National Health Planning—An Appraisal of the State of the Art

Abstract

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 geriatric 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 every clinician is a manager. Rather than be disappointed in the lack of implementation of the planning process, it has a useful purpose as a declaration of intent and in creating a forum for discussion. For most countries this is the beginning of the beginning in the effective administration of medical care.