Planning and management of public health in the Federal Republic of Germany.

In the Federal Republic of Germany, the debate on public health is dominated by the question as to the cost and the financing of good health care. Indeed, expenditure planning has now become the main area of planning in the public health sector. By contrast, the plans to improve health standards and to intensify health protection as well as to improve the quality and efficacy of health provision are somewhat neglected. This is probably due, in the main, to the strong position held by the providers of medicines and medical services and thus, by the same token, to the weak position of the consumers. Although there exists a well known set of statistics and indicators to describe the state of public health in this country, there is an almost complete absence of any attempt to evaluate them for planning purposes. The scope of intervening in the sphere of health care is thus left to a large number of protagonists characterized by completely heterogeneous interests. What we lack is a system of target-oriented plans and concrete measures. In the field of providing health care and combating disease, the only available systematic planning concerns the provision of in-patient and out-patient medical services: there is no planning for the quality of such facilities or for the range and quality of psychosocial and nursing services. As regards health-expenditure planning--which has made the biggest advances--the participants enjoy a great deal of independence: the volume of spending and increases in expenditure are thus the outcome of a process of negotiation. Under the current planning philosophy, consensual decision-making enjoys a high status.