Health systems agencies: designation and funding.
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An 18-month study of consumer participation and influence in a Health Systems Agency (HSA) found consumer board members to be less influential than provider board members in agency decision-making. In an effort to investigate causes of the influence deficit experienced by consumer HSA board members three issues were studied: staff attitudes toward consumer participation; board member degree of representative accountability; and board member attitudes concerning commitment to consumer participation, commitment to health planning, health services attitude, and feelings of social powerlessness. Results indicated that staff members were favorable toward the concept of consumer participation. They recognized a lack of low-income minority participation, but they did not provide support or allocate resources to enhance consumers' ability to participate. Providers were less committed to consumer participation, felt more socially powerful, and had greater representative accountability than did consumers. Several strategies for increasing consumer influence in HSA decision-making processes are proposed.
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In this study, the dependence of the health systems agency, formed under P.L.93-641 in its planning environment, has been analyzed. After presenting some generic barriers to the implementation of the Act, the specific components of the planning environment that support the HSA were identified. The hypothesis is that the viability of the new HSA depends largely upon an improved planning environment. The present constituencies of the HSA are weak, or even negative. A strategy of interventions is tailored for each major component of the planning environment, on the assumption that each is unique in its structure and objectives and therefore in its client relationship to the HSA. The innovative planning processes required by P.L.93-641 will not be achieved without vigorous support from each component.
A Federal law signed by President Ford in 1975 (PL 93-641) mandates the establishment of Health Systems Agencies across the country. The major intent of the law is to provide local direction and control of health care planning. Each Agency shall have a professional staff under the aegis of a board of directors composed of a majority of consumers and a minority of providers. Data identifying health care needs shall be translated into a Health Systems Plan, which is a statement of goals for each Agency; an Annual Implementation Plan shall be developed as a statement of objectives, projects, and strategies requisite to achieving the Health Systems Plan. The concept of the Health Systems Agency has correlate state and federal bureaucratic strata to facilitate health care planning coordination.
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It is a truism that good management is a prerequisite to successful health planning and that essential to good management is reliable data on what is taking place. Health Systems Agencies (HSAs) have, in general, not taken advantage of management information systems (MIS) which might assist them in obtaining such data, perhaps because of cost or because of fear of burdening professionals with too much record keeping. Yet, performance categories mandated for HSAs provide an excellent base on which to build a simple, flexible MIS. The HSA of Western New York (HSAWNY) has installed an MIS, one component of which is a time reporting system for professional activity. This article discusses the purposes of the system, the analysis leading to its design, the input coding requirements, the output reports, uses for the output, the developmental and operational costs, the difficulties with system development and operation, and suggestions for further action.
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Planning for the long-term care and support of the elderly is uncoordinated. Although several agenices are charged with the planning role, the Health Systems Agency (HSA) has emerged as the major planning unit. Long-term care planning is currently based on skilled nursing facility (SNF) utilization rates. This limited focus is inappropriate and the data are inconclusive. Population-based data, including levels of functioning, age, and living arrangements of those in need of extended support would provide a more useful approach. Sources for such information are suggested. The HSA should commit itself to population-based planning with special consideration of the mental health needs of the SNF residents, and the function of nursing home auspice. All types of health and social services should be taken into account in planning a system for long-term care and support.
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