Health planning in the USA.

The U.S. has neither a comprehensive health policy nor a national health plan. However the Hospital Survey and Construction Act of 1946 (the Hill-Burton program) authorized grants to states for hospital surveys and construction. This brought rural hospitals up to minimum standards. Now the program is turning to modernization in urban areas. However only about 25% of the countrys hospital beds are covered by this. The Veterans Administration runs a separate network of hospitals and most private hospitals do not come under Hill-Burton. Mental health is under the Division of Mental Hygiene in the U.S. Public Health Service. Again private hospitals are not covered and serious under supply exists in some areas. In 1955 responsibility for health services for the American Indian was transferred from the Bureau of Indian Affairs to the Public Health Service which was a turning point for this group. A planning-program-budgeting service has been set up to meet the needs of the Indians especially the 400000 who reside on or near feder al reservations. Statistical details of this system are given. Regiona l grants are also given for specific programs in heart disease cancer and stroke. The Comprehensive Health Planning and Public Health Service Amendments of 1966 contain 2 major provisions: 1) financial grants to states and local communities for planning and the training of planners; and 2) financial grants for comprehensive health services both state and local. However the Amendments specifically state that proposed services must not interfere with existing patterns of private professional practice of medicine dentistry and related healing arts. This seriously constrained planners even before they started. These Amendments have been criticized for duplicating existing planning and for competing with similar federal programs for limited funds. Beginning with the Social Security Act in 1935 federal support of health services both personal and environmental has encouraged fragmentation into an amazing number of pieces. A government-wide survey found that comprehensive health care programs for children are not feasible not for lack of money but for lack of physicians particularly pediatricians. This survey also found that health decisions were based on political situations rate and amount of spending and the inability of people to be persuaded to follow programs to improve their health. Traditional clinicians and bureaucrats have resisted comprehensive planning. They wield considerable power.