Long Term Planning: The Alternative Futures Approach

Abstract

In every country, the health system has changed markedly in the last 50 years. What changes might the next 50 years bring? Can we plan effectively for the long-term? Long-term planning is both necessary and feasible. It must be concerned with the extent to which health system expenditures translate into health status gains. Today’s problems point to the need for a systems approach to long-term planning for health, and its integration with other sectors. Among the trends shaping tomorrow’s health system are: changing population structure and size; “Health for all (by whatever year);” advances in health care technology; and increasing cost, competing priorities. Health planning is usually based on extrapolation of past trends, and thus assumes that the future is an extension of the present; it is not. Discontinuities, such as political revolutions, economic shocks, or technological breakthroughs, may be important future shaping events. The future is uncertain, but not unmanageable. The alternative futures approach represents a potent technique for managing uncertainty and improving decision-making. We must either imagine alternative futures for society and the health system or identify those trends and potential discontinuities that might differentiate one future from another. We can then create any number of alternative futures for planning purposes. The alternative futures approach can inform increasingly difficult choices among alternatives, while recognizing the political nature of policy decision-making.

The author thanks Dr. Eugene Boostrom, Ms. Irene Jillson-Boostrom, and Dr. Charles Flagle for their helpful comments on drafts of this paper, and Ms. Dorothy Blount for typing the manuscript.