Hard lessons learned.

Abstract

IN the 1960s, health planning was primarily oriented to the issue of expanding access to medical care. In those days, grass-roots health planners were relatively oblivious to health-care economics and perverse health-system incentives. However, the fixation on the so-called crisis in health-care costs in the 1970s caused an abrupt reorientation of health-planning agencies from the issue of access to that of the bottom line. During this latter phase of health planning a number of lessons have been learned the hard way. Although some of those lessons and prescriptions for the future seem obvious now, they were not so obvious in . . .