Structural analysis: From method and metaphor to theory and substance.

Health and welfare programs continue to be developed and implemented on a piecemeal basis in this country. There is difficulty in recognizing not only that health and social affairs are intimately related, but that the system must be dealt with as a whole of its interrelated problems are to be solved. Increasing costs for health and social programs are becoming of even greater concern, and cost containment (voluntary or regulatory) preoccupies both the payers and the recipients. Complicating the current situation is uncertainty of the role of financing and regulation on the part of the federal government and the states (the New Federalism), and the fragmentation and uncertainty of the private delivery sector and its third party reimbursement agencies. Questions are raised as to whether viable solutions can be obtained until all components (governmental and private) can work together in a partnership rather than an adversarial relationship in the development of an overall strategy with understandable objectives. Of basic importance is consideration of matters of organization, administration, and leadership at all levels so that whatever program may be developed or evolved can be successfully implemented. The subject is of such magnitude and is so complicated that it deserves a major coordinated effort of the federal government, the state governments, and the diverse private sector components to ensure a coordinated and systematic approach to any realistic solution.