Limitations of community control of health facilities and services

Health care programs which will truly meet the needs of the people they are designed to serve require both dedicated professionals and dedicated consumers. Policy-making boards should have consumer majorities. After all, voluntary hospital boards in the private sector, and local school boards in the public sector, have always had consumer majorities, and many have functioned very well. The working class has been inadequately represented on these boards, a matter which must be corrected, but they have been consumer-dominated. As we move toward increasing public involvement in the health care delivery system, the health care delivery system might do well to critically examine and learn both the positive and negative lessons the long history of local school boards in this country has to teach. Boards should make policy; professionals should administer programs. Boards should set and monitor performance in terms of program results and hold the professionals responsible for their work. The special, dominant position of the physician, referable principally to the medical license and the disease orientation of our 'health' care delivery system, should be understood. Whether professional or consumer, board members should be chosen to work in the health care delivery system on the basis of their demonstrated ability to meet the needs of the people, not on the basis of one label or another. The realistic limits of 'community control' in our society must be recognized. Artificial solutions to problems created by a class-based, profit-oriented society do no one any good.