Health Care Planning: "It's Time to Get Back to Basics"

Thursday, February 21, 2008

Health Care Planning: (Ron Carlson) -- Over the past few decades, health care planning has acquired a negative image. It is not clear why. The time may have come to bring health planning concepts back into public discourse. The discipline of health care planning might help clarify the current political debates over "universal health care" and whether the government should mandate health insurance coverage for all. Health care planning is particularly important as a basis for encouraging community involvement in determining responses to these important questions.

Reviewing the History of Health Planning

Health planning first came to the fore, not from federal or state legislative mandates, but from actions taken by communities. Its roots date back to the beginning of the 20th century with the development of an early Community Chest Plan in upstate New York. A local planning committee reviewed requests for capital fund drives. Later, hospital administrators began to meet and discuss funding problems with the idea of involving the community in finding solutions. Local hospital councils cropped up in places throughout the country, especially in the Midwest and in urban areas like Pittsburgh and Detroit.

Motivated by community action, the federal government got involved. The Hospital Construction Act of 1946, known as the Hill-Burton Act, was one of the first national laws that required states to assess local health and hospital needs via statewide reviews. New requirements were imposed to address community needs. For example, hospitals that received Hill-Burton funds had to provide charity care to the medically indigent.

A few years later, even more pro-active health planning began to occur in places like Rochester, New York where consumers, hospital administrators, business and government leaders came together to address local needs. This surge in community involvement led to some refinements to the Hill-Burton Act, calling for the creation of state and regional health planning agencies and for communities to "roll up their sleeves" and to take on the job of making local and data driven decisions about health care needs.

In 1974, this activity culminated with the passage of the National Health Planning Act. The objectives set out in this important law emphasized a strengthened federal, state and local system of health planning and resource development to address:

1. Lack of access to quality health care at reasonable cost
2. Lack of a comprehensive system of quality health care
3. Misdistribution of healthcare and facilities and manpower
4. Lack of basic knowledge of personal health care and methods for effective use of such knowledge

Sound familiar? These objectives sound very much like those we hear so often today: objectives that are well intended, straightforward and community oriented. And yet, the National Health Planning Act was deemed a failure, not because the intent was wrong, but because the decision making process often ended up in the hands of diverse political interests.

Putting Health Planning Back to Work

Some have pointed out that over the years two health planning approaches have developed: the personal health approach such as that in the update New York area mentioned above, and public health strategies in some jurisdictions in California. These two models are being combined in a new form increasingly popular at both the state and local levels. In fact, several states are requiring local jurisdictions to implement local planning initiatives, often using the approach promoted by the National Association of City and County Health Officials. That program, referred to as MAPP – "Mobilizing for Action through Planning and Partnerships" helps communities prioritize health issues and identifies the resources for addressing them. Another model is CHIP – "Community Health Improvement Program" an approach developed through efforts taken by the Institute for Medicine that builds on a collaboration of government agencies and private public health organizations.

In both of these models organizations such as public health agencies, hospitals, foundations and other stakeholders in a local jurisdiction drive the process. They focus on selected infrastructure and health priorities such as improving access to care, e.g., insurance coverage, and reducing health disparities by race, gender and income.