Trying to take the national guidelines for health planning seriously: issues for thought

This paper examines, from a SHPDA's perspective, major obstacles that must be overcome if the National Guidelines for Health Planning are to be viewed as more than a mechanism for "backdoor" regulation: (1) The acceptance of the guidelines by state government; (2) The location of the SHPDA/SHCC in the state's health policy structure; and (3) The lack of an informed general public. If the guidelines have only minimal impact on state priorities, the national policy will be both ineffective and coercive. HSAs, SHPDAs, and SHCCs, through public education, political action, and coordinated public pressure can assist in overcoming these obstacles and, if warranted, change the nature and focus of the content of the guidelines. A fourth obstacle, concerning the types of assistance and guidance provided to health planning agencies, suggests that DHEW has concentrated on using P.L. 93-641 as cost-containment mechanism to the neglect of issues that, in the long run, could have a positive effect on both the health system and health status.