hefere a subvermiittee of the Heuse Coruzlttee on Apprepr riation . : We. < * #, yr ~ “ ae Ves. Reid: ..€6 you have an estima ta ‘cal end State units in the regional medical pregrans? rh yy a re we ret ° ta find thet very aifficu co evaluate. Ag an example et kind of calculation, we heve serving on ical committees, lecal advisory ey cS t oO bt & GR be 3 es ny 9 rm f 3h < tr. o "7 r weg o& y Q lary 1 ba) w ct if o ne Mm hs aud so en, well in excess of 10,080 people neeting anywhere frem 3 te 8 er 10 er 15 cays a yeer Na den't pay consultant fees for any of these individuals. They give theie time. These are hundreds of theusards of wan~heurs ef prefessional time which are contributed. "yn very freqeently invelve major health activities in a coordinated feshicn, anything from the Appalachian pregram te a lecal ceunty health department to make sure their investvent is better desisned and better aimed. "yt yould be possible fer us toe make 2 calculetion cf what this means, but it would be misleading.....I am confident, hevever, thet every dellex invested in the regional medical pregraus has an influence on many wore dollars and has a vav rable influence by having them managed mere Gffectively." Committee on Appr tthe teitiel cencept o3 L971 durin wicle by which scientific knowledge cou yiders of health eervices and, by so deling, impreve the quality of the health care provided. but the begi Regional Medical Programs ‘tthe premise upen which v ing of the responsibilit besed is that the providers of cere quzlity care to ail Americans. epportunities, have beth the innate capacity ene of hew best to develec arings befere the subcemalttee ES Was ta provice @ mere readily transferred ae, hievever, this ss and potentielities ef nl Hecleal Presrams Service is ay in the private sector, given the nd the will to previde o i Accepting thi aption, the issue id promote se opportunities. : ast earings befere e subcermsittes BG Dr. Hergul - a ne of tre eu g eur present health deliver nevcent of all practicing physicians 2 © G a Bs < 7) ie o> * Dy 3 Lis] . a oa pt o * 2 * + estinated 30, ae in the ceuntry, will be invelved in recionsl medical pregcam- supper ted no, Im terms of hogpitals affected by regienel yedical g presently particlpate in o 2 tan wee ty eee eae 3 oes ne adgartea 3 BDeErCcen er benefit From regione] medical pregrens. This represents 25 percent pr. Mergulie before a subcomaittee fT t -, m of the Houses he “a * = aad get apece ti pes . 2tome -y er ft tthe procese we ave using the regiceal mecicel pregvems..is unique. We lock en it es the Fedsral Coverument's most direct and effective thinking ef it in these ‘S the private health-care cystem. Q ee a acceeées t ¢ st 1 ple rt ms Hs teres, we want the many regions which ve have to function n their Els evn resources and as independently ae pessible. tl owe have established the prectice ef allowing the programs te de thelx cun preject review and for the west parc make their own decisions abcut how they imvest their fumes. We carry through a review srecess a8 we have in the past, but we are locking at them (the regions) more as competent inetitutiens rather than as preject mechanics ag they were locked on teo much in earlier daye." « hearings before a subcomnittes 19o71, eurk ; cil > Lr: the House Committee on Approprietiens H -.f the Funce supperting the current 600 cperetional prejects, over i & : ee fer patient care demonstration prejects b>) h ceronecy and ether intensive care actir t re tr fe ate un in oC re ot & rs rs La he ° ms and improvement ef embulatery cere in neighborheod health centers, the expansion and improvement dditiene] 45 percent is used te support activitl tilizetion which will lead to improved care and expanded services. The training prejects include the training of nurses and other exieting health personnel, including physicians, in new skills as well as upgreding existing skills. Our manpower training and utilizetion pregrams involve all ef the verious kinds of heaith fo resources within communities - hespitals, clinics, neighborhoed health ~ centers, specialized facilities, and medical echool health complexes, but indeed are not Limited in any way to the latter. Finally, approx- fuetely 17 percent of our funds support projects concerned with coordineting the ectivities ef cemnu nity institutions in order to de evelo op means of inpreving aceess to and the quality ef available health services." 4 dur ive , Apedl 28, 1971, ies -tien Le nm Appye pr g evic $e g M &e Yu a ba ot conpre- 58d & ” + nesuréeged ¢c Success hoy oy nad 9 = Ww ra) $m @ > sa Q uo e. ue slementatioen gf ena in eaded for plannin a ttee £ “ befere a gubcenm oy fi a} f ved wae anning + a nsive health p wehe ap cCcYw Lae le Ce et @) ¢ a te set pricr 1 ne regione L . - fe ities $ a +. 3 ane ane ‘view 5 £ r £ f consumer's oiut o LS Td teen eid ae on Venat the high cost of medics] care 2 of z came fragt we. -” 7 identified ag being from faderal seu increasing derend that we heave a measurement ef whet we are purchasing. And one jseues before 1975 Ls going te have te de with Ph the tising the quality ef medical care which is being mirchased by federal and 2 private money. And this is geirg to preduce seme profeund changes in Mpuytic huspitals which currently provide pisearable medicel care fer L ie people because they ere indigents ave going te have te face the fact he thet this cere is unacceptable. Payment systems are going to identify the difference between good end bad care at levels cf sophistication which none of us feels ready to take on. " "A aayth we did net speak about is thet bielogical research necessarily _ means better health care. We found that wes not true. The second myth was that if you inerdase the ability to purchase care, the system is infinitely expansible end can respend. We found that is net true. And S the third one, which we ere getting into a better understanding cn, is thet increasing the number of pecple available te provide medical services ls the wey toe everceme the manpower shortage. Thet is pre-- eminently false. vee HE are facing an in teresting dilemma as we go sein... tm into the seventies and eighties. Lf we are te taaintein expert the quality of medical care and meke sure thet it is avellable, what the rele ef the physician and what is the role of the people? L believe the following event will cccur by the eighties: "Snectalists will continue to be traindd; they will be cenfined fer the mest pert te hospite le; they will be governed by the hespitals iy ee ea mE a on . id ya ie : 4 : 4 yether than by ether kinds ef The nederity ef medical cere is eu pliteard piece a or pete fon = ore ms individuels under e eystem of maintenance and supervision volen will depend upen a different kind of physician. Scee ef this will be in greup prectice... “OL think we will diecever thet it is not necesscry te gee a % dete ry £ w a at ors 4, - teh Sang 5 eye - . . Spey imte the seventies, I think we are going oO discover thet a signiticanst L parties of the time epent by professionel people is spent giving atten- tien te individuals who de net need to ba inte g te be the use ef cutemated techniques and >= 5 tw © ete 5 3 fo vt pis Gs qt ® i-* rg I believe this Will include screening wetheds which will have their ntenance rather then en the identification "hs a consequence, there will be a different use ef allied health power. And elthough this may sta artle yeu a little, I think eur tm Ma current efforts to (1) increase the cutput ef wedical schools, asseciated with cur efferts to (2) reorganize the way ia which health care is being provided, will lead to a discovery somewhere along the line that we ere training tco many physiciens. If the latter is successful, the 4 former is unwige. Lf the former is pursuce an the letter is not, we fhe are cong te have toe get around to it a t a later date. So all these o efforts to vastly increase medical schecls, with the illusion that this e@ will provide medical care, ere going to be re-examined and, in the course cf time, I thirk ere going to be aropped. . the solution lies, not la adding to the numbers, but in making gol g to be s ole ere © 2. $ where pee f ae th Lo 2 2 aa 7 ig ” a a > mt ‘at ca 3) uy) “Should RMP and CHP be combined? The answer to that question is unequiv- _ocably ‘no.’ They serve a different kind of a purpose and if | have my prefer- ences, | would say that CHP and RMPs should operate in such a way thet they have a productive tension between them, one forcing demands on the other, the other dealing with those de- mands. They should have a basis be- tween them for an effective negotiation between what the community needs with a resolution in capacity, the identi- fication of reasonable priorities, and the reaching toward those priorities by a common understanding... “1¢é we are to be effective in RMP and. CHP, the problem is a double one. Not only must we be responsive to con- sumers, but we must be able to interpret to consumers the difference between an irrational and the rational effort to meet their basic needs. And because it is a sophisticated issue ana because the health care system is complex, it means that the professional effort of an RMP or any other organization needs the full understanding, the full exploi- tation, and the most minute interpreta- tion to the community so they can appreciate the difference between the visible, the glittering and the glamorous arid what really is essential for health maintenance for contro! of cost and for the basic health of the community.” ——Dr. Harold Margulies it ; > Uber rhe yp i * tye 5, ‘y tet lated Baht Cin Face eles A a ark Ee La Lee ean a ae ik inte EY ae a te A aide 618 the appropriation bills. T weuld have to vote against this because I think this was not an intellizent way of going about a cut. I am sorry to see you people fell in that trap. What you are doing is ha irming your good RMIP’s the bad ones. Dr. Maneuries. We prop so not to continue that hecause I agree with what you just said. The tri-State program is currently funded at the level of $1.8 million and depending upon the availability of funds in 1972 and the way in which they come out in the total array of pro- grams, and I would anticipate they would do very well, they would be above that Jevel. . But it would have to be, a3 vou indicate which are less productive and less mature and less useful. and rewarding wee d. at the expense of programs : L a RMP 20LE IN DEVELOPING H310's Mr. Conve. What is your assessment. of RAIP's an r in the Administra- tion's plan to intensify efforts in the 370 and 7 ipower areas? — DP MG sRe ries: I think the regional medical programs can make a yery major contribution to the development of health maintenance organizations in two substantial ways One of them is to help bring togethe t those individuals and institu- tions which have to form an HALO. If you look at the array of ine i dividuais and institutions identilied as par riners, participants in the provider end of the health maintenance organization, they are the + sare pecple as those in the regional medical progr ams, already meet- ing together. Sothey obviously havea kev role. The other aspect of the ITSO which will require scrupulous atten- tion is the character of the health care which is delivercd through the device which is created in an HALO. We will need to have ways of using manpower more effectively, of monitoring the quality of care, and of making sure chat when quality is inferior it 151 restored to an appropriate ley el, all of which are exactly . the kinds of things in which the regional m redical programs can be effective. RIMEP ROLE IN ChEATING HEALTH MANPOWER As fay as manpower is concerned, I suspect the potentiality for re- gional medical programs has probably been underap ppreciated more than any other field, which is amazing, becanze. of ali of our deficien- cies. the lack of munpower to provide services is the most agonizing. Tf vou reflect on it for a moment, you will see th iat If there are more services to be provided. greater access, croater ouireach, and if we are hot to have enough phy sicians, and we won't i AVE. it has to be done through the hands of other people, physicians’ assis{ants, nurses and so on. The only way in which this can be done with supervision. with ap-- proval, wit imensuremicnt of ¢ paality ether on an informal or formal basis, is by the providers of ex sre who are at. the present time responsible for those : activities, the same people whe make up our regional medical programs ep tach ponld aa a tadacabig Liane 3 mpeictieneaattst Pamd wae Tfa physician or stot ip the patterns of medical e ean do it rapidly. a8 yi of resoure oe BMPS shave: whe Weean also perrain pet feets of that rotraning vw + . Boye te AREA Ti One of the other props this adminsu% ition 38 ah very atirar iive concept, c aie facilities in a Ho As deserwed. such © Antriguing part of Tae “ “regiona it me «diel { progres time Vof closing the | loop - services. aid che praise: At present you have ¢ university health serene? with one another roo Tres . What we nes dito sn measured neainst the se. the relations hip berweel changes, how de it so there is CORTE? This in ihe kind “een Investing i & we probally v have t anywhere Derais for the purpose needs of the peop ie gret. This 1s a toi splendidly tothat m Mr. Conte. Phat it Mr. Gos pords sou aie be tyes UME one Tae TE. district. thes wre In my quite i a fow stude . well. They have roms. see ine r hospit: ul. Ati i LT believe we ery 88 to that dozen st buildinss ie ib need far that at: shire Modte: al Cen dormitories and inere more students. De. MPanec Lins is supported byt Mire Contr. Rig nm my Aisa ha erate de wake Ror antat, «2 om bg aL eencdaSie ee Lata Send no Pit A a i i pats ete ame G19 jan ar croup of physicians or a hospital wishes to change i lize other kinds of Individuals, they ifa phy yoo. gainst this because T P ' Vi or +. wo tepus of medienE care and ule coming about a cut. bo am he patiorns OF i aan : Ch ey _ ‘ _s ‘ wan de it rapidly. and I think with good justification, with the kinds af pesOH Fees RMT’: have available. cated carlier, and measure the ef- sod RAIP’s and rewarding tinue that becanse TI agree evranvis currenily funded at in the availability of funds it in the total array of pro- lo very well, they would be at the expense of programs a less useful. ; HMO’S RMP’s in the Administra- nd manpower areas? ‘ical programs can make a nt of health maintenance z¢ individuals and institu- viook at the array of in- ‘iners, participants in the reauzation, they are the } programs, already meat- ao We ean also retrain people, as Tindreat it being heavily involved in institutions. fects of that retraining withor ANFRA HVALTHT EDUCATION CENTER righ on the list of activities in this administration is the ation center, which is a very attractive concept, typing toprether ell of the service and training facilities in a community with the gervice needs of that community. As described, such centers are not very remarkable, but. the jutriguing part of the concept, which is close to the heart of the ical programs, is the possibility it provides for the first woon services provided, the need for those people who must provide the services. At present you have education here ina hospital or junior college or university health science center and service out there, and the two relate with one another too frequently only by accident. What we need (o know is what happens when the training is measured against the serviecs provided (or not provided). What is the relationship between the two, and having discovered the need for ‘changes, how does ane ¢o back into the educational system and redesign it so there 3s continuity between what is taught and what is practiced? 'This is the kind of thing which regional medical programs hare Sheen Investing in effectively. In tact in the Watts-Willowbrook area sample of an aren health education center ~~ One of the other proposals which is ] area health educ regional medi time of closing the loop bet eepvices, and the training of the “we probably have the best e é t ~ scrupulous atten- . : . i tyered throuch the anywhere because 1f was designed in that troubled Black community Soe - i for the purpose of building a service system and institution around the : rave a yoice In what they rower more effectively, of i sure that when quality dyallof which are exactly , ; 7 * “ - ¥ nedical programs can be needs of the people and to Jet the people } get. This is a total institutional concept. I think we can contribute splendidly to that purpose. Vr. Conte. That is tremendous. 1 couldn't even begin to start putting it into the words you did, but you are absoluicly right. : MANPOWER SERKSHIRE MEDICAL CENTER ae . . t the potentiality for re- : In my district, the Berkshire Medical Center las taken over : underappreciaied more ; quite a few students. from the Albany Medical School. It has gone ‘se, of all af our deficien- t well. They have room for maybe 30 or 40 there. lt is a very good “is the most. agonizing. 2 teaching hospital. At the University of Massachusetts medical school see that if there are more : I believe we only have a dozen students, If you are going to add on ronutreach. and if we are . to'that dozen studenis, you are going to have to have more expensive t have, it has to be done ‘ buildings and Jabs and all the trimming whereas maybe there 15 no is’ assistants, nurses and é need for that at all if you take the students to a place like the Berk- : shire Medical Center. With only a little money invested there for ith supervision, with ap- i dormitories and increased laboratory facilities, You can educate a Jot. a aninformal or for ; more students rit ormel ee - . yas . ' present time responsible ' Dr. Mancciins. You know the activity at Berkshire Medical Center up our regional medical is supported pe Albany regional medical program. Mr. Consr Right. . sees eer eee ene mere Sew sete tea St et oe Ba tae ae de OO EA ae ie el eT Ser penne e peakate nga dnp Ree te E, P ERENEEEAE IF epee eee igo © trp Ne rene aig een mp inarnge pet Em anc anon emt Me fem “ , if 4 RN te Peyton Sem fae ea einen Pat tt at OD a ee a 621 INPLATION AND TIE NEED POR aFORE RAP FUNDS vir. Casey. Tthink vou well know, from what you heard in the ques- (ions, that it is not only the chairman but the fill committee is very interested in the program. Tam sorry the chairman hud to leave be- cause T think you have given some very good answers on why you need more money. I am sure you suffer inflation and increased costs just like anyone lee and if you just give the sune numbers of dollars, you are not coing to give the sane amount of support are you! Dr Marctcims. No. I think our best hope is fe make sure that. we trim out anything winecessary and sharpen what we do toa very fine point. ALY. Casuy. Are you going to have enough money to do some of the things you were telling Ain. Conte, some of these arca programs you think ought to be instituted in other parts of the Nation ? Der. Manotums. Lilink we can make a very significant contribution to them. I don’t believe that regional medical programs needs to func- rould function alone in such activities, We can do tion alone or even sh what needs to be done in consort with other programs and other AgeENCICS. Mr. Casey. The trouble is most of ihese other programs are getting pretty tight, too. The helt is getting awful ficht. At least that is what [ heard. I happen to have a medical center in my district which has heen helped a erear deal by TOW and National Institutes of Tealth and all of the other programs. ‘Chey all seem to he worried about the cntdown as they call it and it isa cut. You say the same amount of money isn x same amount of service for your dollar as you did Jast year, They are afraid we are losing ground in research and in supplying this demand for improved medical services and better distribution of oat cut, but you can’t get the medical services. Dr. Mancrrirs. We do feel the squeeze. MULTIPIPASIC FIFALTIE TESTING in greater detail the automatic Mr. Contr. Would vou deserthe uve 241 of the multiphasic health testing that is mentioned on pt justifications? : Dr. Mancvirs. Regional medical’ programs, in cooperation with local clinies, hospitals, and neighborhood health centers, is support- ing several automated mntiplasic health testing activities around the country designed to provide preventive and ‘early diagnostic services for heart and Jung disease. cancer, Giabetes. and other diseases and conditions. These automated testing services involve the conduct of a series of sequenced. multiple laboratory tests on such items as hlood and urine samples. EKG's, and N-rays, by utilizing automated equip- ment and analyzing the results with computers, Withhr the regional medical programs, these services are developed as integral components . . c eee meme RR eT mn tae case eine ery ae ardna ethan ME Re We FR neal Ce ara adi ts oh tea nate eee PLS oe feel a enn its babe 622 yy a of larger health service programs and invelve ihe development of cloge ties among local physicians, hospitals, and clinics, for referral and followu up services, Many of the [UMP activities are tied to neigh- . borhood health centers and inelude training of local community resi- denis to work as technicians in the programs. ” Multiphasic sereening activities are being carried ont in the Mem- phis, California, Tennessee/Midzouth, Rochester, and Intermonntain . regional medical programs, to name a few, For examples) in Salt Lake City tlie Intermountain regional medical program is providing auto- inated mu Jtiphasic health testing services as part of the prowram of a neighborhood health center which js delivering comprehensive, acces- sible hoalth care toa low, socio-economic target populition. The sereen- ing activity involves extensive patient histories. physical examina- tions, including hearing and eye tests, and several Jaboratory tests, as well as the training: of screening and Jaboratory aides who are recruited from among “the community population. These, and other RMP sereening activities, are helping to provide and promot e preven- tive medical care with the expectation that through carly detection efforts the cost and disabilities incurred from advanced stages of disease will be reduced. EFFECT OF SMOKING ON PREGNANCY Mv. Conrr. What are the statistics on the chances of smoking mothers having a significantly greater number of unsuccessful preg- nancies than non-smok ing mothers? _ Dr. Hous. The British Perinatal Mortality study is one of the largest studies dealing with this question. I will place in the record inforination gathered from more than 17.000 births recorded in 1 week throughout 2 nel: and, Scotland. and Wales. (The information follows: ) " fPer 1,099 births] Reonatal Stillhirth Geath rates rates Shroking mothers... oo... soccceceeeecceecccecercececececquececceceseccecsecececs 1.20 ORB Nonsmeking methers..............0... see ee cee seen, accecacerecccencsacee 13,1 19.3 Analysis of these rates shows that smoking mothers had 31:3 percent: more neonatal deaths than nonsmoking mothers and smoking methers had 43 percent more stillbirths tha in nonsmoking mothers. There were no vi ita concerning abortions and miscarriages, Tn another study of nore than 2.000 births.in Eneland. Ruszell found th na smoking mothers had sigiifieantly more uns snwecssful preg- nancies die to stilibirih, neonatal devih, and aboriions than the non- smoking mothers, He concluded that 20 percent of the unsuccessful preananeies In women who smoke regularly would have been suecessful if the mother had not been a regular smoker. neat en i att Ee Bie le thy a aN en alate SL | tweed Taree ge Ae Bem bootie Ratt Shans arieans T healk t ‘ y ark OF tir. Fn rr, Phase ‘] . n TT eR MY site : v a A ae tue tty wyse ~ ves a toe “Phara wim _ady e . Pyenptes foroar tehat wham WE c: cme ted an dnemeven is try an ye: yon. ra sniokers rn Pann, i eifo. IMPROVEMENT en bre CUimad Mr. Contr. How have Seenth Operant toy Hnpreved overt d not Dr, Mancenins. “Phe yey Word; from ee baveric donors ho thary 2 pereent daring io; ey w pereeist because ab rejec es: accid an hemes diabysis ean a we lelins investigators have report ds, th, transphintswis else fof Ally es By the end of Dt a. int the United States, ‘GF 8 an | daring (370, : hos} Ine rensed confidence tn Land: in Inerensed utilization, ivits, w She yn : rT) y von te plants stemmed fron ur every other kh The irerensed eihes tissue-typing, anil ees tributine: toward the ord 1 te sf bility. ~ spital , THe Is 9 al Mr. Contr. What mh oreren sill become oper: ation tite ho Dr. MEARGULIES. % “ost im program in New Yors: Coney: port RELATION STE ‘ted : Mire Conre. You state “an from dreas whieh apoes 7B a. Jectives of | lorionnl 3 IEA N ess verbiage. vs 1 vities “PESO? eramand why are the att Dr. Mancunres. Denn: reiterating the quoiatien wan. . ag—pas O—Ti—ph 2 ona iba ata ie Fi a a tne cd die eaten ate 624 lt is the objective of the Regional Medieal Progenmus to Improve availability of and access to high quality health care te all Ameri aus thresh inpreyvements in the development and more cilcient utilization of health manpower and other resourees, , As for why erants are being reduced, I can onbly repeat what Mr. . 18 : eae PE rif vee FOr \ t Meyer has said cartier that this is essentially a holding action rntil some sense of inteeration exists wnonge already existing efforts and those newly proposed. IMPROVED DESIGN FOR INTENSIVE CAKE Mr. Conte, On page one of your statement you mention improved design for intensive care that lng resulted from efforts under this pro- gram. What is the improved design that has been brought. about? Dr. Marciunars. The improved desien that T nade reference to re” I = Jates Jargely to putting together the several essential pieces required ~ for the larger “system” of intensive care. It did not refer to “design” in the niore commonly understocd sense. of that word; that is, the plan- ning and layont of intensive or specialized coronary care units physi- cally, While it js true that an intensive care system, whether of a more ‘generalized character such as that for treating accident victims or a ; mere specialized one such as that intended for vietims of heart attacks, / requres an intensive or coronary care unit or beds, that is but one cle- } ment. The uit itself is of little use if other equally essential elements re not present, ~ Its effective functioning requires that there be an adequate trans- x portation system for getting the victim to the hospital promrly. ambulances that have a coronary care capaeity—and here I am not Jy falking about so-called mobile Coronary care units, which will help “keep the patient alive while he is enroute, or tying into the Army's Medical Assistunce to Safety and ‘Traffie (MLA ST) program whieh * provides helicopters for emergency Gransportation in thase areas where it is being tried and tested. , Atalso requires having nurses adequately trained to staif such units . around-the-clock, In many small, remote rural hosvitals, a telephone » tie line to another larger hospital af. sorve distance is an alternative, ) For it permits trained nurses in that Ja ror hospital to monitor and, fin the event of a crisis, prescribe appropriate emereeney treatment | for the patient being cared for in 2 CCU in the remote hospital. “2 Such “improved design” also means and this is most. important, that the planning for such intensive care systems, or currently missing ele- » Ments, make adequate provision for continued support once initial regional medical program grant support. is terminated: that is. that there be reasonable acsnrance that the operating cests ean be absor within the regular health care financing system within a 2- or 5-year \ period. v Ut was in this conse that 7 referred to RMP activities as leading ( fo “improved design for intensive care.” For the 55 regional medical ee, y - fe hie a a aati, BE at a set gp hentacewereh abn eet abe le we a programs have in large re10 Ta tributing to building sulin heiag content with sing Win that the others whiely e's whi rialize. Mr. Concp. That is . That Mr. Casry. Air. | NATION AL CLEATS AL C. Mr. Henn. Dr. Mareuir. Mfny Clearinghouse for Smoki'or Sn Dr. Manqunres. Yes. es. Y Mr. Henn. De. Margit. May sider to be the duties af cuties . Flealth? Dr. Marcurtzs. The is. T Health was established inlishe geon General's -AdvisorvAdyvis health hazard of suffeie:! suf rant appropriate remedis reme Hiness and eariy death : deat. education and research. seare] TITS LINK Bi LINK Afr. Henn. Thuve a corve a ¢ the Clearinchouse sent to sept that an enclosed poster hroster iween Cigarette Smokiremoetki) Diseases is Now *Yell msteel] Ks thing as “cause.” T heliere belie year the National Institut Mmstit nouncements which stated state but suspect combinations all Americans, gtants end contracts effort the local. medg heelth care providers problens, connitnente a1 oand technical ess C local ¢ istence : ‘tities a cal ee S and ar} a voluntary commitment of” tve use of medica] °F pnt 7 *icat z 8 ieal Cére resources “te health care we Ereatesr Causes pred Ses ilitares ang erunenta] and ond Of healch ae i or tering Progréns ch heve Significanr Hey ? other ' ' -delive tributing tocard the AEE See memati AE ate tee bility of and access to hig Nae A anit 639 _ Regional Medical Programs: Increase or 1971 Estinate 1972 Fatimate Tea $70,298,000 $75,600,009 +$4,702 ,090 f(a) Grants .- «+ Grants are avarded te assist in the planning, establishment and operation of Regional Medical brograms for research, training aud demonstrations of patient care. , — “ _ ““3t'is the ebjective of the Regional Medical Programs to improve availa~ gh quality health care Co all Americans threush d more efficient utilization of health - stitutions including inprovements in the ceveloprient an simately 2,700 ins mannower ond other rescurces. Appre a variety of State and. voluntary all redical schools, 1,209 hospitals and ipating in. this effort to improve the nniques in the delivery health organizations are now partic quality of. care aad the aceptien of the latest tec of health services. _ The Regional Medical Proprans Service seeks to assist the established Regicnal Medicel Progra s to develop a framework of coonerative relationships for insproving the orga: delivery of services fo people. This francwork is structured by developing the voluntary cooperation of the various providers of gervice, both public and private, in identifying the patients’ nee e have tean determined, the Jocal groups and institutions 5s to maet these needs. The : activities of include the full spectrom of health care: prevent; gation and € Ss . bhen s 6 a é {alized care using the latest scientific 1, Regional Medicel Programs provide funds for care locally acceptable and responsive, but not available locally. Pont a o Program for 1971 Fifty-five Regional Medical Pregrems are now conducting operational activities. During the past yeer, events in the various regions have provided significant directions fer the furure, The newly exerging cooperative arrangenents within t regions have demonstrated the role the Regional Medical Programs can play as a ré snizable anc lecally acceptable force not enly for health planning but ior duproving che organization and delivery of health care as well. These changing patterns in the health care system are affording the consumer brovght abour through operational activities {mnediate and direct benefits. . . a 62-088 O- 71 - pt. 2-41 fin aeape oe pee rene cae ea he a ae thy the fact that fer prajects which enerease From previous af ~ re receiving Imercana! av rural end urban populst mate che regionalization of rs of care at the cain provide seches. rextons in developing a base for representation and parsici- viceals on the plannizs opment of such Eocal ehensive Health a requires reciprocal hor event ead support, one another 45s area, close cooperation will be a collection efforts and common oted in Califernia where, for reeentiy provided. beth finencial itfes ia Tast Las Angele ‘est fealth needs or aa jooking at a "berrio” ngecents are tm jor thenes of is and linkages among community _ centers ere among the privwry ecialized health resources and 4 wore specialized ones is en of- certein resources, and thereby w accessivility. i] and institutional linkages th ang education within en entire -jon. It also helps to emphasize amity level, while promoting onter end larger community f comprehensive stroke programs unit a¢ the Eéwnan Gray School ing undertaken, including pubii- oes, educational activities such workshops, stroke consultation Lact ae Pa aca nd apart tae te ag TRG En oy Pot ea NE EN TE AAI means meme ge 641 service for phyziciens through the cooperation of the neurological staffs of the three medienl centers, aud é family-pationt education unit, designed to help patients end their fomilics learn to cope vith the long-term effects of stroke cisability. . ree me we eT TT a ee wer activities is being developed to impact on the” A broad array of manpo oe health care delivery system. Estinated numbers of health prefessionals who wilt be trained in 1971 as a result of Regional Medical Progrésnt activities are as follows: . Doctors 31,628 55,295 . NS . Allied/Cther Health 49,000 Y La ae . “ eee Total 125,923 cet In addition, over 25,009 erergency health personnel (firemen, ambulance drivers, policemen, ete.) will receive training. These programs will: include both the teaching of new skills and also the upgrading of cxisting skills as well és treining new people in the allied and other health areas. Many Regional Medical Progroms have conducted studies to determine the need for, willingness to eccept and feasibslity of training categories of wanpower fo extend the services of physicians. Most of these are related to the physicians’ essistant concent. Sone kegicaal Medical Programs are designing such prajects and several have funded operational projects in this area. In Alabama, the Regional Medical Program is sponsoring a program to formlate t training prograss for allicd health technicfans through the cocpera- ilities already in existence at the junior college and vocatic rics ing schools level. . By Linking the reseurces of the University of Alabama, Regional Technical Institute, the Appalach Pevelopment Commission, and 17 state supported junior colleges, Alabama a giant step teward solution of its. health manpower shortage. and imple: tive use of funds, mr A Guest Residency. Program, sterted two years ago with Regional Medical Frogram funds, has helped pave the way for what is a significant innovation in medical education (SAMT) by demonserating the practicality of its decentraliza- tion. The tee wedic2] education plan, taking its name from the four States involved. (fashington, Alaska, Nenrana, jdshe), recently received a $1 million grant froz the Cor Alaska wes selected as the first State to inplement the new ington/Alaska Rei Medical School and a mwee lth Fuad. sien because of the close ties already creared by the Wash- onal Mediral Program between the University of Washington laska academic end medical communities. Virtuelly all Rerfonsl Medical Programs have projects designed to augznent “the knowledge and levcl of performance of health professionals and parapro- fessionals. Many of these prejects lead to the utilization of personnel in new wevs. Perhaps the greatest Regional Medical Program thrust in cthis 3rea is the tréining of coronary cere unit nurses; over 7,000 registered nurses and licensed practicel nurses heve been trained to date. Although Regional Medical Programs does not provide for patient services directly, it eften gets involved in planning for and helping to establish those health care components which will deliver service. This includes a broad range of patient care demonstrations, including screening end early diagnosis activities, projects relating to coronary care, and stroke rehabilitation programs TIENT A AEN te REAR STR OME OIA balan ebtew ieee ae Currently dewoustrations sre being funded for activities such Corenary and other Intensive $13,800,600 enact, teem Geeta a ene em ? cere - 114 corenary care units end 8 mcbile units Ambulatory care - 24 neighbor- 3,900,000 hood health centers, clinics end out-patient departments v6 «Extended and hone care . 2,209,090 QGther - such as emergency and 1,309,000 transportetion services : Total $21,200,600 As a result of these demonstrations, communities and hospitsls not directly involved in these projects have been spurred to make much necded improvements. For exemple, in 1966 there were only 375-425 coronary. caré units end 1,100 other, intensive care units in the United States. Ry 1969 these hed increased to 2,101 coronery. care units and 2,556 other intensive cere units, corresponding to. 509 percent and 150 percent increases, respectively. This range of accivity and the types of operational components - avyetisble rescurces, ceuwes ee It is cupected | thac an increasing portion af available funds during 1972 li te directed coward the following general areas: personnel, heaith resources and services, with the fecus on 2ud cther corsunity health facilities. Planning agencies and similar agencies which fester cor cations/distribution for health at che local level. ' . Projects which emphasize disease prevention and eatly detection, including carly and easy access Lo care. ». Activities which encourage and support the development, operation and success of the ewerging Health eintenance Orcpunizagions. 3 & és: being carried on varies from region to region. Ta praviding 2 techanism for planning, decisien-caking, and sharing limited health manpower and facilities, the stress hes been cn local initiative end control to match local needs, problems, and Activities which lead to more effective and efficient utilization of health manpower, especially in patient care settings. Training for new types of healch manpower (e.g., physician assistants) will be emphasized, as will new organizational pattems which meke greater use of paramedical . Operational activities vith increased emphasis on regionalization of strengthening Linkages between those institucions providing specialized care, such as the tedical centers and affiliated hospitals, and primary care, being provided by smaller community hospitals, nceighburheod health centers, . Conjoine and collaborative efforts with Areawide Comprehensive Health aunity-based planning and programs that can begin to materially effect resource allo- Bs biel a Laon itt a3 aah oS 8s Ang The increase in total fan provide $75,000,000 in 1922. - struction of a regicnal cencer Srates. The balance will + selected programs based ca 4 In exercising the curves. planning end evaluctton, and contracts, these { sexvices required te pre; Such consultative services we of part-time or intersiteent ce Regional Medical Prograns: tt rene (b) Direct operations 1e7, . Pos. rte teat mentees sieniineemanit Personnel compensation and benefits.......> $1 Other expenses........ = Total... tenn beace St This activity su eeeinte tear tes of Regional } develops ¢ agencies acrvices. Seed aha annie,