Interest group representation and the HSAs: health planning and political theory

Abstract

Examination of the provisions of the National Health Planning and resources Development Act, P.L. 93-641, concerning the composition of Health Systems Agencies, which are to be the primary building blocks of local health planning, suggests that expectation of substantial change may be unrealistic. Specifically, in its provision for representation on the HSAs, Congress appears to have been accepting an implicit theory of pluralist interest group representation that has long been prevalent in other sectors of public life in the United States, and long subject to significant criticism. Such forms of representation tend to lead to bargaining, log rolling, and collusive competition among narrowly defined special interests, with the interests of the broader general public less well served. The application of this theory to health planning in P.L. 93-641 is examined, and predictions drawn about the implications of this analysis for health planning and health policy in the United States in general.