discussed	under the
, health	faci li ties
health	education,
r, preventive care,
al retardation, and
in health planning
in turn is discussed
e recommended. The
the area and a table
o county. (MTIS)
Reference:
kuidslinss. lat iiie	al a SaimlY. camtsliensile
ixsalth oi^Di
Salem:	Office of Health Planning Services, Oregon State
Health Division, Aug. 1974PUBLISHED PLANS
Page 654
The development of a format for a State comprehensive
health plan in Oregon is discussed. The entire State of
Oregon is first viewed as a planning jurisdiction and then
in terms of developing plans for each areawide agency to
meet specific needs. The State plan will be organized in
two parts: (1) data and documentation to provide the
basis for plan analysis; (2) short-range and long-range
goals and objectives in a general framework for
presentation to decision-makers. Formats for both parts
of the plan are presented. The development of county
plans is an integral part of the State plan/ and
procedures used to organize/ develop/ and assign people or
agencies to the project are described. The development of
a basic community profile is outlined/ including
geographic and demographic data/ socioeconomic indicators
and their source/ environmental data and source/ health
status indicators and source, health facilities and
services, manpower, and utilization. Methods of
assessment tor current programs are presented with
examples, and jurisdictional concerns are considered.
Maps and data collection sheets are provided. (NTIS)
Reference:PUBLISHED PLANS
Page 655
Guidelines ior Efijllii $.££ vises!	Haiiota Hfifiitb
£l3n ELafflajdai]^
Bismarck:	Division of Health Planning/ North Dakota State
Dept. of Health/ Feb. 1976.
Guidelines incorporated in the health systems plan
framework of North Dakota are outlined in looseleaf
format. The health systems plan framework of the State is
the primary basis for decisionmaking in project review
activities. State project review authorities include the
North Dakota Certificate of Need Law/ Section 1122 of the
Social Security Amendments Act of 1972/ and the Project
Notification and Review System of the Office of Management
and Budget (Circular A-95). The framework is also
designed to aid in the development of health systems plans
and annual implementation plans by agencies at the local
level. The State Health Planning and Resources
Development Agency in North Dakota has five goals:	(1)
optimize health and prevent disease? (2) promote health
problem identification and diagnosis and treatment? (3)
treat health problems with a full range of health cars
services in an economical manner; (4) provide long-term
management of health problems; and (5) devise mechanisms
for consumer and professional audit. Health priorities
and purposes and use of the health systems plan frameworkPUBLISHED PLAMS
Page 656
in North Dakota are delineated. The guidelines pertain to
the following aspects of the health service system,
special services/ secondary services/ primary services/
and emergency medical services. Consideration is given to
other major health system components/ including manpower/
financing/ education/ quality/ system monitoring/
government controls/ and annual implementation of the
health systems plan. (NTIS)
Reference:
iisal-tlj Easiliiifis Eessaicb and El^oniniia. Eliass 1	- Salk
Frankfort:	Health Facilities Program/ Kentucky Dept. of
Health/ Aug. 1972.
A regional approach to health facilities planning/
developed by the Kentucky State Department of Health in a
demonstration project in one of Kentucky's 15 planning
regions, is documented. The planning criteria and
concepts presented are based on a comprehensive evaluation
of the	areas of consideration for health facility
planning. The basic concept is that of levels of carePUBLISHED PLANS
Page 657
primary/ secondary/ and tertiary. At each level there are
different ranges of services and support elements needed
to deliver care. Interrelationships among the levels are
established within the framework of comprehensive health
services delivered through a regional network. This
service network supports health care in the areas of joint
and shared facility support/ manpower availability/ and
health services access. The design of the system is
determined by considering social/ economic/ and cultural
factors of the existing delivery organization and by
forecasting future delivery needs. The optimal regional
network satisfies all elements of the levels of care
criteria and also takes into consideration the expected
service area/ the demography of the service area/
availability of manpower resources/ the distribution and
nature of existing facilities, existing patterns of
utilization, and avialability of construction and
operation financing. The use of outpatient services and
other alternatives to acute inpatient care is recommended
for the health care network. Before additional
expenditures for new facilities are contemplated,
efficient use should be made of existing facilities. When
capital improvements are required, the following
considerations should be taken into account: creation of
the least expensive facility consistent with the level of
care required; elimination of elements of constructionPUBLISHED PLANS
Page 6S8
cost not essential in providing care? and inclusion of
new techniques of design and construction to minimize
construction costs. The application of the planning
criteria in the Lake Cumberland Region is described. Th<?
case study involved a complete regional analysis and a
health inventory, supplemented by consumer and provider
surveys. Recommendations for health needs were made, and
a corresponding plan for health facilities was developed.
Data from the case study and a bibliography are included.
(NT IS)
Reference:
ii£iU-Lh in laD££S5££i A Slaiislical Dxslallsh ifidliico Ha*
21x
Nashville:	Office of Comprehensive Health Planning,
Tennessee Dept, of Public Health, July 1975.
A comprehensive health plan is presented for
Tennessee which establishes health goals and policies for
the State, notes general trends in health care delivery in
the State and in the Nation, and surveys the four generaL
areas of health problems, health services, healthPUBLISHED PLANS
Page 659
resources, and health financing. Narratives are provide!
for the nine Tennessee planning and development regions.
The chapter on health problems addresses accidents, dental
problems, chronic and communicable diseases, mental health
problems, and birth defects. The discussion of health
services includes preventive, curative (primary),
institutional, and rehabilitative care. The health
resources section deals with manpower, facilities, and
financing. Summary data on the status of these areas in
the State are given, and conclusions and recommendations
for improvement are offered. (NTIS)
Reference:
fls-alili EIadi £h*)2i£i:s i ^ 2x
Ogden, Utah:	Weber Basin Health Planning Council, March
1975.
A health plan is formulated f
(Weber, Morgan, and Davis Coun
identification of existing facilit
future needs. Acute care cente
care centers (nursing homes), and
or the Weber Basin Area
ties) of Utah based upon
ies and projection of
rs (hospitals), extended
special facilities arePUBLISHED PLANS
Page 650
assessed with regard to occupancy rate, staff/ services,
inpatient beds, source of payment, and patient origin.
Recommendations are made on the assumptions that. (1)
conditions such as population trends, economic conditions,
etc., in the Weber !3asin area in 1930 will substantia 11 y
correspond to present-day conditions; (2) patient days
will tend to increase or decrease in each county in direct
proportion to age—specific population changes; (3) each
of the individual county recommendations will assume an
optimal occupancy rate of 85 percent; (4) patient days
for noncounty residents will increase or decrease at the
same rate as patient days for county residents; and (5)
the average lenght of stay will remain at the present
minimum level. It is not contemplated that this plan is
in its final form. With the attainment of new plateaus of
information and the expansion of goals and initiation of
programs, the plan and the programs resulting from it will
find themselves in a state of continual change. (hTIS)
Reference:
Ilaalil	.GflalS 2l £U21Ll iSfLSLBQd 2Qd lkU<3
coiammsnisl - CflaaxaliansiJig. Kfiallb Elan lax liia Iscxilat*
aI EuaauPUBLISHED PLANS
Page 651
Agana:	Office of Comprehensive Health Planning, Guam
Dept. of Public Health and Social Services, Aug. 1972.
The second and third components of Guam's
comprehensive health plan are devoted to a description of
the health care resources in the territory and to
guidelines for health policy and action. The latter
section expands upon health problems outlined in the first
component of the plan, and offers a discussion of goals,
objectives, and means for solving health problems. The
document opens with an overview of the health care
delivery system, followed by detailed information on:
health care manpower, training and financial aid programs;
professional licensure and registration laws; and
civilian and military ambulance use and coordination.
Attention is given to availability of services, inpatient
facilities, and health care financing. An index of health
services and resources in Guam as of May 1972 is provided.
The policy section lists priority health problems,
including environmental problems, accidents, communicable
disease, chronic disease, mental health and social
adaptation, dental health, physical and mental impairment,
reproduction and development, and nutrition. Detailed
assessments are presented of the following major health
problems in Guam: diabetes; leprosy; venereal disease;PUBLISHED PLANS
Page 662
the need for public health education? drug abuse;
tuberculosis? and consumer and environmental protection.
In these problem areas/ goals, objectives, and action
strategies are set forth as a guide for health policy. A
glossary, supporting tabular data and graphs, and maps are
provided. (NTIS)
Reference:
fiaallb 2&0-U3 Qeysiamasni EldB/
Roanoke:	Roanoke Valley Health Services Planning Council
Inc., 1972.
Findings are presented of a feasibility study on the
organization and delivery of comprehensive health care
services in a six-county area of Virginia and an adjacent
three-county area of West Virginia. A comprehensive
health care delivery system was to be designed to meet the
health needs of the area, and specific points to be
considered in the plan are: the identification of the
boundaries of the catchment area to be served? the
recommendation of ways to better utilize existing health
resources? the development of plans for supplying healthPUBLISHED PLAMS
Page 663
facilities, services, and manpower to satisfy both present
and future needs; the assessment of the accuracy,
consistency, and feasibility of such plans in comparison
to plans from other regions; and the recommendation of
methods for the analysis, organization, delivery, and
evaluation of health services in the catchment area.
Recommendations for both State areas are made, and
methodologies used in the development of the plan are
presented. Perceptions of health status, resulting from a
household survey, are provided, and health facilities and
services are inventoried and analyzea. Perceptions of
need for health facilities, services and manpower are
presented separately for each State area. Implementation,
evaluation, and follow-up data also are provided. (NTIS)
Reference;
ilaalih iyaiaas Elan,
Fort Wayne, Ind.; Region Three Comprehensive Health
Planning Council, Inc., 1975.
An overview of Indiana Region Three Health Planning
Council systems planning is provided. The component partsPUBLISHED PLANS
Page 654
of the plan document that provide long-range health goals
are delineated/ and a description is provided of the
Council's information system and of a regional health need
assessment. Appendix 1 presents a flow chart for the
information system of Region Three and a chart on
maintenance of the information system. Appendix II lists
the top 50 health care problems within the Region/ most
important among which are the inadequacy of the solid
waste disposal systems throughout the Region/ inadequacy
and maldistribution of primary health care personnel, and
excessive cost of certain health care services/
appliances/ and products. (UTIS)
Reference:
lifisillii 2.1210.31 s Elan Annual Imalsfflsnialian Inn Ana 1
AnJinnsaa/
Russellville:	West Arkansas Health Systems Agency Inc./
1977.
The West Arkansas Health Systems Plan (HSP) is d
detailed statement of quantified goals and objectives
which respond to identified needs and describe desiredPUBLISHED PLANS
Page 665
achievements in the health status of the residents «and in
the health care systems within the area served by a health
systems agency. The goals consist of improvements in the
availability/ accessibility, cost, acceptability,
continuity, and quality of health care. The Western
Arkansas Annual implementation Plan (AIP) is a statement
of quantified objectives to be accomplished within one
year. AIP objectives relate to high priority objectives
of the HSP. AIP objectives are based on: cost/benefit
considerations; identified unique needs of the area;
health systmes impact; feasibility.; and health status
improvement. (NTI5)
Reference:
Hsalili ovstems Plan and Amniai XuinlsJisiiAalioQ Eliaux Aimi!
1211,
Buffalo:	Health Systems Agency of Western New York, Inc.,
1977.
The Western New York Health Systems Plan (HSP) is a
detailed statement of quantified goals and objectives
which respond to identified needs anu describe desiredPUBLISHED PLAN'S
Page 666
achievements in the health status of the residents and in
the health care systems within the area served by a health
systems agency. The goals consist of improvements in the
availability, accessibility, cost, acceptability,
continuity, and quality of health care. The Western New
York Annual Implementation Plan (AIP) is a statement of
quantified objectives to be accomplished within one year.
AIP objectives relate to high priority objectives of the
HSP. AIP objectives are based on: cost/benefit
considerations; identified unique needs of the area;
health systems impact; feasibility; and health status
improvement. (NTIS)
Reference:
Galana Elan and Annual lanlaaenlaiian Elan/
Rochester:	Finger Lakes Health Systems Agency, Jan.
1977.
Health goals for the nine-county region served by the
Finger Lakes Health Systems Agency in Rochester, New Yotk,
are documented in a health systems plan, and short-range
objectives are presented in an annual implementation planPUBLISHED PLANS
Page 667
for the region. The health systems plan opens with a
description of the work of the Finger Lakes Health Systems
Agency and a review of the characteristics and health care
resources of the Finger lake region. Health status goals
and long-range objectives are then presented relative to
leading causes of death in the region. The remaining
sections of the plan concern primary care; hospital care?
chronic care? mental health, mental retardation, and
alcoholism; and environmental health. Each section
contains information on the availaDi1ity, accessibility,
and cost of services; states principles to guide the
planning and delivery of services; and sets forth goals.
The annual implementation plan of primary care services
areas, the development of stratified systems of care
linking hospitals in the region, the development of a
regional plan for computerized transaxial tomography
equipment, the development of a community health plan
methodology for use in a ratesetting experiment, and the
identification of criteria concerning home care. (NTIS)
Reference:
A Ufialiti	Elan teLlhzm Indiana*
South Bend:	Northern Indiana Health Systems Agency, Inc.,
tPUBLISHED PLAN’S
Page 668
Aug. 1977.
The Northern Indiana Health Systems Plan (HSP) is a
detailed statement of quantified goals which respond to
identified needs and describe desired achievements in the
health status of area residents and in the health systen
within the area served by the planning agency. The goals
cover a variety of health services categories and are
based on an analysis of needed improvements and
alternatives for achieving them in the various settings of
service delivery. The goals are directed toward
improvements in availability/ accessibility/ cost/
acceptability/ continuity/ and quality of health care.
Five year objectives are set for high priority goals.
Long-range recommended actions necessary to accomplish the
objectives are also specified. Resource requirements
derived from alternative long-range recommended actions
are indicated/ as appropriate/ for manpower/ financing/
equipment/ and facilities/including the type and number of
beds and services. (NTIS)
Reference:
PUBLISHED PLANS
Page 669
itealUi Sisiaaa Elan io£ SIslsia £dJ Imasnial Cauniia^'
San Diego:	Comprehensive Health Planning Association of
Imperial, Riverside and San Diego Counties, 1976.
A health systems plan (HSP) for Imperial and San
Diego Counties, California is presented by the
Comprehensive Health Planning Association of Imperial,
Riverside, and San Diego Counties. The HSP represents the
foundation upon which decisions regarding health services
and facilities planning in the two counties will be made
in the future. An introductory chapter describes in
general the health system envisioned for the area by 1981.
Trends in the delivery of health care are noted, and the
effects of social changes, political views, and other
factors influencing the delivery of health care are
considered. Demographic and other data necessary for
formualtion of component subgoals and objectives are
presented, and specific subgoals and objectives are stated
in the following areas:	community health education,
ambulatory care, acute care, long terra care,
rehabilitation, home care, quality of care, and
environmental health, among others. Four major areas of
service — general acute hospitals, acute psychiatric
hospitals, skilled nursing facilities, and intermediate
care facilities
are examined in the 1976
health care.Page 670
PUBLISHED PLAN’S
services and facilities plan for the two counties. 3e1
needs and utilization are analyzed by county and by
individual health servcie areas. Alternative means for
implementing each objective are presented/ providing the
basic framework for the 1976 work program. The HSP for
Riverside County and appendices containing guidelines for
the organization and delivery of selected health care
services in the planning area are presented in separate
volumes. (NTIS)
ilfi-allli SysIses Elan Ion	llaho.*
Pocatello:	Subarea Health Council Region/ Southeast Idaho
Council of Governments/ July 1975.
The background and status of health planninq in
southeast Idaho are documented in the first health systems
plan produced by the Subarea Health Council and sponsored
by the Southeast Idaho Council of Governments. Purposes
of the plan/ the state of health of the region/ and goals,
objectives, and priorities are discussed in both general
and specific terms, and evaluation and implementation
are Drovided. Major goals oet Lorth in the planPUBLISHED PLAN’S
Page 671
are: (1) provision of needed preventive diagnostic
treatment, rehabilitation, and custodial care programs to
assure the best possible physical and mental health for
ail citizens; (2) achievement of a quality environment
conducive to good health; and (3) development of a basic,
effective and economical health delivery system available
and accessible to all citizens, with a comprehensive,
coordinated, specialized health facility and delivery
system within the region. The seven-county area for which
the plan was developed is characterized as sparsely
populated but united by geographic, social, cultural,
economic, and political factors. The plan documents
resources and needs in the specific areas of acute
hospital care, special inpatient care, long-term care
facilities, outpatient care, home health services, public
health services, school health facilities, emergency
medical services, environmental health services, mental
health services, veterinary serevices, and allied health
education. Appended documentation includes a resolution
in support of the reorganization of the Southeast Idaho
Health Planning Council to seek Suoarea Health Council
status, bylaws of the Subarea Health Council, the
executive order establishing Idaho health service areas,
anu details of an attitude survey undertaken in the
determination of goals and objectives. Supporting tabular
data are included. Portions of this document are notPUBLISHED PLANS
Page 672
fully legible. (NTIS)
Reference:
Hs-allh attains £ian Guilius,
Birmingham:	Association of Health Planners of Alabama,
1976.
An outline of a health systems plan is presented,
based on developmental work conducted by health systems
agencies (HSA) in the State of Alabama and the State
Health Planning Agency. The legal sanction for and
physical characteristics of a health systems plan are
noted, as well as demographic and socioeconomic
indicators. A description of health status and a health
system is presented that incorporates four basic elements:
(1) indicators of health status (vital events, disease
incidence, and functional disability); (2) indicators of
the prevention of ill health (direct and indirect
prevention); (3) indicators of the medical care syste/n
(ambulatory services, inpatient care, home care,
rehabilitation, and health maintenance organizations);
ano (4) indicators of the mental health system (preventivePUBLISHED PLANS
Page 673
care/ ambulatory services/ and inpatient care). A health
sytems plan must include health status/ prevention of ill
health/ medical care/ and mental care components. Health
system goals and minimal data base are delineated in
relation to these components. (NTIS)
Reference:
Hfi-alih	Elanniim/
Columbia:	Mic-Missouri Areawide Comprehensive Health
Planning Agency/ Inc./ 1976.
A comprehensive health plan is presented for the
eight counties served by the Mid-Missouri Areawide Health
Planning Agency. The document uses a four-unit format/
with each section composed of need-identification
statements/ goals/ objectives/ and recommendations. The
recommendations stated under each objective provide a
basis for action steps necessary in a work program for
health planning. The planning document explores 10 basic
areas of the health care delivery system:	acute care/
ambulatory care/ chronic and convalescent care/
community-based health services/ data management/ dentalPUBLISHED PLANS
Page 67 1
health, emergency medical services, environmental health,
health education, and mental health. A data profile for
the Mid-Missouri area is provided, included information on
population characteristics and trends, migration, race,
age, education, income, mortality, fertility, and
morbidity. A brief review is included of the historical
development of comprehensive health planning, the planninq
philosophy behind Mid-Missouri's efforts, the plan
development process, and the approach taken to evaluating
and revising the plan. Appendices include previously
published policies of the agency in reyard to project
review, inpatient bed needs, plan development procedures,
and community health services development. (NTIS)
Reference:
EldQ
Denver:	Colorado Dept, of Health, Div. of Comprehensive
Health Planning, Dec. 1975.
The health systems
Colorado's Department of
plan framework developed by
Health is described. Two major
objectives of Colorado's
health systems
plan
arepublished plans
Page 675
delineated: (1) facilitate the identification of problems
and needs in the health system in Colorado; and (2)
provide a base in the conduct of review activities for
capital expenditure proposals (Section 1122 of the SociaL
Security Amendments and the State Certificate of Need law)
and for local, State, or Federal plans and policies
affecting the health care delivery system in Colorado. An
overview of the health system is provided, and the health
services component of the system is discussed. Primary
services are identified as acute ambulatory care,
preventive and maintenance care, referral services, and
emergency medical services. Intermediate services include
general hospital acute inpatient service, long ter«
nursing care, hospital-based support services, alcohol
abuse, convalescent services, drug abuse, facilities for
the mentally retarded and developmentally disabled,
geriatric services, home health services, mental health
services, outpatient surgery centers, rehabilitation, and
resioential care services. Specialized services are noted
as computerized axial tomography, end-stage renal diseas*
services, radiation therapy, high risk perinatal care,
burn care, cardiac surgery, blood banking and processing,
cardiac catheterization, newly developed equipment,
special laboratory services, and neurotrauma centers.
Other components of the health system are discussed which
involve manpower, financing, education, planning, qualityPUBLISHED PLA.'JS
Page 676
control/ system monitoring/ and governmental controls.
Provisions of the annual implementation plan foe
Colorado's health systems plan are outlined. (NTIS)
Ref erence:
Francis M. Henderson/ and Belle SpatZ/
CfiiaiBUDiiiL	£*£i£ias Hfisian Qntli££z.
Little Rock:	Arkansas Health Systems Foundation/ June
1973.
The planning framework for a comprehensive health
care system for the new town of Maumelle/ Arkansas is
presented by Arkansas Health Systems Foundation for the
Maumelle Land Development/ Inc. The core framework for
the community health design is illustrated by a flowchart/
and health services needed in the new town are shown by
projected populations from 1973 through 1977. Estimated
costs are outlined/ and the program objectives of the
health delivery system are detailed. Among these are:
the development of a comprehensive health care syste.*
which is regionally integrtaed within the fraatework of
facilities and services available in the metropolitanPUBLISHED PLANS
Page 677
area; development of a responsive health system which
relates to other community activities, programs and
organizations? provision of appropriate health and
medical services accessible to ail in the community
(fee-for-service basis, prepaid group practice); and
provisions of opportunity for private practitioners -
medical and dental - to practice in village centers. It
is believed that five existing hospitals in the Greater
Little Rock area will serve as regional medical facilities
for vaumelle. Recommendations for introduction of basic
medical services on a time schedule basis are made for a
five-year period, and it is suggested that a consultant
explore the various possbilities of health care delivery.
It is expected that a mature health care system in the new
town would encompass: primary care, specialized care,
emergency care, environmental care, and preventive care.
Portions of this document are not fully legible. (NTIS)
Reference:
Idjiia Slain Hsiiliti £laoz.
Boise; Idaho Governor's Advisory Council on Comprehensive
Health Planning, July 1972.PUBLISHED PLANS
Page 678
A health plan for the State of Idaho is presented by
the Governor's Advisory Council on Comprehensive Health
Planning in the following format: (1) a statement of
concern regarding a health problem or issue determined by
the Council to warrant planning priority; (2) a statement
of goals regarding the health problem; (3) a resume and
discussion of all substantive recommendations adopted by
the Council pertinent to the problem; and (4) an impact
statement relating to the effectiveness or lack of
effectiveness experienced to date (i.e., July 1972) in
implementing the Council's recommendations. Health
problems and issues are thus examined in the following
areas: public health, mental health, health services in
rural areas, health needs of the socioeconomically
disadvantaged, dental health, health manpower,
environmental quality, health facilities, an)
comprehensive health planning. Portions of this document
are not fully legible. (MTIS)
Reference:
lanlsoinniatinn ELiani Enlim and EnonadJinea,
Milwaukee:	Southeastern Wisconsin Health Systems Agency,
Inc., 1976.PUBLISHED PLANS
Page 679
Guidelines to be followed by the Southeastern
'Wisconsin Health Systems Agency (HSA) in developing its
annual implementation plans in accordance with the
provisions of the National Health Planning and Resources
Development Act of 1974 (P.L. 93-641) are presented. The
rationale behind the agency's implementation planning
function is set forth/ with reference to excerpts from
P.L. 93-641. The annual implementation plan is defined,
and its purposes are enumerated. Steps in tins
implementation planning process are outlined, including
activities involved in initiating, developing, adopting,
and modifying the plan. Descriptions of preliminary staff
activities (formulation of project design, data analysis,
formulation of draft implementation plan) and of elements
to be included in the annual implementation plan are
provided. Procedures for notifying the public during the
course of the planning process are outlined. Limitations
and safeguards relative to the annual implementation plan
are stated. A timetable and an activity flowchart are
included. (NMS)
Referenc e:
Eaniaaa Stale. Elan Lor Esaim SiuMatE/PUBLISHED PLANS
Page 680
Helena: Div. of Planning and Resource Development,
Montana State Dept. ot Health and Environmental Services,
Aug. 1973.
Problems discussed in the Montana State Plan for
Health are listed and objectives and sub-objectives
adutessinq each problem are enumerated. The following
problems are considered:	(1) lack of emphasis on
preventive health services; (2) under-estimation of
health education as an integral part of the health care
delivery system; (3) unavailability of primary and
emergency medical services; (4) lack of a uniform minimum
level of local	public	healtn services;	(6)
under-utilization of existing health resources; (6) lacc
of emphasis on home health care as an alternative to
institutionalization; (7) lack of uniform strategy for
assessing development and implementation of mental healtn
services; (3) inadequate coordination of alcoholism and
drug abuse planning and administration; (9) insufficiency
of primary health care providers; (13) maldistribution of
physicians and other health manpower; (11) inability o
some areas to attract a resident physician due to
insufficient population bases and/or lack of amenities for
the physician or his family; (12) under-representation of
racial minorities in the health professions; (13)
PUBLISHED PLANS
Page 681
inadequate coordination of health manpower utilization/
(14) limited coordination of health facilities offering
all levels of care; (15) uneconomic overlaps in existing
services; (16) failure of National legislation to reflect
needs of rural populations; (17) proliferation of
environment related health problems; (13) unavailability
of health	services to off-reservation			Indians; (19)
inadequate	health-related data;	and	(20)	high cost of
health car	e as a barrier to	the	rece	ipt of medical
services.	(NT IS)			
Reference:
Hexada	Elan Ian iiaalilit laluaa one; siale
SaiEEifiiiSDsiiLe Eaalib zianniaa*
Carson City:	Advisory Council, Neveada State
Comprehensive Health Planning Office, July 1975.
Goals, priorities, rationale, background and
recommendations are presented for major health issues in
the first volume of the Nevada State Plan for Health. The
document opens with a statement of the purpose of thg
plan, a description of the authorities
under which thePUBLISHED PLANS
Page 687
plan was developed, a brief outline of the methodology
employed in creating the plan, and an explanation of the
organization of the plan document. The plan addresses the
following health issues as they relate to the citizens of
Nevada: health education? personal preventive services
(nutrition, communicable disease control, health
screening, family planning, prenatal care)? environmental
health (noise pollution, consumer health, food and dru<g
sanitation, vector control, radiological health,
pesticides, accident prevention, land use planning, air
quality control, water quality management, solid waste
management, housing); public health; physical health
care services (dental health care, vision care and
services to the blind, catastrophic illness, emergency
medical services, home health and homemaker care services,
and speech, language, and hearing services); health
facilities and manpower; and volunteer health services.
Each health issue is given a priority rating of very high,
high, moderate, or low, based on a correlation between
identified needs and available resources. The statement
of rationale defines the health needs in regard to the
issue, the impact of unmet needs on the Nevada population,
and the benefits to be derived froai health services
designed to meet those needs. The background discussion
for each issue explores further the relevant needs and
resources. Recommendations, both long and short range,PUBLISHED PLANS
Page 683
specify ways to achieve stated goals. Where possible*
time limits are noted in the recommendations. (NTIS)
Reference:
Elan 1st JLnsuaimiUf E&allli in Nfliih ilaairnl laxas*
Arlington:	Regional Health Planning Council of the North
Central Texas Council of Governments/ Mar. 1975.
A community health plan in which high priority is
assigned to the areas of health education/ communicable
disease control/ chronic disease control, health screening
services/ and organizational and delivery considerations,
is summarized in tabular format. The plan was developed
to meet the most critical needs of a 16-county area of
north central Texas. Goals/ objectives, strategies, and
implementation and evaluation measures are outlined.
Objectives include: improvement of health education
programs; provision of comprehensive nutrition services
to 75 percent of high-risk residents of the region;
provision of information necessary to reduce injuries,
disabilities, and deaths due to accidents; raising
immunization rates (polio, diphtheria, whooping cough.PUBLISHED PLANS
Page 684
tetanus/ measles/ rubella and mumps) to 60 percent of tna
preschool population by 1978? lowering incidence of
gonorrhea by 40 percent and syphilis by 20 percent by
1978? increasing physical examinations for detection of
chronic disease? coordination of agencies assisting
chronically ill patients? increasing the number of
persons in target groups covered by periodic multiphasic
health screening? achievement of 90 percent followup rate
on positive screening tests? extension of basic services
to 10 counties presently without health departments?
anticipation of changes in health care financing (national
insurance) and appropriate response? improvement of
operating efficiencies of community agencies? and
completion of studies relating to expansion of regional
laboratory facilities/ merger of services/ and health
personnel. (M7IS)
Reference:
Ulan let liejlfhi £hisiciil U.s.allh HflaaansDi*
Eureka/ Calif.:	NorCoa Health/ 1972.
Overall goals and priorties of an areawide healthPUBLISHED PLANS
Page 685
plan developed for the northern coast area of California
are detailed. Elements of the plan's framework include
the following; (1) goals or statements in broad terms on
the values and expectations of a community concerning the
desirable health status of its residents and the
configuration of that community' health delivery system?
(2) identification of health needs; (3) priority setting
among needs; and (4) recommendations for action. The
areawide plan for health evaluates health programs in viaM
of existing and future health needs and makes
recommendations for improvements. It estabishes areawidi
priorities in response to legislative mandates/ in
collaboration with local groups. The plan establishes
broad planning guidelines for use by health planning
bodies and decisionmakers and insures that local agencies
and private and voluntary organizations continue to plan
for specialized programs. Data on regional priorities for
the promotion of optimal health and well-being are
provided. To facilitate the plan's use/ the personal
health component is subdivided into three areas; physical
health/ mental health, and mental retardation and
developmental disabilities. Major changes affecting
medical care systems are noted, as well as the elements of
such systems. Priorities are identified for tha
communities included in the plan's jurisdiction. General
and health-related information on the northern coast areaPUBLISHED PLANS
Page 686
of California is included. (NTIS)
Ref erence:
Eeaiaiial SLamatetisnsiys Msaltii £1 an,
Lewiston, Maine:	Tri-County Health Planning Agency, 1975.
A comprehensive health plan is presented for the
three counties comprising the region served by the
Tri-County Health Planning Agency, Inc.	The region
includes 13 percent of Maine's total land area and 16
percent of the population. The twin cities of Lewiston
and Auburn are the major urban center;	two of the
counties are primarily rural in nature. Section I of the
plan describes the Agency, the plan, and the planninq
methodology.	Section	II	presents	regional
characteristics,	Including demographic	information:
social, economic, and heath status indicators; and health
resources highlights. Section III sets forth goals and
objectives relative to social issues impacting on health
status, nealtn services delivery, and environmental
health. Section IV presents findings and recommendations
resulting from a consumer health survey, task forcePUBLISHED PLANS
Page 687
efforts, and public meetings. The findings are presented
by generic designation/ i.e./ acute care/ ambulatory care/
dental health/ emergency medical services/ maternal and
child health/ mental health/ nutrition/ problems of tha
aging/ rehabilitation/ and vision/ speech and hearing;
and by functional area/ including administration/
education/ manpower/ transportation/communication/
prevention/ facilities/ legal reform/ financial/ services/
and feasibility studies. Section V presents seven
recommendations for action/ which comprise a program
design developed from functional areas. Appendices
include supporting tabular data/ task force materials/ the
consumer health survey questionnaire/ and a glossary of
health terms. (NTI5)
Reference:
Esaiaaal Esal-tii Lacilliiss ELatu An Aid	Lang flauae
El£imi££s
Tulsa/ Oklahoma; Tulsa Area Health and Hospital Planning
Council/ 1975.
A regional plan is presented to guide and promote thePUBLISHED PLANS
Page 680
development of a coordinated system of health facilities,
resources, and programs for the three counties comprising
the Tulsa, Oklahoma, health planning area. The plan
presents information on the population of Creek, Osage,
and Tulsa Counties; on the changing health needs of tha
population; and on the resources available or being
planned to meet those needs. Criteria and standards to be
applied by the Tulsa Area Health and Hospital Planninq
Council in its planning and review efforts are summarized.
Gaps between existing and required hospital facilities and
services are identified, and strategies for closing the
yaps are recommended. The plan outlines several
approaches for exploring the regionalization of health
services on a voluntary basis and recommends that
possiblities for expanding ambulatory care and other
outreach services in hospitals be considered. A policy of
discouraging the construction of additional hospital
facilities in the area is stated. It is noted that
approval will be limited to construction proposals that
foster closer relationships among health care institutions
and agencies, that expand or provide basic health services
to underserved groups, that incorporate mechanisms for
containing costs without jeopardizing quality, that reduce
the capacity of close underused obstetrical facilities, or
that eliminate unnecessary duplication of expense an!
specialized services. It is also recommended thatPUBLISHED PLANS
Page 689
amendments be sought to State regulations requiring all
hospitals to provide obstetrical services and that the
capacities of hospitals serving rural communities be
upgraded. Statistics are included. (NTIS)
Reference:
Easiacal aaaliti sustains Elan Ian iiatiliaaslatQ
Eauca^l^aDia/
Avoca/ Pennsylvania:	Health and Hospital Planning Council
of Northeastern Pa.y 1976.
A re	yional	neal	th sys	te	ms	plan	for	the developm	ent	of
health c	are servic		es in		nor	theas	tern	PennsyIvan	ia	is
described	. A basic		assump	ti	on	of t	he	plan is th	at	an
effective	and effici		ent he	al	th	servi	ce system will 1		ead	to
an improv	ement i	n th	e heal	th	of	the	?opu	iation. A	mod	el
of a re	gional	hea	1 th s	ys	tem	is	pres	ented. This	mod	e l
describes	the or	gani	zation	0	f a	reyi	onal	health syst	em a	nd
contains	recoium	enda	ti ons,		on	how	to	achieve improv		ad
health	care	serv	ice	or	gan	izati	on	in northe	aste	r n
Pennsylva	nia-	Planning		fc>0	sit	ions	are	delineated	wh i	ch
have been	adop te	d by	the P	ennsylvani			a Bo	ard of Health and		PUBLISHED PLANS
Page 690
Hospital Planning Council. The planning positions expand
upon certain recommendations made in the model. Planning
positions in the areas of long-term care services/ acuta
care and raedical/surgical services, obstetrics,
pediatrics/ and emergency medical services provide
detailed gualitative and quantitative standards to
determine the need for these health services. Planninq
positions also provide guidelines to assist providers in
the planning and development of needed health services and
criteria to review and evaluate proposals. Additional
planning positions for health systems areas are under
development, such as radiation therapy, end-state renal
disease, mental health, and ambulatory care services.
Health status indicators are used to project 1980
objective health levels, and information is provided on
health system goals, indicators, and objectives. A
profile of the health sytems area in northeastern
Pennsylvania is included, with tabular presentation of the
area's vital statistics, health status, income and
employment, health care costs, death rates from various
diseases, average number of bed days, and number of
physician visits. Portions of this document are not fully
legible. (NT IS)PU3LISHSD PLANS
Page 591
Reference:
E&£2£l q1 iha Easiaaal Elao EasiDlaonisni lask E2LS2 2q
Eriaao: iLs^ltii £ai£ i£2§i Ad initial Elan £21: MaalaxQ
Haiti laxi*
Buffalo:	Comprehensive Health Planning Council of Western
N.Y., June 1975.
Recommendations are presented for the development of
primary health care services and resources in the seven
counties served by the Comprehensive Health Planning
Council of Western Hew York. The recommendations are the
product of an 13-month effort by the Council's Plan
Development Task Force on Primary Health Care that
included a review of the health status of the population
and an analysis of the health care system itself. The
report includes study findings on eight characteristics of
primary health care: availability, accessibility,
acceptability, affordability, coordination and continuity,
quality, accountability and evaluation, and economy,
efficiency, and effectiveness. Included in the analysis
are the following primary health care resources: priroary
care physicians, physician extenders, emergency rooms,
hospital outpatient departments, county health
departments, occupational medicine, and other health care
professionals. The report includes a graphicPUBLISHED PLANS
Page 692
representation of primary care and establishing objectives
within the above eight characteristics of primary care are
descirbed. In addition to the statement of primmary care
objectives and the narrative sumary of findings relative
to each of the eight characteristics, the report presents
guidelines for planning and operating primary health care
services and criteria for the establishment of primary
care centers in the region. Appended materials include a
discussion of methodology for determining the number of
physicians needed for primary care, information on the
index of medical underservice used in the study, and
statistical profiles for each county. Portions of this
document are not fully legible. (NTIS)
Reference:
Slain Annual InialSBisnialion Elan Ian 121&*
Denver:	Division of Comprehensive Health Planning,
Colorado Dept. of Health, Jan. 1975.
The 1976 health implementation plan within Colorado's
health systems plan framework is discussed. The primary
objective of the health systems plan framework is toPUBLISHED PLANS
Page 693
provide a base for the conduct of review activities
pertaining to capital expenditure proposals (Section 1122
of the Social Security Amendments and the State
Certificate of Need law). The major purpose of the
implementation plan is to summarize the health systems
plan framework and make it a more workable document- The
annual implementation plan for 1976 lists goals and short
term implementation recommendations for various health
services and established priorities for action among these
recommendations. The following priorities are identified
for 1976: general hospital acute inpatient services,
computerized axial tomography, high risk perinatal care,
and burn care- In 1977, emphasis will be placed upon
emergency medical services, long term nursing care,
specialized cardiac surgery, dental care, and home health
services. Major problems that may affect the
implementation of recommendations and further plan
development are identified- Appendices provide background
information on the development of Colorado's health plan
framework and activities of the Colorado Division of
Comprehensive Health Planning- (NTIS)
Reference:PUBLISHED PLANS
Page 694
2i.aJL£ Qsm2L£h£nsiy.2. itealth Elan 1st iLaaaii-
Honolulu:	State Advisory Council for Comprehensive Health
Planning, Hawaii State Dept. of Health, 1975.
The first edition of the State Comprehensive Health
Plan for Hawaii addresses selected priority health needs
for the counties of Hawaii, Kauai, and Maui. Of the city
and county of Honolulu, only windward Oahu is dealt with,
due to lack of funds. In the introductory chapter, the
planning process is discussed and planning participants
are identified. Subsequent chapters include:	a statement
of the missions and goals for the State Advisory Council
and the Windward Health Planning Council; a discussion of
the rationale behind planning area designation; and
descriptions (geography, population, health status, health
resources, political structure, economy, etc.) of each
area and of the State as a whole. Existing programs,
problem areas and needs, objectives, and recommendations
are described in detail for each of the following:	early
detection and screening; outpatient services; dental
services; ambulatory services; venereal disease
services;	health education; nutrition services;
emergency medical services; substance abuse services;
long-term care; and specialty services (olood banking,
burn care, oncology - radiation, open-heart surgery, organPUBLISHED PUNS
Page 695
transplant/ perinatal care/ poison control, and renal
dialysis). Each service is discussed separately for each
geographical area in which the service exists or is being
planned. Tabular data, graphs, and naps are incorporated
in the text. (NTIS)
Reference:
21 £)2ii2J:aiiensiide Haallh LUn 1225,
Columbia:	South Carolina State Dept. of Health and
Environmental Control, 1975.
The South Carolina Comprehensive Health Plan is
designed to (1) identify health problems in the State, (2)
set priorities for solving these problems, (3) identify
methods of addressing them, (4) make cost-effective
recommendations, and (5) recommend organizational
arrangements for solving health problems. An overview of
the State is presented, and the steps involved in the
planning process outlined. Broad health goals are to
reduce the suffering, disabilities, and deaths resulting
from limited availability of preventive, diagnostic and
curative attention, accidents, and trauma; and toPU3LISHKD PLANS
Page 696
maintain the health and comfort of the aged and the
mentally or physically infirmed. Health care costs
related to man-hours lost from the job, of illness
prevention/ diagnosis/ treatment and rehabilitation should
be minimized. Lastly/ handicaps from sight/ speech and
heating defects should be reduced/ and actual loss of
sight, speech and hearing should be prevented. A list of
health priorities is provided. Projected health needs ace
summarized for South Carolina in terms of hospital beds,
long-term care beds, emergency medical services, health
professionals, and ambulatory canters. The report
concludes with an evaluation of the original comprehensive
health planning goals and a summary of plans of health and
health related organizations in the State. Portions of
this document are not fully legible. (NTIS)
Reference:
Siaismsni of Msallb Issues is bs AxJdissssii b^ m^i ilsslib
Elsas,
Philadelphia:	Government Studies and Systems, Inc., Nov.
1974PUBLISHED FLAN'S
Page 697
Heaith issues to be addressed by local health
planning agencies are identified in a technical aid for
health planners developed for the Division of
Comprehensive Heaith Planning/ Department of Health/
Education/ and Welfare. Following a review of legislation
relating to local health planning and a discussion of
basic assumptions and definitions/ listings of health
status issues and health system issues are presented.
Health status issues are classified as dysfunction/
morbidity/ combined dysfunction and morbidity/ and risk.
Health system value issues include: availability/
accessibility/ and acceptability; continuity of care;
quality of care; service integration; and economic
feasibility. Related technical issues and information
questions are enumerated for each value issue. In
addition/ issues which a health plan should address/ but
which are not solely within a local agency's jurisdiction/
are identified/ including: legislative issues; research
issues; and related systems issues/ such as education/
welfare/ housing/ transportation/ and protection.
Appended materials include an outline of planning issues
linked to the project review function; information on
health status class if icatior.; examples of organizing
principles of health care delivery components; and
guidelines for selecting health system taxonomies. (MTI3)PUBLISHED PLANS
Page 698
Reference:
«
Stewart C. Smith/ Paul S. Rose/ and James P. inlheeler/
flaa lbs* Ua 111	1	lbs Ctsatiaa ai §
Caji!£iLsiiaDsii[£ Heaiib iiasJLei: £l£H in Ills -Siaifi al Ulab/
Salt Lake City:	Utah Dept, of Social Services/ 1973.
Re
Health
regard
d iscuss
process
te rms
problem
review
me thodo
Compreh
number
In ord
me thodo
commendations for legislation concerning Priority
Needs in Utah/ and subsequent actions taken with
to these recommendations/ are reviewed prior to a
ion of the Utah Comprehensive Heath Planning (CHP)
. Organization and purpose of CHP are discussed in
of those who are to be served/ the nature of the
s with	wh	ich	planning	mus t	deal/	the	need fo
of	he	a 1 th	services	and	programs/		and th
logy	re	quir	ed to	achie	ve	these	goals
ensive	H	eal t	h Planning	is	complex/ involving		
of inte	r-	rela	tionships/	proces	ses	and activities	
er for		the	planning	to be	successful/		a carefu
logy mu	st	be	formulated.	(NT IS)			
Reference:
A £unsaatftiJ £12203 Ini lbs	al Qiinsiiitas lacPUBLISHED PLANS
Page 699
d£.5££lUi]£ S3D££al
£.2.2211 2l ££352
£2Y2l2Em2Ql Sludge.
Portland, Oregon:
il222il3lz. 0L3DI5 £235* Q££32Hi £lDJl
III 2l 3	2££3£::.Efc352 I<iDi3-££DJS
vaU 2*
Arthur Young and Co., June 1972.
The report presents results of the third phase of a
long-range planning study designed to suggest ho*
Josephine	General Hospital,	Josephine County,			Oregon,
could assume a new role %		and	accomplish	the	primary
objectives	recommended in	the	first two	phases. A	
cooperative improvement plan for emergency room services
is recommended for Josephine General Hospital, including
the adoption of a mutually agreed upon plan of action, the
formualtion of emergency room service standards, and the
development and implementation of a public information
program. The status of working relationships within the
hospital and the status of relationships among hospital
personnel and involved representatives of the community
suggest that community representatives are poorly informed
on health issues. (NTIS)
Reference:PUBLISHED PLANS
Page 700
Summary al Suiilslinas iax iiaaltjj SuLYiuasi Sarin Cakaia
iianliii 2zalias Plan .EramsHarir/
3ismarck:	Div. of Health Planning* North Dakota State
Dept. of Health* Dec. 1975.
A summary of the North
Plan Framework
preparation
The goals/
agency are
outlined,
the healt
process
Plan Fr
(1) a
for Fis
pr ior it
med ical
chron
bank
State
1976.
their
annua
Dakota State Health Systems
health systems agencies in the
entation plans is presented,
purpose of the State planning
the planning process is
the roles of the State and of
in the health plan developa»ent
lights from the Health Systems
d* including the following:
objectives and recommendations
an outline of problems and
of acute inpatient services*
long term care services*
-risk neonatal care* and blood
outline of the
through June
agencies in
as a type of
as an aid to
of annual implem
objectives* and
described* and
A diagram showing
h systems agencies
is included. High
amework are presente
tabular summary of
cal Year 1976;	(2)
ies in the areas
hospital services*
ic renal dialysis* high
and blood processing; and (3) an
agency's work program for July 1975
In addition to aiding health systems
activities* the summary is intended
l report from the State agency. (MTI3)
tPUBLISHED PLANS
Page 731
Reference:
Cfluatx iinalia £lai>/
Sodus:	Wayne County Comprehensive Health Planning
Committee, Dec. 1971.
A plan to guide the development of health services in
Wayne County, New York, is presented by the county's
comprehensive health planning committee. The county,
located in the northeastern corner of the 10-county
Genesee Region, had a population of 79,404 in 1970. The
population is scattered throughout a number of towns and
villages, with manufacturing the	major source	of
employment. During the harvest season, Wayne County has
the largest concentration of migrant workers in New York
State. The plan presents demographic information on the
county, including data on physical characteristics,
population, housing industry commuting patterns, and
economy. The implications of the demographic information
for the development of health services in the county are
then outlined. The county's health care resources
facilities, services, training programs — are described,
and utilization data are presented. A survey of need for
inpatient beds	and related home care services is
documented. The needs survey	employed	the method
developed in the Genesee Region for assessing bed needs
*
rPUBLISHFD PLANS
Page 702
through clinical evaluations of the levels of care
required by inpatients and potential inpatients. Findings
and recommendations are presented relative to hospitals,
nursing homes, ambulatory care and physician services,
mental health facilities and services, home care services,
emergency services, environmental health, schools, dental
services, and health personnel and training programs.
Supporting data are provided. (NTIS)
Reference:
Edmond sieiss, Adele Hebb, Boyd Palmer, and Charles
Goldman,
EI&d	A Suiile is ihs ELannins Erassss
in Iks Ilsaiiti Svstamx
Philadelphia:	Government Studies and Systems, Inc., Aug.
1975.
A plan development process is presented, based on
experience gained from planning system design and
execution in a number of comprehensive health planning
agencies. Developed prior to the enactment of tne
National Health Planning and Resources Development Act ofPUBLISHED PLANS
Page 703
1974/ the manual is said nevertheless to have relevance
for the kind of planning mandated by that legislation.
The principal focus is on planning concepts and technical
methods supporting the political process of decision
making in plan development. Methodology in comprehensive
plan development is stressed. The primary intended
audience is the staff and council members of health
planning agencies at the State and areawide levels. The
manual includes the following: a discussion of the
benefits of comprehensive health planning; an overview of
the plan development process, followed by detailed
descriptions of each stage of the process (health status
and health system assessment, goal/need analysis, program
design, plan selection, and plan dissemination); plan
development procedures; managing plan development
(project analysis, scheduling, resource estimating, and
control); implementing plan development (ongoing planning
versus planning capability, evaluation of staff and
organization, system development, and internal management
of developemtnt process); and a discussion of immediate
and long-range benefits of health planning. A glossary of
health system and planning concpets, a bibliography,
illustrative data, and flow diagrams are included. (NTIS)PUBLISHED PLANS
Page 704
Ref erence:
LUcansin £omatatiansiya tiaailh Elan/
Madison:	Wisconsin State Health Policy Council, 1975.
A comprehensive health plan for the State of
Wisconsin, embodying a discussion of the status of health
delivery, problems, accomplishments, and needs in that
4
State, is presented by the Health Policy Council and the
State Division of Health Policy and Planning. Following
an introductory discussion of the planning process and a
statement of general goals, Chapter 1 examines health
resources, including health facilities and related
services, health personnel, and health care financing. An
overview,	specific goals, and objectives and polic/
recommendations are presented for each area. Chapter 2
similarly examines specific healtn services, including:
maternal and child health; health services for the
elderly? services for mental illness, chemical abuse, and
developmental disabilities;	environmental health
services,	including governmental environment-related
services, air quality, drinking water qualtiy, and food
processing and handling; emergency medical services;
Health Maintenance Organizations and other alternative
prepaid delivery systems; and health education. Chapter
4 considers health services research and development, andPUBLISHED PLANS
Page 70S
organization for planning and resource allocation.
Chapter 4 outlines implementation and evaluation tactics.
Associate health plans concerning alcoholism/ construction
of comprehensive community mental health centers/
developmental disabilities services and facilities
construction, drug abuse prevention and treatment, and
hospital and medical facilities are presented in Chapter
5. Posters of State planning staff and committee members
and an index to health plan implementors are appended.
Supporting tabular data are included. Portions of thi^
document are not fully legible. (NTIS)PUBLISHED BIBLIOGRAPHIES
Page 706
Reference:
Documents Eslaisd to Eeallti Ifanaflafit Elaonina -	1
A Etsliminaxi:
Rockville, Ma.:	Div- of Comprehensive Health Planning,
Bureau of Health Resources Development, Jan. 1974.
A subject-classified bibliography of 1,550 books,
reports, monographs, journal articles, and other documents
related to health manpower planning is presented in
preliminary draft form. The bibliography is the result ot
a project conducted in 1973 by the Bureau of Health
Resources Development, DHEW, in which approximately 1,800
documents, and other information items were collected and
screened. The listings date from 1969 through 1973.
Major subject categories are as follows: (1) methods and
procedures (e.g., problem-policy studies in health
planning, program planning research and development
methodology, survey and other statistical methodologies);
(2) population and area characteristics; (3) health care
needs, programs and facilities; (4) health manpower
resources and requirments (e.g., maldistribution, mobility
and migration, foreign graduates, trends and projections);
(5) health manpower employment, utilization, and
regulation; (6) education and training; (7) general
(non-health) economics, manpower, and welfare; (8)PUBLISHED 313LIOGRAPHIISS
Page 707
information systems/ methods and s
miscellaneous (e.g., volunteer health
science centers/ health service technol
Plans to reissue the bibliography in
edition are noted in the preface- (MflS
ources; an
manpower/
ogy developm
a more co
)
d (9)
health
ents).
mplete
Reference:
Jean Doong/
fiaxiiciaalifla in iiaalili £launiiisi An AmoialLiJ
lUbliaaLanhix
Rockville, Md.:	Div. of Planning Methods and Technology,
Bureau of Health Planning and Resources Development, Nov.
1976.
This anotated bibliography, limited to publications
issued from January 1970 through Febraury 1976, is
intended to serve as a reference guide for health
planners, educators, and members of the general public who
are concerned with consumer representation and
participation in the health planning process. It contains
fifty-nine citations divided into seven categories. These
categories and the subject matter of the literature citedPUBLISHED BIBLIOGRAPHIES
Page 709
in them are: The Office of Economic Opportunity
Experience (issues raised in the 1960s regarding community
board role and consumer representation and selection)?
Selection (selection of 'representative' consumer
members)? Role (the roles and interaction of consumers
and providers on boards and the problems arising from this
interlace); Outcome (evaluation of consumer participation
on boards and the effects and impact of this
participation); Models (health care systems models
enhancing consumer input/ includes proposed legislation)?
Training (training of consumers and providers for
participation on health planning boards)? and Training
Materials (manuals or guides to be used in training board
members). Most of the citations refer to articles
published in readily available professional journals. In
some cases/ however/ the citations are to monographs or ta
publications with limited availability which can be
obtained from the cited publisher or author/ or iron
either the National Technical Information Service or Xero<
University Microfilms. (N’TIS)
Reference:
Elizabeth Harrison/PUBLISHED EI3LI0GRAPHIES
Page 709
liaaliii i^slenis. Aa.2QC.ias. LA aiLLiQQJCQaai: uiib AhsluasiLslx.
Springfield, 7a.:	National Technical Information Service/
March 1978.
The selected abstracts of research reports discuss j
health planning and resources development agency
designated under the terms of the National Health Planning
ana Resources Development Act of 1974/ Public Law 93-641.
Health systems agencies are nonprofit private
cor	porati	ons,	pub	lie	reg	ional	P1ann ing	bodies, or si	ngle
uni	ts of	local	gov	ernme	nt,	and are charged with perfor			ming
the	heal	th pi	ann	ing	and	r e so u	rces dev	elopment funct	ion 3
1 is	ted in	Sec ti	on	1513	of	the Public Hea		1th Service	Act.
The	repo	rts co	ver	a br	oad	range	of sub j	ects pertainin	g to’
hea	1th sy	stems	age	ncies	•	Heal th	sys terns	plans have	been
exc	luded	from		this	bibliog		raphy.	It contains	103
abs	tracts	. (NT	IS)	•					
Pef erence:
Elizabeth A. Harrison/
&JIL££££I1£Z MsJical &e£2i££Si	£Lannillflr
Springfield, 7a.:	National Technical Information Service,PUBLISHED 3iuLIOGRA°HIES
Page 710
Oct. 1977.
Communication/ training/ transportation/ emergency
care facilities and community education for rural and
urban areas are included in the bibliography. The reports
discuss plan implementation and plan development for
states and regions. Ambulance and hospital emergency
services are also discussed. It contains 65 abstracts.
(NT IS)
Reference:
Elizabeth A. Harrison/
Hsalth Elannina Laaislaiiim LA JLLbliaacaatiif aiib
Absiiaclslx
Springfield/ Va.:	National Technical Information Service/
June 1977.
Health care costs/ health systems agencies/ mental
health care/ and health care delivery organizations are
specific topics covered by the selected abstracts of
research reports on health planning legislation. Other
subjects are health care facilities/
health manpower/PUBLISHED BIBLIOGRAPHIES	Page 711
health care utilization/ health resources/ state and
Federal government/ and health education. It contains 108
abstracts. (MTIS)
Reference:
Elizabeth A. Harrison/
liaalih £laimiiisi iaaamjiJty Saauliiiian C&a£afLt££iali£S
LA Sii2lia^£32iiY dLLh Aas-Uaiisl*
Springfield, Va.:	National Technical Information Service,
Nov. 197o.
The bibliography contains
research reports covering
socioeconomic factors/ ethnic
communities, populations, rural
related to health planning. It
(NTIS)
selected	abstracts of
socioeconomic status,	
groups.	age groups,
areas.	and urban areas
contains	91 abstracts.
Kef erence:PUBLISHED 8I3LI0GRAPHIES
Page 71?
Sue Ellen Jacobs/ Timothy Berkesch, Samuel Goesham, and
Mary Vance/
C^Iimon^Di 13	Hsi£.£l2£J3.£3t:	k
iiialifliiLaohiLt
Monticello, 111.:	Council of Planning Librarians/ June
1974.
A 46-page bibliography is presented to serve as an
introductory source for understanding problems of health
planning in community development, to give exposure to
alternative systems of health and medical care deliver//
and to provide a basic introduction to inter-ethnic
relationships.	Books/	articles/ and	reports ace
categorized as	follows:	(1) general	introductory
materials useful for comparative study and comprehension
of the diversity in life styles, culture, health
practices, and beliefs throughout the world, as well as
for understanding variances in response to pain and
treatment; (2) introduction to the relationship between
ecology and health; (3) preliminary sources specifically
dealing	with	p" (0 01	1th	and	medic	al systems	on an
in ternat	ional b	as is;	C	4) examp	les of	the principal	means
of delivering		heal	th	ar.d me	dical	care in the	United
S tates;	(5)	intro	due	tion to	the	interrelatio	nships
between	health	and	y	o 1 i t i cs;	(6)	introduction	to thePUBLISHED BIBLIOGRAPHIES
Page 713
economics of health and medical care; (7) public health
perspective on health and medical care; (3) ambulator/
and home health care; (9) experiences of various
neighborhood health centers throughout the United States;
(10)	examples of roles of professionals and
paraprofessionals in medical and health care systems;
(11)	basic introduction to complexities of health
insurance in the United States; (12) examples of health
and medical problems encountered with various groups of
American society, specificaly including Blacics, Chicanes,
the chronically ill, the elderly, Eskimos, Indians, the
poor, Puerto aicans, rural populations, urban populations,
and youth; (13) preliminary sources useful for
comprehensive health care planning; and (14) a listing of
relevant journals and newsletters. Entries are listed
alphabetically by author within each category. The
majority of listings were published between 1960 and 1972.
(NTIS)
Reference:
william Meyers and Robert Sorwart,
E3£.t.i£iDaiiafl ia	baalihi a 3ibj.ipgcaahy,
Monticello, 111.:	Council ot Planning Librarians, AprilPUBLISHED BIBLIOGRAPHIES
Page 714
1974.
A bibliography of materials containing information on
community mental health planning and development is
presented. Over 200 studies, journal articles, books, and
reports are listed alphabetically by author. Listings
dated from 1953 through 1973 cover a variety of topics
related to community mental health development, with
emphasis on citizen participation. (MTIS)
Pef erenc e:
Virginia C. Parkum,
CiliifiD LariiciiiaXiimi A diJalisax-aaii* aX liiaaiY and
£jLa£li££* dith Sassial Smahasis an XaaDtaiiansiys. itedlib
Eldaninax
Harrisburg:	Office of Comprehensive Health Planning,
Pennsylvania Dept. of Health, 1973.
A bibliography is presented which was developed as
part of a 2-year study of consumer participation in
comprehensive health planning in Pennsylvania. ThePUBLISHED BIBLIOGRAPHIES
page 7lS
contents of the bibliography are divided into sections on
theory and actual participation in health and social
service activity. The participation theory section deaLs
with general theory/ complex organizations/ and specific
variables such as age/ sex/ race and political
participation. The participatory democracy section
provides a philosophical and practical transition frora
social science-oriented observations on participation to
the actual health area concerns. The participation
activities covered include comprehensive health planning
and social services and community planning. The entries
consist of books/ publications/ and journal articles on
citizen participation and were published during the years
1948-1973. (N TIS)
Reference:
KtLi	iifialtb £laimiiia Etastaa - A Sallied
iiiklifiiiLasiiiu
Rockville/ Md.:	Bureau of Health Plannning and °esources
Development/ 1976.
This bibliography which consists of a selection ofPUBLISHED BIBLIOGRAPHIES
Page 716
articles pertaining to the National Health
Resources Development Act of 1974 (P.L.
intended to be helpful both to persons
previous knowledge of the law or of hea
nationally and to professional planners and
who are more knowledgeable in the field. Th
are to articles published since the law was
the most part, they explain the principal p
the law, explore its implications, and predi
of its implementation on health care and deli
U.S. The citations are unannotated and have
into three categories:	general/analysis (45
hospitals (16 citations); and State and loca
(9 citations). (NTIS)
Planning and
93-641), IS
who have no
1 th pi	anning
other p	ersons
e r e f e	rences
si gne d,	; for
rovisio	ns of
ct the	effee t
very i	n tne
been g	rouped
c itat	ions)*
1 gover	nments
Reference:
Germantown, Md.:	Aspen
AssesiDlSElz
Systems Corp.,

Nov. 1976.
ia.c
The development of health care programs and services
requires compilation and analysis of information on the
PUBLISHED BIBLIOGRAPHIES
Page 717
health status of the population to be served. ThiJT
bibliography provides 177 citations with abstracts for
both published and unpublished literature on methodologies
for community health status assessment. The references
are divided into three categories: (1) health status
measures — documents concerned with the development of
health status indexes and indicators,. measurement
techniques relevant to the definition of the health status
of a given population, the use of economic and demographic
predictors of health status, and the use of mortality and
morbidity statistics as variables for determining
community health status; (2) health status assessment
studies -- documents which deal with the application of
health status measures to determine the health status of a
given population, including several community health
surveys and accompanying methodological information; and
(3) health status and the evaluation of health care
services — documents which use health status indexes as
outcome and evaluation measures and which measure the
impact of a given health care facility, service, or
program on the health status of a defined population.
Most of the entries are arranged alphabetically by title
within each subject section. Document availability
information accompanies each reference, and an author
index follows the last subject section. (NTIS)
PUBLISHED BIBLIOGRAPHIES
Page 718
Reference:
Marvin D. Strauss and Ido de Groot/
"Bookshelf on Community Planning for Health/"
AiisjcisLan JaaiQiil ai Euklic Esal-tiix voi.6i. No. 4/
p.656-679/ (April 1971).
Following an overview of the history of community
health planning as reflected in the development of the
public health federation of Cincinnati/ Ohio/ a
bibliography of materials concerning community health
planning is presented. The introductory essay suggests
that the health council model may be more useful than the
health facilities planning agency model in considerations
of comprehensive health planning. The bib.1 iograohy
includes newsletters which focus on health planning/
resources of special interest/ periodicals/ journal
articles/ books/ and government publications. Over 600
items/ dating from 1945 through 1970/ are listed. (NTIS)
Reference:
Salvador Waller and Karen Fink/
Eukiit Law 21rai.ll
Eatlsuai ilaallh Planning arid Rsssii££32PUBLISHED BIBLIOGRAPHIES	Page 719
Hsyelasaenl Act*.
Rockvilie,	Md.: Parkla van Health Library* Office			of the
Assistant	Secretary	for	Health* Dept. of	Health*
Education,	and Welfare*	May	1976.	
Materials pertaining to P.L. 93-641/ the National
Health Planning and Resources Development Act/ are
presented in a selected bibliography compiled by the
Farklawn Health Library/ DHEW. Fifty books/ journal
articles* and reports* most published in 1975 and 1976*
are listed under the subject headings: general/ analysis*
hospitals* and State. The listing includes summaries of
the legislation itself and discussions of its possible
impact on various professional groups* institutions* and
State governments. (MTIS)
Reference:
I
Freida ,\ieise*
Stalis-tics Bad Haallii mauaiaa/
Chicago:	Library of the Health Sciences* Illinois
University at the Medical Center* 1975.
ftPUBLISHED BIBLIOGRAPHIES
Page 720
A selected/ annotated bibliography is presented of
statistical publications/ monographs on health planning/
and bibliographies and indices pertaining to health
planning. The statistical publications are categorized
f i i '' '
under the following headings: demographic/ general
medical care; health facilities and services; health
manpower; and vital and health statistics. These
publications are presentations of health-related data, not
discussions of data gathering and analysis techniques.
The health planning monographs concern such subjects as
health care delivery in rural areas, health planning,
national health care policies, management uses of health
services data, statistics for comprehensive health
planning, planning for nursing needs and resources, and
guidelines for producing uniform data for health cara
plans, among others. Most of the materials cited were
published between 1970 and 1975. Approximately 130
publications are listed, including several with particular
relevance to health planning in Illinois. (NTIS)
I
«PUBLISHED niDLIOGPAPHIES
Page 721
SOURCE INDEX
Note: This index was prepared by using the author's name
or the first author's name when there were multiple
authors; in cases where no author existed/ the name of
the sponsoring agency was used.
B.	Abel-Smith.. 321/363
to. Abernathy.. 505/519
J. Acton.. 23
I. Adize.. 5
M. Alderson.. 363
h. Altenderfer.. 365
C.	Altenstetter.. 144
American College of Physicians*. 176
American Hospital Association/ Chicago/ 111... 329
American Public Health Association.. 22
Donna Anderson		.. 213
David Anderson		.. 565
J.	Anderson..	481
H.	Anderson.•	24/26
□ .	Anderson..	145
K .	Anderson..	27
Areawide and Local Planning for Health Action/ Inc./
Syracuse/ N.V..• 379
D.	Ardell.. 30/157/288
Arkansas Dept, of Planning/ Little Pock/ Ark... 637
Arkansas Health System Found./
Little Rock/ Ark.
676PUBLISHED BIBLIOGRAPHIES
Page 72 2
M. Arnold..5/289/322
Arthur D. Little/ Inc... 298/647
Arthur Young and Co./ Portland/ Oregon.. 698
Aspen Systems Corp./ Germantown/ Md... 716
Assoc, of Health Planning of Alabama/ Birmingham/ Ala...
672
A. Atkinsson.. 169
E. Back.. 30
H. Baligh.• 565
R.	Barlow.. 417/581
S.	Barnoon.. 550
•M. Barry.. 106
K. Bates.. 213
R. Battistella.. 32,170/599,621
K. Bauer.. 614
M. Baum.. 413
K. Bay.. 413
C.	Bell.. 407
R. Beller.. 419
D.	Berry.. 7,323
V. Berry.. 366
T.	Bice.. 325
R. Binstock.. 72
J. Bithell.. 550
aPUBLISHED BIBLIOGRAPHIES
Page 723
F. Blewett.. 566
W. Blockstein.. 153
H. Slum.. 33/34/153
H. Bluraberg.. 483
H. Boaz.. 567
L. 8 o d i n . . 420
R. Bradbury.. 313
H. Braun.. 290
L.	3reslow.. 35
H. Brickman.. 105
R. Bridgman.. 35/326
M.	Brown.. 107
T. Brooks.. 172
J. Brotherson.. 363
J. Bryant.. 36
W. Bunch.. 582
Bureau of Health Resources Development/ Rockville/ Md...
706
Bureau of Health Planning and Resources Development/
Rockville/ Md... 373/715
J.	Bush.. 421/583
K.	Butler.. 37
California State Dept, cf Public Health/ Sacramento/ Ca...PUBLISHED BIBLIOGRAPHIES
Page 721
R. Canvin.. 306
D. Cardus.. 160
R. Carlson.. 161
Catawba Regional Planning Council/ Rock Hill/ S.C... 639
CENTO Conference Proceedings/ Ankara/ Turkey.. 8
Central Arkansas Planning and Development District/ Inc./
Little Pock/ Ark... 633
R. Chapman.. 39
J. Chasse.. 413
M. Chen.. 323/422
C.	Chiang.. 482
R. Chorba.. 534
D.	Christenson.. 215
R. Cibotti.. 10
». Clark.. 201
Clark Council Areawide Comprehensive Health Planning
Assoc./ Las Vegas/ Nev... 641
H. Clarke.. 218
L Cloe.. 318
A. Coburn.. 40
R.	Coffey.. 535
S.	Cohen.. 11
M. Colburne.. 41
Colorado Dept, of Health/ Denver.. 674/692
A. Colt.. 42,319
Comprehensive Health Planning Association of Imperial/PUBLISHED 3I3H0GRAPHIES
Page 725
Riverside and San Diego Counties/ San Diego/ Calif... 669
Comprehensive Health Planning Council of South Florida/
Inc./ Miami/ Fla... 369
Comprehensive Health Planning Council of Western New York,
Buffalo, N.Y... 691	* '
Comprehensive Health Planniny Service, Rockville, Md...
620
R. Conant.. 42,146
E. Conley.. 597
G.	Connor.. 44
M. Connors.. 551
CONSAD Research Corp., New York, N.Y... 401
R. Corbett.. 45
H.	Correa.. 423/424,425/426,586/587
R. Crane.. 329
M. Creditor.. 46
J. Cumming.. 110
'*• Curran.. 173
W. Daechsel.. 568
R.	Daniels.. Ill
S.	Dastidar.. 428
B. Dean.. 430
J. DeMiguel. . 113
J. Denne.. 12PUBLISHED BIBLIOGRAPHIES
Page 726
J.	Derry..	37 0
•	Dever..	370
K.	Dietz..	588
M.	Dolfman.	. 331
B.	Donald..	49
J.	Doong..	707
C.	Douglass	.. 149,220
W .	Dowling.	. 434
T.	Doyle..	520
C.	DuElor ey	.. 208
fi.	DuFour..	150
L.	Duhl.. 209	
Duke Univ..		. 216
I.	Duncan..	499,503
D.	Dunlop..	308
M.	Duval..	50
I. Easling.. 114
East Tennessee Health Planning Council, Inc., Knoxville,
Tenn... 109
Economic Development Assoc, of Eastern Montana, Sidney,
Montana.. 648
C. Edwards.. 207,600
S. Edwards.. 435
J . Elinson.. 332,333PUBLISHED BIBLIOGRAPHIES
Page 727
R .	Elling..	52
L.	Elveback.	. 589
K.	Endicott.	. 53
A.	Engel.. 55	
A.	Esogbue..	552
C.	Evashwick	.. 222
J.	Falick..	57
J.	F alkson..	224
S.	Fanshe1..	483
E.	FeingoId.	. 72
M. Feldstein.. 436,437,438,439,590
P. Feldstein.. 440
A. Fernandez.. 522
R. Fetter.. 441,489,553
Finger Lakes Health Systems Agency, Rochester, N.Y... 666
D. Fink.. 162
J. Fitzsimmons.. 408
C. Flagle. . 335
A.	Fonaroff.. 116
B.	Forst.. 591
T. Frazier.. 370
R. Fredicks.. 592
3. Frieden.. 58PUBLISHED BIBLIOGRAPHIES
Page 728
I.	Cabr ielson..	371
N.	Geller.. 522	
J.	Gentry.. 14,	372
0.	Gish.. 60	
J.	Glass.. 294	
E.	Glogow.. 225	
G.	Codber.. 309	
Golden Empire Comprehensive Health Council/ Inc./
Sacramento/ Calif... 652
M. Glodfarb.. 523
J. Goldman.. 554
F. Golladay.. 524/526,529/529
Government Studies and Systems, Inc., Philadelphia,
Pa	...350,696,70	4.
R.	Greenberg..	175
S.	Greenberg..	227
M.	Greenlich..	442
R.	Griffin.. 15	
R.	Grigon eff..	151
D.	Grimes.. 117	
P.	Gross.. 228	
Guam Dept, of Public Health and Social Services, Agana,
Guam.. 660
I. Gupta.. 530
F. Guptill.. 615
R. Guri ie Id
593PU3LISHED BTSUCGPAPHTES
Page 723
D.	Gustafson.. 375/555
C. Gutkin.. 556
T. Hall.. 118,119
W. Hall.. 409,410
J. Hallan.. 376
A. Handyside.. 490
J. Hansen.. 443
A. Haro.. 119
L.	Harris.. 336
E.	Harrison.. 708,709,710/711
M.	Hartgerink.. 121
J. Hatch.. 231,232
R. Hausman.. 557
Hawaii State Dept, of Health, Honolulu.. 694
Health and Hospital Planning Council of Northeastern
Pennsylvania, Avoca, pa... 689
Health Planning Assoc, of Northwest Ohio, Maumee, Ohio..
400
Health Planning Council for Greater 3oston.. 61
health Planning Council of Appalachia Maryland, Inc.,
Cumberland, Md... 624
Health Planning Council of the Midlands, Omaha, Neb...
627,636
Health Planning Research Services, Inc., Fort Washington,PUBLISHED BIBLIOGRAPHIES
Page 73)
Pa... 203/292
Health Resources Administration/
Health Resources Administration/
Health Systems Agency of Western
Hyattsville/ Md
Rockville/ Md..
New York/ Inc./
N.Y... 665
c.	Hearn..	57 0
p.	Heath. .	122
F.	Henderson.. 676	
P.	Henry..	235
W.	Herzog..	237
H.	Hi 1leboe	.. 66
W.	Hiscock.	. 63
G.	Hirsch..	445/515
G.	Hochbaura	.. 238
L.	Ho ffman.	. 378
L.	Holder..	312
W.	Hollister.. 240	
J.	Hoitzman	.. 196
J.	Honey..	69
P.	Hornby..	69
D.	Horwitz.	. 446
W.	Howie..	193
J.	Human..	337
H.	Hyman..	112
.. 195
431
Buffalo/PUBLISHED BIBLIOGRAPHIES
Page 731
Idaho Governor's Advisory Council on Comprehensive Health
Planning, Boise, Idaho.. 677
A. Idciss.. 122
S. Ingman.. 211
K.	Ittig.. 214
A. Jacobs.. 178
S. Jacobs.. 712
H. Jackson.. 448
R. Jelinek.. 531
John Hopkins Univ... 13
E. Johnson.. 71
b. Jansson.. 553
M. Jordon.. 617
L.	Judd.. 245
L. Kaiser.. 207
P. Kalisch.. 246
A. Kaluzny.. 163
D. Kane.. 247
J. Kane.. 449
R. Kane.. 249,515
H. Kauiman.. 72
F. Kennedy
450,532PUBLISHED BIBLIOGRAPHIES
Kentucky Dept, of Health/ Frankfort
II. Kerschner.. 607
J.	Ketchel.. 333
K.	Kilpatrick.. 499/533
J. Kirk 1 in.. 313
ini. Kissick.. 339
H. Klarman.. 74
U. Knotts.. 571
J. Knowelden.. 331
P. Kolesar.. 559
R. Kramer.. 295
E. Krause.. 17
E. Krill.. 130
D.	Lane..	. 608	
J.	Lapatra..		451
R.	Lapr..	. 602	• ' Ji I., 9 n,-'
M.	Lee..	18	
P.	Lee..	153/	164,340
S.	Lee*.	572	
M.	Lernei	:.. 3	42
I.	Leves<	5n..	123
A.	Levin.	• . 60	3
R.	Llewe.	lyn-D	avies..
J. Liebman
534PUBLISHED BIBLIOGRAPHIES
Page 731
J. Lipscomb.. 535
M. Lipsky.. 250
S. Litsios.. 613/619
R. Logan.. 604
Lousiana Capital Area Health Planning Council/ Baton
Rouge, La... 631
J. Lubin.. 382
c.	Mackenzie.	. 343	
K.	MacNeilage	• •	252
R.	Macstravic	• «	180
P.	Mahadev..	506	
(j •	Majone.. 3	45	
R.	Makowski..	77	
Mariscal and Co., Los Angeles, Calif... 219
E. Margolis.. 124
toassachusetts Office of Comprehensive Health Planning,
Bos ton..		643		
B.	Matti	son.	. 253	
J.	May..	78,	133	
J.	McCar	thy.	. 79	
J.	McCla	in..	414,	491
*4 •	Me Cue	.. 2	53	
R.	Me Nam	ara.	. 81	
L.	veisn	er. .	255,	256published bibliographies
W. Merten.. 346
Metropolitan Health Planning
J. Metsch.. 19/258^259/347
is. Meyers.. 713
J. Michael.. 333
Page 731
Corp./ Cleveland/ Ohio.. 229
Mid-America Comprehensive Health Planning Agency/ Kansas
City/ Kansas.. 630
Mid-Coast Comprehensive Health Planning Assoc./ Salinas/
Calif*.• 650
Mid-Missouri Areawide Comprehensive Agency/ Inc./
Columbia/ Missouri.. 673
Midwest Center for Health Planning/ Madison/ Wis... 297
N. Milio.. 166
J. Mi Isom.. 49 2
Montana State Dept, of Health and Environmental Services/
Helena.. 679
R. Moroney.. 384
R. Morril.. 507
B. Mott.. 72
P. Mott.. 127
Mountain Ramparts Health Planning/ Inc./ Asheville/ N.C...
626
C. Muller.. 167
S. Mushkin.. 348
S. MuszynsJci.. 3 2
S. Myrtle
611PUBLISHED BIBLIOGRAPHIES
Page 735
National Health Planning Consortium, Washington, D.C...
131
V. Navarro.. 127,129,4o2,453,454,455
Nevada State Comprehensive Health Planning Office, Carson
City.. 691
J. Newheiser.. 456
P. Neuman.. 458
J. Noble, Jr... 335
Norcoa Health, Eureka, Calif... 684
D. Nordstrom.. 386
North Central Comprehensive Health Planning Assoc., Inc.,
Port Collins, Colo... 623
North Dakota State Dept, of Health, Bismarck.. 655,700
North Shore Health Planning Council, Inc., Peabody,
Mass... 651
North West Indiana Comprehensive Health Planning Council,
Inc., Highland, Ind... 642
Northern Indiana Healtn Systems Agency, South 3end, Ind...
667
H. Notkin.. 260
P. Nutt.. 262
J.	0'Connor.-	. 183
M .	Oglesby..	459
A.	Oreg1ia..	337,388,339,391,392PUBLISHED BIBLIOGRAPHIES
Page 736
Oregon Health Planning Committee/ Salem.. 644
Oregon State Health Division/ Salem.. 653
Orkand Corp./ Silver Springs/ Md... 194
J. Ortiz.. 460
•
A. Packer.. 351/461
Pan American Health Organization/ Washington/ D.C... 353
A.	Parker..	263
B.	Parker..	516
R.	Parker..	493
K.	Parkum..	264/265
V.	Parkum..	714
D.	Patr ick.	. 435
R.	Pecarchik.. 267	
C.	Pegels..	500
L.	Perez..	134
C.	Pierce..	83
A.	Pizam..	132
L.	Poc inki.	. 462
L.	Polk.. 133	
6.	Popovic.	. 133
S.	Por tnoy.	CO t
J.	Powell ..	135
J.	Pliski n.	. 494
Proceedings of 1st Canadian Conference/ Health EconomicsPUBLISHED BIBLIOGRAPHIES
Page 737
Symposium.. 543
J. Prussin.. 463
Pugh-Poberts Associates, Cambridge, Hass... 429
M.	Rabinowitz..	501
if.	Radtke.. 454	
H.	Pasmussen..	466
G.	Rath.. 502	
P.	Peeves.. 353	
Region Three Comprehensive Health Planning Counicl, Inc.,
Fort Wayne, Ind... 663
Regional Health Planning Council of the North Central
Texas Council of Governments, Arlington, Tex... 683
J. Reid.. 136
C. Revel 1e.. 594
Rhode Island Dept, of Health, Providence.. 177,310
E.	Ricci..	153
E.	Richards	.. 39
J.	Richman.	. 85
R.	Pikkers.	. 560
r c< •	Rising..	560
Roanoke Valley Health Services Planning Council, Inc.,
Roanoke, V3... 662
E. Roberts.. 467
F. Robeson.. 574PUBLISHED BIBLIOGRAPHIC
G.	Robinson.. 561
P. Rogatz.. 263
C. Roseinan.. 87/458
H.	Rosen.. 269
L. Rosenfield.. 195
A. Rourke.. 87
E. Rub el.. 136
C. St. Pierre.. 395
B.	Saltzman.. 89	
L.	Sasmor.. 411	
R.	Sasuly.. 21	
S.	Sauber.. 155	
E.	Schach.. 470	
M.	Schaefer.. 313	
R.	Schiffler.. 486	
H.	Schmitz*. 575	
Daniel Schneider..		536
Donald Schneider..		537
F.	Schofield.. 91	
G.	Schultz.. 508	
S. Schweitzer.. 595
M. Secord.. 199
R. Seder. . 91
R. Sellers.. 270PUBLISHED BIBLIOGRAPHIES
Page 731
Seven County Health Planning Council, Wooster, Ohio-. 628
A. Shol'f.. 272
W. Shonick.. 93,495,496
L. Shuman.. 355,509,510,538
A. Siegmann.. 356
S. Sieverts.. 187,188
R . Sigmond.. 94
G.	Silver.. 204
H.	Simaions.. 274
A. Singh.. 576,578
W. Skerry.. 315
F. Sloan.. 539
R.	Smallwood.. 540
A. Smith.. 316,504
D. Smith.. 190
K. Smith.. 541,542
S.	Smith.. 693
W. Smith.. 357
A. Snoke.. 95
A. Somers.. 96,137
A. Soriano.. 562
South Carolina State Dept, of Health and Environmental
Control, Columbia.. 695
Southwest Idaho Council of Governments, Pocatello, Idaho..
670
Southeastern Wisconsin Health Systems Agency, Inc.,PU3LISHZD BIBLIOGRAPHIES
Page 74<3
Milwaukee/ Wise... 679
J. Souza.. 143
C.	Sparer.. 275
D.	Starkweather.. 471
C.	Stevens.. 277
D.	Stewart.. 97
L.	Stiffman.. 472
S. Stiles.. 191
D. Stirason.. 473
M.	Strauss.. 278/718
P. Strauss.. 98
G.	Stuehler.. 211
H.	Sultz.. 397
A. Sumner.. 579
G. Swartzman.. 563
G. Taffola.. 279
L. Tannen.. 98
C. Taylor.. 138
L. Taylor.. 609
Tennessee Dept, of Public Health/ Nashville.. 658
W. Thomas.. 544
J. Thompson.. 498
C. Tilquin.. 393
*
C. Toregas.. 512PUBLISHED BIBLIOGRAPHIES
Page 741
G. Torrance.. 416
R. Tranqu3da.. 280
Tri-County Health Planning Agency/ Lewiston/ Maine.. 636
Tulsa Area Health and Hospital Planning Council/ Tulsa/
Oklahoma.. 637
U.S. Public Health Service.. 28/65
University of North Carolina.. 130
Utah Dept, of Social Services/ Salt Lake City/ Utah.. 693
D. Uyeno.. 545
B. Vladeck.. 205
J. Vora.. 474
H. Vuori.. 403
J. Wagner.. 359
H. Wallace.. 403
S. Waller.. 718
G. Warheit.. 404
S. Warren.. 100
Washington State Office of the Governor/ Olympia.. 234
W. Waters.. 101/102
Wayne County Comprehensive Health Planning Committee/
Sodus/ ,J.Y- -. 701
Weber Basin Health Planning Council/ Ogden/ Utah.. 659PUBLISHED BIBLIOGRAPHIES
Page 742
D. Wegmi1ler.. 137
B. Weisbrod.. 475
' F. W e i s e . . 719
E« Weiss.• 702
B.	Wells.. 232
W. Wenkert.. 299
S.	werlln.. 192
J. West.. 301,302
West Arkansas Health Systems Agency, Inc., Russelville,
Ark... 664
West Virginia State Dept, of Mental Health, Charleston..
646
Western Wisconsin Health Planning Organization, Inc.,
Lacrosse, Wise... 634
J.	Wheeler.. 283
K.	Wheeler.. 303
C.	White.. 140
K. White.. 406
T.	Willemain.. 546
A. Willieas*. 360
Y. Wind.. 517
Wisconsin Regional Medical Program, Madison.. 242
Wisconsin State Health Policy Council, Madison.. 704
Wisconsin University.. 4b
S. Wolfe.. 235
A. Wong.. 512PUBLISHED BIBLIOGRAPHIES
Page 743
/locld Health Organization.. 56,63/64/501
J. Wysony.. 304
A. Yankauer.. 103
G. Yankelavich.. 475
D. Yett.. 479,547/543
R. Young.. 235
R.	Zemach.	. 479
A.	Zhuk..	142
D.	Zschock	.. 10
D.	Zwi ck..	605
•D.S. GOVERNHfMT PSINTIKG OFFICE i 1980 0-628-650/2676V2546
A'BpU.C. BERKELEY LIBRARIES
CDEfi5E33flb
C028523386