Even in Western industrialized countries which have for several decades spent around 5 per cent of their Gross National Product on health care, interest in planning for health is recent. In countries like the United States, with what is sometimes described as a pluralist system, this is scarcely surprising. When the United States is described more bluntly, as it was for example by Walter Reuther, the incompatibility of planning with the general pattern of delivery is clear: ‘What we have, in fact, is a disorganized, disjointed, antiquated, obsolete, non-system of health care.’ But even in the United Kingdom with the framework for planning provided by the National Health Service, observers have been struck by the failure to develop an adequate planning mechanism in twenty years. This view has not been confined to foreign observers nor to British commentators outside the medical establishment.