The Social and Health Systems Context for Health Services Planning

Abstract

Any planning activity requires a complete understanding of the context in which planning is taking place. Effective planning cannot occur without an in-depth comprehension of the population that the plan is meant to serve and the social attributes that have influenced it. The social, political, and economic characteristics of the target population must be thoroughly understood. This chapter addresses the key social and health systems characteristics that are important for framing a health plan. It reviews the evolution of the US healthcare system from the second half of the twentieth century to today. Since health care is a requisite need that every society must fulfill, the sociocultural context provides the framework for the establishment of the healthcare institution. A healthcare system reflects both the social structure and the culture of its society and is influenced by the beliefs, values, and norms characteristic of that society. This chapter goes on to review the history of the US healthcare system in this context and chronicles its emergence as a dominant institution. Changes initiated by the healthcare system itself are noted and their interplay with changing social attributes is highlighted.