National policies and local planning for health services.

The primary reason for health planning in this country is the numerous instances in which 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. 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. What 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 versatility 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 opposite propositions from theory. In specified circumstances the federal government is expected to serve as the superseding decision maker.