Luft H S, Frisvold G A
J Health Polit Policy Law. 1979 Summer;4(2):250-72. doi: 10.1215/03616878-4-2-250.
Health Systems Agencies (HSAs), the new regional health planning agencies established by the National Health Planning and Resources Development Act of 1974, have as their major goals quality, accessibility, continuity and cost containment. One of the tools for cost containment available to HSAs is their active participation in the statewide certificate-of-need (CON) program. To help anticipate how HSAs may play their CON roles, this article reviews the CON decisionmaking processes of two Comprehensive Health Planning (CHP) agencies, the predecessors of HSAs. While most CHPs lacked specific health plans and powers. the two California agencies examined have had both regional plans and roles in CON programs comparable to the present HSAs'. Our focus is on the decisionmaking process rather than the effectiveness of CON programs. A simple descriptive model is developed based on the assumptions that the planners seek satisfactory, rather than optimal solutions and that the data available are extremely limited. The cases analyzed suggest that, while most projects exceed the bed need standards, institutions were almost always able to demonstrate a need through various special circumstances. Once a need has been shown, the agency was able to deny an application only if a better alternative were available. This study suggests two approaches to improving regional health planning decisionmaking. First, identified needs can be better met either by increasing the agency's ability to generate alternatives or by encouraging health facilities to submit competing applications. Second, a regional health care budget would force the agency to make choices among competing needs.
卫生系统机构（HSAs）是根据1974年《国家卫生规划与资源开发法案》设立的新型区域卫生规划机构，其主要目标包括质量、可及性、连续性和成本控制。卫生系统机构可用于成本控制的工具之一是积极参与全州范围内的需求证明（CON）计划。为了帮助预测卫生系统机构如何发挥其在需求证明方面的作用，本文回顾了两个综合卫生规划（CHP）机构（卫生系统机构的前身）的需求证明决策过程。虽然大多数综合卫生规划机构缺乏具体的卫生计划和权力，但所研究的两个加利福尼亚州机构既有区域规划，又在需求证明计划中发挥着与当前卫生系统机构相当的作用。我们关注的是决策过程，而非需求证明计划的有效性。基于规划者寻求令人满意而非最优解决方案以及可用数据极为有限的假设，开发了一个简单的描述性模型。分析的案例表明，虽然大多数项目超过了床位需求标准，但各机构几乎总能通过各种特殊情况证明有需求。一旦证明有需求，只有在有更好的替代方案时，该机构才能拒绝申请。本研究提出了两种改进区域卫生规划决策的方法。第一，通过提高机构生成替代方案的能力或鼓励卫生设施提交竞争性申请，可以更好地满足已确定的需求。第二，区域医疗保健预算将迫使该机构在相互竞争的需求之间做出选择。
