mye
. Federal funds cut off

 

OT +f is[ 73

How medical plan
has been crippied

By Richard Brooks

SEVERAL WEEKS ago on a Monday,
Dr. Dexter Nelson kissed his chiidren

: goodby, and began the 100-mile drive to
Chicago from Princeton, Ill. He had
made the trip many times before, and
he was used to driving. His rural prac-

tice takes him from one distant nospi-

_ tal to the ext.

"But this day the drive was longer
. than usual. It would be the last trip to
fulfill what Dr. Nelson had known as a

. peal commitment to an idea that cou'd
work--the Illinois Regional Medic:
Program.

“~The pregram was designed to utilize
a reservoir of professional medical ex-
pertise, nat ruled by fiat fram Washing-
ton, but by advisory councils of prac-

_ titioners Eke Nelson who volunteered

their time.

"THE IRMP WAS perhaps the best

_ plan of its kind in the country. It was a
blueprint foc making medicine accessi-

ble, a model for local and regional
health systems. In the last seven years,
apparently the Department ef Health,

Education, and Welfare agreed with its

potential; more than $500 million was

funneled into Regional Medical Pro-
gram coffers nationwide.

. But like RMP officials everywhere,
Illinois planners received an abrupt tel-
egram in February telling them to phase

out all operations by June. Dr. Nel-

son had the unpleasant task of chairing

;-his last regional advisory group meet-

“ing. He confirmed the fate of the IRMP

“with its director, Dr. Morton Creditor,
who was charged with the task of wind-

- ing down the program.

‘The tragedy that day several weeks

“ ago was mot just ancther casuaity of

the communications gap between Wash-

ington and the hustings. The IRMP was
more tham “just another program.” It
was a regionally organized effort, the
excited response of practitioners to the
simplest medical demand of all—that

~ the world’s best heaith —_ be

; accessible to all citizens... -

‘ In seven years, comprehensive health
care had moved from burocratic jargon
to a practical concept. Where experts
from the federal government ad
failed, people like Nelson and Creditor
made the leap from theory te practice.

With $2.3 million, a pittance by feder-
al standards, the IRMP funded projects
fer health screening in industrial
piants, community health information
and referral services, more centralized
and accessible kidney disease and hy-
pertension control programs, prepaid
comprehensive health care programs,
health systems for doctorless communi-
ties, the Metropolitan Blood Council,
and other projects. :

STAFF SUPPORTED projects includ
ed work with the Brown County Health
Center, a clinic for senior citizens,
studies in physician distribution in the
Chicago metropolitan area, and a push
for. use of problem-oriented. medical
records.

The IRMP also worked for assess-
ment and evaluation of medical pro-
grams, training of more health person-
nel, and. pressed for development of a
health-education consortium.

Health care, IRMP officials believe,
should begin as early as an individual
recognizes what health is. Preventive
medicine is the key. Rather than pro-
mote insurance that pays only. when a
cure is needed, the IRMP endorsed the
concent of Health Maintenance Organi-
zations—-to make good heaith rather
than poor health the primary concern. .

By supporting the use of problem-ori-
ented medical records, the IRMP want-
ed to help health personnel easily ar-
rive at an-accurate appraisal cia Par
tient’s condition. -

As Dr. Nelson ironically. noted, ‘a
week before the final regional adviscry
group meeting 5,000 orientation books
on the use of problem-oriented records
arrived at the TRMP office for distrib-
ution.

That. untimely arrival characterized
the dilemma of many HEW-funded pro-
grams, from OEO agencies to educa-
tional projects authorized under the El-
ementary and Secondary Education Act
of 1965. Via the HEW shift in priorities,
millions of dollars are being “reey-

' cled”’— slowly. if at all. vw

‘. In the case of the IRMP, the tragedy

is double. The technology for health

‘eare exists, the spirit and the personnel
-who can deliver are willing, and the

mechanisms of delivery are off the
drawing boards. Cooperation long sought
but rarely achieved had built up mo-
mentum.

But the momentum is now lost. Tho
the carrot of revenue sharing is held
cut for almost all the HEW. programs
that are being phased out, prospects
for a quick regeneration are dim. Some
tregrams eventually may be picked up
in piecemeal fashion, but the interim
between June 30 and whenever states
are motivated to move with their antic-
ipated financial shares will mark a
substantial waste in human and mana-
gerial terms.

What disturbs observers away from
Washington is the cold shift of power
with few, if any, provisions for the in-
terim period until state resumption of
funding.

For those progressives who were set
ting up Health Maintenance: Organiza-
tions the cutoff means a postponement
of a healthy idea. For the company
health centers supported by the IRMP,.
-jthe cutoff means a lessening of their
' ability to serve their clients.

FOR PATIENTS everywhere. in Ti.

‘nois, the cutoff probably means a posi-

ponement in the establishment of a
medical record keeping system that
might speed diagnosis and-cure. For
the Metropolitan Blood Council and its
thousands of clients, the cutoff means a
serious blow to expansion.

For the more than 250 health profes-
sionals who volunteered their time to
serve on the regional advisory group
and other IRMP committees, the cutoff |
means a swift devaluation of their
thousands of hours of effort.

Finally, for Dr. Nelson the cutoff sig-
nals a few hundred fewer miles of driv-
ing per week and a disappointment that
will be hard to conceal.-- os mete

r

“ . Richard Brooks ts ‘the education edi-

tor for the Pioneer Press.

eee TT eK