Planning and Implementation

Abstract

Amidst the political sloganeering about health issues, there is a basic tension between those who plan goals for the health care system and those who try to implement them. This article examines that tension by first discussing the context of planning and its application to health affairs; then discussing the issue of implementation and its problems; and finally applying these to the particular case of health care costs. Among the topics discussed are the functions of planning (technical tool, coordination device, symbolic reassurance); the issues of participation (who gets represented, how, and at what levels of government); and the features of implementation (multiple goals, macro- and micro-arenas, private versus public interests). The current study provisionally concludes that health planning has changed little in the health care system of any country because inadequate attention has been paid to questions of implementation.