The politics of trauma system development.

Federal and state policymakers have turned to health planning programs as a means to rationalize the delivery of health care services in the United States for over 3 decades. Early federal initiatives such as the Comprehensive Health Planning Act of 1966 and the Health Planning and Resource Development Act of 1974 were widely criticized for their inability to control costs effectively or to increase the efficiency of health services delivery. The design and implementation of the federal government's latest entry into health planning, the Trauma Care System Planning and Development Act of 1990 (Pub. L. 101-590), suggests that federal and state officials are poised to repeat the mistakes that plagued previous planning programs. The implementation of Pub. L. 101-590 illustrates the dilemmas that federal and state officials must confront in achieving effective representation and ensuring active participation in the planning process. Successful regional and statewide planning ventures must devise strategies to overcome the inherent collective action problems associated with cooperative solutions to underserved populations. Contemporary approaches to health planning, however, are based on a number of questionable assumptions. The creation of new institutional structures merely shifts the venue for existing conflicts among health providers, third-party insurers, and other participants in the health policymaking process to a new arena. In addition to examining possible alternatives for improving current trauma system planning initiatives, this paper presents a new paradigm for designing and implementing state and federal planning programs.