Anticipation versus results: an approach to improved program forecasting

Health planners may be an integral part of the decision-making process when new programs are designed and legislation and regulations are drafted. The appropriateness of the resultant program design will depend on the quality of the guidance provided by the planners. In many cases, this guidance is primarily determined by the philosophical beliefs, subjective system insights, and communication skills of the individual--supported by a little data. Pressures of the moment and limitations in existing impact prediction techniques may restrict the use of more systematic methods of planning. This historical approach has produced numerous planning failures, when success is measured by comparing anticipated and actual outcomes. Planned changes have often been accompanied by significant, unpredicted side effects that reduce the political credibility of decision-makers and produce programs that are criticized by the public that they are intended to serve. Thus, the need seems to exist for new approaches to the analysis of the potential impact of program changes. Planning, decision-making and implementation processes for health programs should be studied in order to enable planners to provide improved guidance to decision-makers. One conceptual approach to the performance of such studies is explored here.