BOOKS OF RtfiDIfGS - PAHO/WHO

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T1c Iteole of Olieraionls Rcscarlch iii
Rcgioulal IIeCilIh Plauniiig,
Larry J. Shlmatgant, llarvey W1olfe
Unive s",, g/ ittlisbrgh, P'ittisbudrgl, P'mJs!lh ni(
It. I)ixois Sjl)'is, Jr.
,imaiJord Ul,.. r,!/, , Slnalford, California
(llec'eived Augist 1, 1972)
Operations-research workers have not met with much success in being accepted
as integral members of regional-health-planning teams, owing in part to a lack
of understanding by health planners of the skills the operations researcher
has to offer and in part the analyst's inability to demonstrate that he can close
the gap between theoretical modeling and the impleulentation of his res-lts.
This paper explores tite growth of regional health planning in the United
States and highlights its important problem areas. The literature of operations-research
applications to health planning is reviewed critically with respect
to thie feasibility of miodels atid the appropriateness of assuinptious.
Specific problems with the types of studies currently in the literature are identified
and recommendations are made for improved coordination between operations-research
workers and health planners.
H 'AI,TII Pl1,ANNEli Iiave! inlriltld ' ,liv(ry sstemn tliat d(,vtlol),)d lini>ost
randomly iii accord withi local politica. economic, and/or parochial interests.
Cammuility3-wide planining typically pl:tyed a minor role. As a result, tlih( untvent
distribution of healit resoaurces :ad s(rvi(ces tirotugalio t a region Ih:.s Ih(4et a per.
tist(eit Irobhlmi coimnlic:ttinig pliininig. F'urlher, aus long as h(iolitals wvr( required
to provide relatively simtple procedures, no great strain vwas placed on nianpow(,r
sul)plies, nor was the ecoeonomi burdent caused by duplicatiozn of servic((s undluly
heavy. Specialization and advanciing technology lhave elihaigd thlis situation.
'T'oday's compl('x medical Iroccedur(es r'luirae X,.l),isiv(,, soplisticite(ld (lUiil)mei't
facilities, as well as teams of higlhly skilled personiíel.
ntl
2IAYslI h1as described the history of health planning in the United States as
highilighted by thr(e lanidmvark é(vSents: Tli( pass:ag( of tite Hill-Burton Ael (1>1. 79-
725) in 194(i; tithe 1Xi joiit publ)lic(atio, by tie, Amnerican Hlosp)ital As.ociationm anud
Ih(, Jublic Ilailtlh Service of tllt report, "Area-wvide lhlalinitig for Isl)pit:is andl
lelated He(alth l Facilities;" tui and th(e pamssage of the Co)mpr-ehensive Ilealth Pllanning
Act of 1966 (J>L 89-749). To th(lies might be added the Regional Medical
Irograni (1>1, S!)-23:i)) eitclted i¡n 1!XiS, ai(d thi(! I',xpeiriillttl l leaultlh Servicets l)e.
liver3y Systems programn adopted iii 1971.
Health planinning int the United States most likely originated with a volulntary
groul) that formed tihe Cinciiimmti Public Healtli Council iin 1917.11 Tihe growth lof
Coinmiunity hicalth couiicils miimlSrooi(cmld; by 1(M99 tih.re ;were 1222 suieih l!o:ld anil
st:te orgtaniz:ttiots. Ma\lanl of thi(s councis served ns the maini htulti-)lt:iiiiiiiLg