Distributing Medical Care Services: Coronary Care Units in the United States and Sweden

Abstract

Planning in the United States is based on an institution's perceived need, whereas in many other countries it is based on population need. These unique approaches to planning have led to widely differing distributions of facilities and services. Planning by the U.S. method leads to a more generous provision of services than does population-based planning. In both planning systems, the planning process appears of paramount importance, while the fundamental questions of effectiveness outcome and impact of medical care services are usually ignored. Even population-based planning either cannot or will not deal with the conflict between professional desire for highly developed technology on the one hand and treatment effectiveness on the other. Nevertheless, population-based planning has at least the virtue of providing a less expensive yet more efficient system. Physicians and the public appear able to adjust to the quite different resource provisions of the two planning systems; both the abundant U.S. supply and the restricted supply in Sweden are perceived as adequate.