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March 1973 (Volume 51)
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The intent of this article is to present an intensive comparison of one area of health planning, viz., planning for health facilities in the United States and in Germany. In both countries federal legislation increasingly has attempted to achieve comprehensive policies through planning. Most attempts have been markedly influenced by various levels of authority which exist apart from the federal level. In the United States the notion of comprehensive health planning seems to be an indirect outcome of several isolated decisions. In Germany, on the other hand, state and local governments have long accepted health as a public responsibility and have been involved in hospital-related matters within certain limitations, i.e., hospitals have not been directly influenced by centralized decision making. While the German health bureaucracy remains the principal vehicle for hospital decision making, consumer advocacy planning in the American sense does not exist. Health planning in the United States under the Regional Medical Program and Comprehensive Health Planning provides an example of the interaction and interrelatedness of many political factors which influence health planning. Paradoxically, the American health planning process lacks a clear mandate from the consuming public in terms of developing fiscal, political, and legal powers over the subjects to be planned, including hospitals.
Author(s): Christa Altenstetter
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Volume 51, Issue 1 (pages 41–71) Published in 1973
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The Milbank Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, historical, legal, and ethical dimensions of health and health care policy.