yun
    

  

Meter « eshororientiy ores orcviéine for clinical

   

#egwcm 6 Fin iy am we gen Aa, al > a ht ~ Some o3o Meoat

favecuigetiion, tucching, na peticay tars, ‘Loestied in universities,
x “ ee - > ea pie pe ate ase tty tag oo 7. @ rapa ee he

3. Diagnestie and Troviscns Stations = videly dispersed in local

communities

2

Ltermutive Methods For Sstwblishiny ‘his rebvoerk = Pros and Conn:
Alternative 1 + Planning and & Gninintrotive responsibility for the
entire notwors given to the mgcical complexen which would serve
ag the ehannel tor funds cad provide tha odainistrative mechanism,
thas assuring a clos® relaticnsiip between the coveral conponeats
of the network.
Pros:
- Futs control of the network tn the hands of the component
wht she highest professional cont motence, hore’ a facilitating
tho maintenance of high standerds of core in the diagnostic and
treatment stations.

- Inmares a strong conne:  -) between the teaching competencias

 

of tha medlen complex end the programs of contioring education

_ (
for modical pérronné? in tho local comunity. ‘

 

we
XN
Cond

we

  

 

 

   

 

>
2
. Ce anaes 1 fe wens ant
- SOY wee Sat lag rky
Bes mw EF * =. a4 cee be pee . Pe s + th
Re VEAL On Gyo “ey SOQ angvncr.
oom: ms, hee “ rt oe oh OM
Affords the maximum oF weity Sor Pach tna etecetiva
Ae yn ~ tt Poke on wen ony top yy tee s «,
comombentiou 0 BOT ROMS wae ov vec yeh from the mh ‘en complex
é3 gens neta pray th dee ee ee ont Tt
to ‘he Megha it Lathe Bak A whee aby et 1a
LN he oF ft. « ane + ag ™, o
“ Gtimalates wore Lye OF We GS “— by
* +a at em mo cee ty tht Op ea oo t
provs ding Por GLc Te to. OEOPETNVOLOTL: Ga Susu es and Dunc ston ©.
wm * 4d wee eee Por abe
e. 5 component and by provaaang ey -oona for effective utilization

of centralized enecihliastion in fosllisics, cquipnent, and porsonncl.
ih the stotus quo in medical

ty for a d@remotic overhaul

 

nd practiee, cresting tne oopo:
end Improvement ia tae pregent systeu.
- Avoids frvolvemens in the f moliticsl, social, andneconomio:problems
of State governucnts ang the uneven quality oF State hecith

vercmtes
- Politically unfeacible--by pypaccing the State and local

govermments, professionel societies, local hospitals and tnatitutions,

this approach would greatly augment. the political opposition which
is eure to arise from any attenps to pring this network into being.

Po age of qualified manpower in the medical complexes to take

on this additional soxrvice responsibility. .

we Sono oxinting medical aehools and medical complexes mint

vatuea $0 prvilaipate on the grounds that the ei4ition of this vast
aduinistratvive rovponsibility would consvitute « diversion Fee

beets wooroneibilteic: for teaching, rorcarch, snd related BaTVICa.
3
By concentrating on ceabrad administration by an often
| distant modier complax,fadie to come to grips with the problems
of providing volunta ry incentives Tor exfactive portietpating vy
tocal commnities, institutions, cnd pacetitioners.
a * Padle to provids for she dupes of coctal and political forces
g ° g@etersining the needa for ond the shape of the regional network.
ese political and soci nl forces cro often the controlling factors
in the distritation of service.

- Thea geogrephice distribution oF medical complexes, cspecially

of high competence, fo not coincident with dintribution of -

 

 gemand for medical care. |
@ : oo. Since this alternative gould concnd on ‘the willingness of

existing medical complexes to take cn this responsibility, a likely
result would be a raising of the standards of medical care and |
practice in those arcas where the cara is already above the national
average and where there is already good access to modical complexes —
of superior quality. Asa result, the existing gap in the quality
of medical care available in aifforent areas of the country might.
actually widen for some years pefora ao truly national network could

be eatablished. Political forces could not be expected to tolerate.

 

this system 42 such networks are financed with Federal funds.

 

~ BY senoring the Btate ond local governnents, this alternative

enproaen might further weaken the acm role of the State and Local a .

“governments at a time when there is considerable atacussion 6F tho

eo 3 Renn ee WEEROGEGSH Bhnhe ANA Loc? eovernientes

 
 

 

1,
- Most medical cehools, whicn vould pave to va the nucled of

hose motworss,lack the ac ministrative competence to undertake

a vast expansion Inte the ares of loenl medical eare and practice.

Aiternctive 2- This alternstive vould adopt a two-pronged approach,

utilizing both the Gtxte sovernnents nnd the medical complexes

channela for Federsi funds. Foderal funds for the dtagnostié
and treatment stations would be given through the States, whieh
would distribute the funds according to a State plan (analogous
‘to the Hill-Purton ond Comaunity Mental Health Centers program).
Planning on an interstate basis would be roquired for States
without @ medical school or for googrephie areas (such as
certain metropolitan areas which cross State Lines) where

ovgtate plenning would ercate a more effective network. The
Federal Goverrmecn: would deal diz rectly with the medical couplexes |
and the regional centers in providing grants for the strengthening
of the research, teeching, ond service capacities of the medical
complexes and for constructing and steffing tho regional centers.
These grants would have to provide for ougmented staff and for

other inducements sufficient to motivate the medical complex in

- establishing relationships with the diagnostic end treatment stations.

Prost |
- : Involves State end local governuonts in the plenning of an

| important innovation in medical care.

UeAliaes administrative capabilities: -arenay in being.
tive inbegrabien gf the eivoaneepe re

   

 

cob mt Sie. a oom,
. &

?
‘thoreby providing an opnoriunity to  crengenen the capabilities
of the State and local, health awvhorities end encouraging choir
guvtert of these innovations.

- By involving the Sccte governucts and local inatitutions in

+

the planning administration of t.12 Gloenostie and treatment

stetionsa, allows for greater Input of social ond political
considerations which bear on the distribution of medical services.
— Relieves the medical couplexes of a major administrative
'. burden in the administration of diagmostic and treatment stations.
- Provides the opportunity for adainistretive {nnovations in
relating the dlagnostie and trectens stations to the medical

-@omplexes and regional centers. Suca innovations to: be consis-

 

tent with American practices and traditions.

- Provides the opportunity, in some States, to use the state

— government as the link between the gtete-sunported medical

complex and the network of diagnostic and treatment stations

: within the State.
‘ - Provides greater opportunities for the integration of the
| - planning of these categorical dis egaostie end treatment atations
with the State plonning and other nealth satters, inclucing the
distribution of hospital facilities.

Cons:

 

i Wethods ¢an be devised to require the diagnostic and tieat~

ie

ment stations to establish a reletionshtp with a medical coupiex a

  

LOAIEY 1 PRA HRD eahter, it would be very ‘at: teat +6 areate
 

 

“. Alternative 1.

 

   

 

 

- equivalent incentives for the mecical complex to play a
* significant role in the State or veplonal network.
oe Even if such a network 1s eotoblished, there «re Ilkely to

bo considerable cdminiatrative a nd professional frictions between

3

the diagnostic and treatment stations end the medical complexes

and categorical centers.
The addition of quedisied sommower to stat? the diagnostic

and treatment stations presenta almost insuperable problems for.

tus foreseeable future. eee mee?

a The medical societies are likely to oppose this system even

"> though such opposition might be less strong than in the case of

 

oe By making less of a break with the status quo in medicalc

 

= 5) care than Alternative 1, this approach will probably be less a : chee

. “" effective in refaing the quality of medical practice made availe _

able to the local commnity.
- r - The capability of State governments fe variable and their
_.. Lnvolvement will be accompanied by political interference in many.

,

- of the States.

te, Because of the spit dns ednini stration and funding vetween op. a2

the medical complex and the diasnostic ond treatment station, the oa me

flow of professional ‘expertise and the timely epplication ¢ of .
- renetices -- cilts will be less effective.

4