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The article presents a memorandum of the Royal Medico-Psychological Association on the Second Green Paper on the future of the National Health Service in Great Britain. The association aims to coordinate the National Health Service and the Local Government services and welcome the participation of legal professionals and consumers. Policies concerning the management are given more importance rather than the daily administration activities. Furthermore, a single authorities should be recognized in each areas of the Health Service, including the social work and medical services.

Health planning in this paper is considered as a developmental process in which different types of planning appear at different times. These types are discussed and the place in the complex health care system developing in the United States is assessed. [ABSTRACT FROM AUTHOR]

In a recent article Lindsay [16][2] invented a theory of the National Health Service (NHS), which in its normative form implies the possible Pareto optimality of a nationalized health care system, and in a positive form shows that such a system may be an implication of rational collective behaviour by individuals having certain arguments in their utility functions. In common with other rationales for government intervention in the market for health care, Lindsay's "sharing" hypothesis is based upon the externality relation in health care consumption. The sharing hypothesis differs, however, from more conventional approaches in that the externality-affected parties (e.g. the relatively rich) have their utility levels affected by the quantity of health care each individual receives in relation to others rather than only the absolute amount each receives. The present paper seeks to re-instate the more traditional approach as a "philanthropy" hypothesis in which it is the quantity of "suffering" felt by people rather than the distribution of "suffering" that forms the basis of the externality relation, and which affords a better explanation of the NHS. In this paper the normative interpretation of Lindsay's theory will not be considered since a necessary condition for testing propositions in collective welfare economics (i.e. consensus decision-making) is clearly not fulfilled (Buchanan [2], Buchanan and Tullock [5]). For positive analysis, however, we might proceed faute de mieux on the assumption that collective decisions are made "as if" this condition were fulfilled, or introduce modifications where appropriate. [ABSTRACT FROM AUTHOR]

This paper provides information on contraceptive practices of women in certain low-income areas useful for family planning agencies, and examines the utilization patterns of the medically indigent poor as compared with others in low income areas. [ABSTRACT FROM AUTHOR]

This paper describes the program of the U.S. Army to identify heroin users in Vietnam and how it operates. Whether methadone can be used with servicemen is discussed. [ABSTRACT FROM AUTHOR]

This paper discusses principles of group activity and bases their validity on behavior in an actual setting, as applied to health planning. [ABSTRACT FROM AUTHOR]

The article reports that the health policy issues become increasingly more salient to political scientists as a whole series of major decisions about future causes of action in health emerge before the U.S. President and Congress. State and local governments are also responding to the continued pressure of rising expenditures in health, especially for care of the poor and the medically indigent. On the current national legislative agenda are such items as a major expansion of national health insurance, restructuring of local and state health planning, continuing the commitment to health research and increasing health manpower training support.

Since June 1963 official groups in all fifty states, plus the District of Columbia, Puerto Rico, and the Virgin Islands, have been participants in the most exciting and comprehensive attacks on the problems of mental illness and mental health ever to be attempted in this nation on the state level. With the financial assistance of the federal government, each of these mental health planning projects will be engaged in the process of developing a comprehensive mental health plan. This nation ride effort has stimulated the attention of many citizen and professional groups. To social work, which still looks to the heritage of the settlement movement, there is a familiar ring to the concept of meeting the nation's mental health needs in the community. This paper reports the early stages of the effort in one state, Massachusetts. It is not intended to reflect directly the situation or experience of other states, but much of what is reported will sound familiar. Though the focus will be local rather than national, the Massachusetts Mental Health Planning Project can best be examined within its historical perspective.

ABSTRACT This paper is concerned with the differential impact of the Medicaid program on state incomes in 1967-68. Benefits and costs of the program are calculated for each state and the results are evaluated in terms of the perceived original intent of the program planners. It was found that although the program favors the poor in all states with Title XIX plans, it does so at the expense of extreme horizontal inequity. The conclusion is that federal incentives for the development of comprehensive state Medicaid programs are inadequate to insure an equitable system for the distribution of program benefits and costs. [ABSTRACT FROM AUTHOR]

This paper endeavors to overcome one difficulty in health planning, namely, the transformation of general goals and ideas into operational objectives for programs. A method is developed to be used for generating such program objectives. [ABSTRACT FROM AUTHOR]

This paper emphasizes the need to bring environmental health into the framework of comprehensive health planning. The author discusses how this can be done. [ABSTRACT FROM AUTHOR]

The author of this paper argues that we need a national system for collection of health data which will meet the needs of planners, evaluators and investigators at local, state and federal levels and that national health insurance legislation should require the collection of these data as well as the facts needed for fiscal management. [ABSTRACT FROM AUTHOR]

This paper deals with the political strategies employed by the Minnesota Comprehensive Health Planning Program to remove legal impediments to effective manpower planning, as well as the consequences. Conclusions as to alternative courses of action are stated. [ABSTRACT FROM AUTHOR]

Information about several papers discussed at a lecture on psychiatric issues among developing countries is presented. Several medical personnel identified these problems that had apparently limitless concept of morbidity. These include infection, faulty sanitation, malnutrition and diseases which had a minimal number of trained personnel to cope. Public health planning prioritize the deployment of preventive measures against debilitating disease and focuses on a campaign for adequate nutrition.

The article offers information on the challenges faced by the American Public Health Association on the development of the association's Medical Care Section in the U.S. On November 10, 1948, the American Public Health Association's Governing Council voted to approve the petition requesting the establishment of a Medical Care Section. In 1972, the association expanded their health services because of the changes on their needs and demands. In 1920, the association created a committee to study the municipal health departments and determine the extent of variation on the health services and procedures offered in a specific community.

The article focuses on the development of neighborhood health center approach to health care delivery in the U.S. The neighborhood health centers have proliferated under a variety of federal grant-in-aid programs and private sources of support. It was mentioned that neighborhood health center approach demands an increasing emphasis on cost-effective management of neighborhood health centers and increased revenue generation activities. In addition, changes in federal health service funding policies have necessitated a reevaluation of sources of future support for neighborhood health centers.

A theoretical model using mainly the theory of absorbing Markov chains is applied to several human-blood-issuing policies. The objective of the model applications is to determine the effects of the Suing policies on average inventory levels, which determine blood shortage probabilities, and on the average age of blood at the time it is transfused. Issuing policies that issue (transfuse) fresher blood with a higher probability than older blood are defined as modified LIFO policies, and issuing policies that issue older blood with a higher probability than fresher blood are defined as modified FIFO policies. Application of the theoretical model to the various issuing policies allows complete evaluation of the policies, and a policy choice can be made on the basis of the evaluation. [ABSTRACT FROM AUTHOR]

The article presents a discussion on medical care policies. The detailed analysis of costs and the changing character of medical expenditures is very useful. The interpretation of the statistics is confined to those facts on which an economist can rightly pass judgment. Monopsonistic buying by government may eliminate some selling and advertising expense but the procurement experience of the United States government does not augur well for efficiency. The amount of the total cost to be allocated is of considerable importance in discussing methods of financing compulsory health insurance. The actual cost of compulsory health insurance would depend on several variables. These include: the efficiency with which the government operated its ventures in general, the number of people covered, the number and kinds of medical services and facilities made available, the extent to which people made use of the system, the number of governmental payrollers involved in addition to medical personnel, and the volume of abuses that developed.

A list of articles related to public health published in several journals are presented including "Integration of Medical Research and Health Policies," by S. P. Strickland, and "Strokes and Hypertension," by A. B. Carter.

The article reports on the final Hover Commission report, which focuses on the subject of government research and development in the U.S. According to sources, the report reversed its usual plea for reduction of federal spending by recommending increased support for research activities. Moreover, the report stressed the overriding importance of basic research, in which the safety, the increase in productivity, and the advance of health in the country must come from constantly increasing knowledge through fundamental research. Thus, five overall recommendations were made, including increased support for basic research, and establishment of assistant secretaryships in research and development in the Army.

The article examines the role of public health to promote family planning in the U.S. In 1965, the Office of Economic Opportunity have made domestic grants in family planning wherein the Children's Bureau were then given the authority after two years. By 1970, legislation have been implemented which made all components and methods of family planning available to the public to include abortion and sterilization. The possible costs of complete family planning services for the population was also taken into account.

Improvement is required in the theoretical bases of health planning in order for needed advances to occur in health planning practice. Four major planning strategies are utilized in other public policy sectors: the rational, the incremental, the mixed scanning and the radical strategies. All four strategies are potentially useful in health planning and their impact is suggested in a health planning situation. [ABSTRACT FROM AUTHOR]

A method was developed for the evaluation of alternative primary health care team compositions and for the examination of skill levels for new categories of personnel. This procedure determines the appropriate composition of primary health care teams for differing demand levels and facility availabilities. A simulation model of a general primary health care delivery unit was developed as part of this procedure. This simulation model given demand schedules, team compositions, and facility levels, produces information relating to the efficiency and effectiveness of that alternative. An application of the simulation model and the evaluation procedure was made to the area of pediatrics. A time study was taken of pediatric office practice. The data gathered therein were analyzed and used to create various demand schedules. Task-capability lists were created for various proposed categories of allied child health personnel, and these personnel were incorporated into various alternative team compositions and tested against varying facility and demand levels. Results indicate there are instances where a team structure is inappropriate and that the first member added to aid the physician is probably a person to assume lower level repetitive tasks. [ABSTRACT FROM AUTHOR]

The article examines a federally funded guidance clinic to determine its treatment for lower classes and minorities. It was found that this clinic provides treatment without bias in all groups, regardless of ethnicity, education, or occupation. Its nondiscriminatory policy in the selection and treatment of those belonging to ethnic and social classes is undermined by its complex intake procedures and long waiting lists. About 49 percent of clients requesting services was never seen by the clinic.

The study assess the extent of utilization of preventive health care services by eligible residents of low income neighborhoods in the U.S. Previous studies have indicated that preventive health services are underutilized by poor Americans. In fact, this relative lack of preventive care seems to be one of the reasons why poverty and a minority status tend to correlate with higher morbidity and mortality rates. This study was undertaken based on the assumption that the new comprehensive clinics set up in Los Angeles in the late nineteen-sixties afforded new possibilities for preventive health care.

This study reports on the representational composition of several areawide and subarea comprehensive health planning boards in New York State. [ABSTRACT FROM AUTHOR]

To deal more appropriately with elderly patients, a program utilizing a newly developed geriatric preadmissions evaluation was employed. The results of experience with more than 990 patients over a 12-month period are reported. [ABSTRACT FROM AUTHOR]

The article focuses on the occupational survey about the interest, attitudes and involvement of the forty-four dentists who are serving on a comprehensive health planning advisory committees in the U.S. The survey aims to help dentists in formulating ideas on planning, as well as background and guidelines on legislation and provide some of their experience in the planning process. The data gathered in the survey were used as base of the short-term training course offered by the Columbia University School of Public Health and Administrative Medicine. The training course covers a wide range of materials that pertains on the comprehensive health planning legislation, public health law, and regional medical program legislation.

The article focuses on the efficiency of the version of the Comprehensive Health Planning (CHP) Certification Program, a certification-of-need program in Maryland. This has been developed by the Maryland Comprehensive Health Planning Agency and other related organizations. It will be used in considering the certification-of-need concept when designing and modifying other certification-of-need programs. The author provides information on the criteria and health planning process for the state's CHP Certification Review.

The concern over the population growth among the Jewish population in Israel is not new. Attempts to achieve fast population growth, mainly for political ends, have been made for several decades. This may explain why Israel's otherwise extensive public health services exclude family planning. Consequently, there is much public ignorance concerning family planning issues, and, in turn, a low usage of efficient contraceptives among many families wishing to control the number of their children, as is shown by a sample survey of the urban population. Nevertheless, family size is generally small or else in the process of decline which is achieved through tile use of primitive contraceptive methods and also through extensive use of induced abortions. It is concluded that family planning programs are neither a necessary nor a sufficient condition for achieving small family size, and that such programs are efficient in affecting fertility behavior only when applied in a socioeconomic context. [ABSTRACT FROM AUTHOR]

The application of the culture-of -poverty concept to family planning is reviewed. Two approaches to program development are contrasted: accessibility versus cultural-motivational. Experience appears to support the accessibility approach, which seeks to create services where none exist or to remove obstacles which make services inaccessible (distance, crowding, eligibility and fee practices, scheduling, lack of information, and depersonalized delivery). Yet the cultural-motivational view dominates the thinking of many health and welfare professionals and is employed to rationalize slow progress. This anomaly is analyzed as an example of the resistance of institutions to change and in terms of its historical antecedents in upper-class biases about lower-class fertility. The implications for public policy are explored, particularly the potential use of the culture-of- poverty concept to justify selective compulsory fertility control if health and welfare agencies continue to lag in developing voluntary programs. [ABSTRACT FROM AUTHOR]

The article analyzes the first two years of the National Health Service in Great Britain. On November 6, 1946, the British government enacted the National Health Service Act and on July 5, 1948, the Act came into force. The purpose of this Act has been to make all the health service available to every man, woman and child of the population. The net income of the British physician has been not far out of line with general incomes. The rise of hospital charges has been large from pre-war to post-war. The money used for medical services is obtained partly from insurance contributions and partly from general taxation. The increased medical services have been at the expense of other goods and services badly needed for the economy. The diversion of more resources in the pharmaceutical business and medical appliances must also be largely at the expense of other commodities and services needed for domestic consumption or investment or for export. Through appropriate tax and pricing policies, the government has modified the spending pattern in favor of medicine. The pattern of spending the medical pound sterling has greatly changed.

Health planning theory has failed to operationalize the concept of rationality into terms useful for theory building. The concept of rationality has also generally not been translated into a useful tool for the health planning practitioner. En order to decrease the mystique associated with rationality and to aid in refinement of the concept, four attributes of health planning rationality are proposed: (1) Health planning rationality is "bounded" due to the magnitude of problems and man's limited problem-solving abilities; (2) Health planning rationality has multiple dimensions (technical, social, legal, political and economic); (3) The multiple dimensions of health planning rationality interact as complements and substitutes; and (4) Health planning rationality may be conceived of as the exposure of problems to cognitive processes. [ABSTRACT FROM AUTHOR]

Reports on the state of pediatrics in Hungary. Founding of the first children's hospital by A. Schop-Merei in 1837; University medical schools in Budapest; Hungarian pediatric school founded by the Bokays; Socialized health service in Hungary; Number of hospital beds for children; Regional scheme for hospital and outpatient clinics; State restrictions on private practice; Medical research; Society of Hungarian Pediatricians; International relations of Hungarian pediatricians.

In 1965, the U.S. Congress passed legislation by which nearly all persons 65 years of age and over in the U.S. became eligible for health insurance under the Medicare provisions of the Social Security Act. Prompt action by those eligible and desiring to participate in the program is essential, for enrollment periods are limited, and late enrollment increases cost to the individual and may also render him ineligible. With respect to Medicare as well as other programs it would be Ideal if information could be sent through the channels most likely to be used by those for whom particular programs are designed, so that the least effort and expense will be wasted and the largest returns gained. The identification of the social and demographic characteristics of the users of certain media would be a step in the direction of facilitating planning for the transmission of specific messages to particular public. This article reports the sources from which rural low-income women In the southeastern United States heard about Medicare.

A study of first admissions to all state and three large private mental hospitals in the state of Michigan from 1938 to ]942 reveals a concentration of high rates in the Upper Peninsula counties. These counties are part of what has been delineated as a rural problem area—an area of cut-over forests, decadent mining industry and marginal or submarginal agriculture. Exploratory correlations between the county mental disease rates and selected indices of socio-economic disorganization, such as percentage of population on relief, percentage of tax-delinquent land, and average value of land, proved to be non-significant. However, the high rates did seem to be related to nativity composition of the population. Foreign born and second generation immigrants were found to have much higher rates than native born populations. Correlations between mental disease rates and the number of foreign born in each county were inversely significant, both for the total foreign born and the constituent nationalities. The findings would seem to support the culture- conflict, social isolation theory of mental disease. [ABSTRACT FROM AUTHOR]

Deals with health planning in developing countries. Reasons for the different approaches to planning for health care in rich and poor countries; Focus of health care in rich countries; Instance treated as aspects of poverty.

This article presents an overview of the econometric model of the Medicare system in the U.S. Health care industry has become the largest public sector activities. The Medicaid program which was initiated in 1966, provided for federal, state, and local sharing of reimbursement for hospitals and physician services for that part of population identified to be medically indigent. Hospital care which accounts for 22.5 billion dollars is provided almost exclusively by the U.S. government and nonprofit organizations. The model presented explains the interstate variations in five key variables. By the end of the second fiscal year, 84 percent of all Medicare enrollees had purchased supplementary medical insurance, and the additional 11 percent had been bought by their state government.

The article focuses on the economic issues related to the policy of compulsory health insurance in the United States. Voluntary health insurance plans are expanding at a rapid rate in areas where insurance or prepayment methods of meeting health expenses are needed and desired. This encompasses the areas of major illnesses, such as the large, unexpected, and non-recurring expenses for hospitalization and major surgery. Medical expenses fall into two categories: the small, expected, recurring expenses for doctors' visits, dentists' services, etc., and expenses for hospitalization, surgery, etc. It is for the latter category that insurance means of payment are needed. This is also the area in which voluntary insurance plans have been expanding at a rapid rate. Most people can afford to pay for the cost of medical care. It was found that if the policy of compulsory health insurance was adopted, the probability is that it would be so costly that the benefits derived from it would not justify the cost. The major difference between compulsory and voluntary health insurance lies in the element of compulsion.

National provisions for medical care in western societies fall broadly into three categories. The Government may provide a comprehensive range of services universally available and financed wholly or largely by taxation, as in Great Britain and a number of European countries. Alternatively, private individuals and institutions may be the main providers of medical services whose range, quality and availability is determined by the price which the patient is willing to pay, as in the U.S.A. Between these two extremes there may be a combination of government subsidy to private institutions which provide a range of limited cash benefits financed on a voluntary insurance basis by the recipients, as in Australia. The emphasis of each system largely reflects the predominant orientation of public thinking on social welfare, and on health in particular. The British system is broadly collectivist, the American unmistakably individualistic and the Australian a curious combination of the two. [ABSTRACT FROM AUTHOR]

The article focuses on the discrepancies in the functioning of health centres in England and Wales. Although the so called failure of health centres arose from a variety of factors operating at national and local level, it was caused in the main by the limitations on capital expenditure required by the central government. The attitude of the British Medical association (BMA) also demands consideration, for its views and actions have influenced family doctors whose cooperation determines the success of every health centre scheme. That general practitioners can refuse to work in centres derives from their status as independent entrepreneurs. It is in fact, crucial that, whatever the profession's approval of the concept at a high level of generalization, BMA resolutely opposed the widespread provision of centres by local authorities during the planning stage of the Service. Poor communications have also affected health centre schemes. Lack of early consultation with the doctors is reported from some of the centres that came into existence.