By Barry Checkoway

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THE CONDITIONS OF PARTICIPATION The National Health Planning Act and s u b s e q u e n t amendments were intended not only to improve the health of citizens by promoting b e t t e r quality and delivery of health c a r e , b u t also to give citizens a voice in health care planning. Since e n actment of the law, however, t h e r e has grown a sense of 49 50 CITIZENS AND HEALTH CARE dissatisfaction and unease - a sense that things are not right with citizens in health planning (Ellenburg 1979). This unease, I believe, is due to the fact that citizens have been stripped of their most fundamental right - the right to decide policy.

Balbus, I. 1966. The Concept of Interest in Pluralist and Marxian Analysis. In The Politics and Society Reader, e d . , I. Katznelson et al. New York: John Wiley and Sons. Barry, B. 1965. Kegan Paul. Political Argument. London: Routledge and Burke, E. 1969. The English Constitutional System. In Representation, e d . , H. F. Pitkin. New York: Atherton Press. Checkoway, B. 1979. Citizens on Local Health Planning Boards: What Are the Obstacles? Journal of the Community Development Society. 10, Fall: 101-116.

T h u s , when we t u r n at the close to prescriptions for improving the representation of consumer i n t e r e s t s , it is in the light of practical constraints as well as philosophical considerations. The epilogue s u g g e s t s what problems would remain with health planning even if the difficulties of its provisions for consumer representation were adequately worked out. CONCEPTUAL MUDDLES, CONSUMER REPRESENTATION, AND HSAS The health planning law was plain enough about consumer majorities on HS As.

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