AS A MAJOR ECONOMIC PILLAR IT OFTEN TOLLS THE DEATH KNELL

OF A SEs COMMUNITY.
BUT DATA ON HOSPITAL CLOSURES ARE LIKE MORTALITY
STATISTICS, THEY REFLECT DEATH ONLY, NOT SICKNESS AND

SUFFERING.

MANY RURAL HOSPITALS ARE BEING STRANGLED. |

26
THIS MAY RESULT, NOT IN THEIR DEATH, BUT IN THEIR RELATIVE
FINANCIAL AND ORGANIZATIONAL SICKNESS.

ITS
DHHS SHOULD MOVE ON TeEFR PLAN TO ELIMINATE THE
URBAN/RURAL DIFFERENTIAL IN STANDARDIZED MEDICARE
HOSPITAL PAYMENTS AS SOON AS POSSIBLE. MANY RURAL
HOSPITALS WILL NOT MAKE IT UNTIL 1995 WHEN THE CURRENT

PLAN IS TO GO INTO EFFECT.

27
| SEE NO REASON WHY THIS COULD NOT BE ACCOMPLISHED IN FY

91.
CONCURRENTLY DHHS SHOULD REFINE THE AREA WAGE INDEX

UNDER MEDICARE TO REFLECT THE REALITY OF A SINGLE NATIONAL

MARKET FOR HEALTH PROFESSIONALS.

28
HEAL
| CONTINUE TO KAERE STORIES OF AGED VETERANS WHO MUST

TRAVEL A HUNDRED MILES TO A VETERANS ADMINISTRATION

HOSPITAL AND EVEN THEN MAY NOT BE SEEN THAT DAY.

LETS HELP THE VETERAN, DECREASE THE OVER°CROWDING OF V.A.
HOSPITALS, AND INCREASE UTILIZATION OF RURAL HOSPITALS BY

ALLOWING OUR RURAL VETERANS TO RECEIVE THE CARE THEY ARE

ELIGIBLE FOR AT THEIR LOCAL HOSPITAL.

a )

29
INE oF

FARMING IS OUR NATION’S MOST DANGEROUS OCCUPATIONS, AND
Artnover! Ave
FARM ACCIDENTS 8 A MAJOR PROBLEM BE UNDER - REPORTED.

GOOD FARM SAFETY PROGRAMS COULD DECREASE NEEDLESS

SUFFERING AND THE NEED FOR COSTLY MEDICAL CARE.

30
THERE ARE MANY NEW INITIATIVES UNDERWAY.

BUT ! AM ESPECIALLY EXCITED ABOUT THE UNIVERSITY OF NORTH

DAKOTAS’ RURAL RESEARCH CENTER.

THERE THEY ARE DEVELOPING GUIDANCE IN ORDERING ROLL BARS

FOR TRACTORS AND FOR ADAPTING ROLL BARS FOR DISCONTINUED

TRACTOR MODELS.

31
THIS COULD PROVIDE A SOLUTION TO A MAJOR SOURCE OF FARM

ACCIDENTS.

FARM SAFETY IS ALSO AN AREA WHERE THE EXTENSION SERVICE

OF USDA COULD BE OF TREMENDOUS ASSISTANCE.

| ENCOURAGE DHHS AND USDA TO WORK CLOSELY TOGETHER IN

THE AREA OF FARM SAFETY.

32
MENTAL HEALTH CARE SERVICES IN THE UNITED STATES ARE INA

ee

SAD STATE OF AFFAIRS.

THE MENTAL HEALTH BLOCK GRANT PROGRAM, WITH ITS UNDER -

FUNDING, IS A FAILURE.

MOST STATES HAVE ONLY SUFFICIENT RESOURCES TO TREAT THE

CHRONICALLY MENTALLY ILL.

33
COMMUNITY MENTAL HEALTH CENTERS HAVE ABANDONED

OUTREACH AND COMMUNITY S@& PREVENTION PROGRAMS.

THEY LOOK INSTEAD TO MEDICAID AND PRIVATE INSURANCE TO

COVER PATIENTS AND INSURE SURVIVAL.

LET ME REMIND YOU THAT MOST MENTAL DISORDERS ARE TREATED

BY FAMILY PHYSICIANS AND THE CLERGY.

34
WE MUST RECOGNIZE THE INTERDEPENENT RELATIONSHIP
BETWEEN PHYSICAL AND MENTAL HEALTH AND FIND WAYS TO

BRING THE TWO TOGETHER.
IN THE LATE 1970'S THERE WAS AN INNOVATIVE PROGRAM

BETWEEN COMMUNITY HEALTH CENTERS AND COMMUNITY MENTAL

HEALTH CENTERS CALLED ”MENTAL HEALTH LINKAGES”.

35
MENTAL HEALTH LINKAGE WORKERS 3 USUALLY SOCIAL WORKERS,
CARRIED A CLIENT CASE LOAD, ACTED AS A LIASON, AND
EDUCATED AND SENSITIZED THOSE PROVIDING PHYSICAL HEALTH-

CARE.

THE PROGRAM WAS AS SUCCESS, BUT FELL TO THE BUDGET CUTS

OF THE EARLY 1980’S. RENCOURAGE ITS REDISCOVERY”? 4 ©
Ze off CoMSIDERATLE FEWELTT.

36
ON A MORE POSITIVE NOTE I APPLAUD THE RECENT
ESTABLISHMENT OF A RURAL MENTAL HEALTH RESEARCH
PROGRAM AT THE NATIONAL INSTITUTE OF MENTAL HEALTH UNDER

DR. DELORES PARRONE.

| HOPE THEY WILL FUND RESEARCH AND DEMONSTRATION
PROJECTS THAT UTILIZE THE RESOURCES OF PRIMARY CARE
PHYSICIANS AND CLERGY TO HELP THOSE WITH MENTAL HEALTH

PROBLEMS.

WE NEED MORE RESEARCH, BUT WE ALSO NEED PROGRAMS THAT
WILL ADDRESS UNMET LOCAL NEEDS FOR INTEGRATED MENTAL

HEALTH SERVICES.

37
THERE ARE MAJOR SHORTAGES OF HEALTH PROFESSIONALS IN THE

RURAL AREAS.

WHILE | ADVOCATE RURAL HEALTH SYSTEMS THAT UTILIZE

RELATIVELY SMALL NUMBERS OF PHYSICIANS; THERE MUST BE

PHYSICIANS AVAILABLE TO SERVE IN RURAL AMERICA.

38
WE MUST MAKE RURAL PRACTICE ATTRACTIVE TO THEM AND TO

OTHER HEALTH PROFESSIONALS.

| FAVOR REAUTHORIZATION OF THE NHSC, BUT WITH SOME MAJOR
CHANGES. SCHOLARSHIP FUNDING PREFERENCE SHOULD GO TO
MEDICAL SCHOOLS, LIKE THE KIRKSVILLE COLLEGE OF
OSTEOPATHIC MEDICINE, WITH A LONG TRACK RECORD OF

PRODUCING RURAL FAMILY PHYSICIANS.

39
WE DON’T NEED MORE EXPENSIVE URBAN ORIENTED PROGRAMS |
LIKE GEORGETOWN AND GEORGE WASHINGTON UNIVERSITY WITH

EXPECTATIONS THAT THEY WILL PROVIDE RURAL PHYSICIANS.

PAY BACK

WE SHOULD SUPPORT, DEFERMENT FOR PRIMARY CARE PHYSICIAN

RESIDENCIES ONLY IN AHEC OR AHEC-TYPE MULTI DISCIPLINARY

PROGRAMS PHYSICALLY LOCATED IN RURAL AREAS.

| SpeWT YevEAne stove writ SEVEM

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40
RURAL PRACTICE IS DIFFERENT.
F

WE DON’T NEED HUGE NUMBERS OF RURAL FAMILY PHYSICIANS
AND WE DON’T NEED TO SPEND A LOT OF MONEY IF WE SPEND IT

IN THE RIGHT PLACES.

THE N.H.S.C .SHOULD NOT BE A PHYSICIAN - ONLY ACTIVITY.

41
WE HAVE JUST AS GREAT A NEED FOR NURSE PRACTITIONERS,
PHYSICIANS ASSISTANTS, NURSES, AND ALLIED HEALTH
PERSONNEL.

Als 0
WE SHOULD ENCOURAGE STATES TO LICENSE MORE INDEPENDENT

NURSE = PRACTITIONERS FOR RURAL

 
 
    

pf

AREAS | WOULD ALSO ENCOURAGE MORE FLEXIBILITY IN NHSC
ASSIGNMENTS TO ALLOW FOR EXPERIMENTATION IN NEW MODELS

ee,
OF CARE. (E.G. ALLOW COMMUTING, ALLOW COMBINATION CH

HEALTH DEPT./ PRIVATE COMBINATIONS.

42
| WOULD LIKE TO SEE STRONGER STATE ROLES IN ESTABLISHING
HEALTH MANPOWER SHORTAGE AREAS THAT ARE MEDICAL

SERVICE AREA BASED RATHER THAN COUNTY BASED.
STATES SHOULD BE GIVEN AN OPPORTUNITY TO SET THEIR OWN

PRIORITIES, WITH APPROPRIATE SAFEGUARDS) FOR COMMUNITY

HEALTH CENTER’S / COMMUNITY MENTAL HEALTH CENTER’S.

43
Wauow'T 17 BE 6909
AQUGEED*REE TO SEE STATE OFFICES OF RURAL HEALTH AS A
erptc7 Teemu 70
MECHANISM FOR THIS AND #6?2=7R@ Wel TAKE THE BROAD
APPROACH OF WORKING WITH PRIVATE AND PUBLIC PROVIDERS Sve
AS #gps@ JIM BERNSTEIN, HAS PIONEERED IN NORTH CAROLINA FOR

ALMOST 20 YEARS.

44
| REFERRED EARLIER TO THE "RURAL CHRISTMAS TREE” IN THE

SENATE APPROPRIATIONS REPORT.

IT CONTAINED SOME VERY ENCOURAGING THINGS : EQUITABLE
FUNDING ALLOCATES TO RURAL / URBAN COMMUNITY HEALTH
CENTERS, RURAL MENTAL HEALTH RESEARCH, INCLUDING
RESEARCH & DEVELOPMENT 38@®8 CENTERS, TWO ADDITIONAL
RURAL HEALTH RESEARCH CENTERS ( ONE MINORITY ), ACADEMIC
/ PRACTITIONER LINKAGE GRANTS, AND A COMPREHENSIVE RURAL

POLICY RESEARCH STUDY.

45
| CONTINUE TO WORRY ABOUT ”SPECIAL POPULATIONS” : BLACK,
HISPANIC, ELDERLY, ETC. AS COMMUNITY HEALTH CENTER’S /
COMMUNITY MENTAL HEALTH CENTER’S, HEALTH DEPARTMENTS

HAVE CUT BACK OUTREACH, THESE ARE FORGOTTEN PEOPLE,

| HOPE THERE ARE RESEARCHERS IN THIS AUDIENCE WHO WILL GO

OUT AND SURVEY THESE renews)

 

SO WE CAN RE - INVENT OUTREACH WORKERS AND COMMUNITY

CASE WORKERS.

46
—

THESE SPECIAL POPULATIONS ARE DIVERSE AND WILL REQUIRE
NEW APPROACHES SUCH AS WORKING THROUGH THE BLACK

OLDER.
CHURCHES, AS WELL AS, METHODS TRIED AND TRUE.

47
ALSO IN THAT REPORT WAS THE REQUIREMENT FOR SOME PILOT
PLANNING GRANTS TO COALITIONS OF STATE HEALTH
DEPARTMENTS, STATE PRIMARY CARE ORGANIZATIONS, AND
UNIVERSITIES TO DEVELOPE STATE MIGRANT HEALTH AND SOCIAL

SERVICES PLANS.

48
THE MIGRANTS ARE TRULY ”THE WORKING POOR”.

THEY DO SO MUCH; THEY ASK FOR SO LITTLE, 7~

JUST A SHOT AT THAT AMERICAN DREAM | MENTIONED EARLIER.

MIGRANTS HAVE NO POLITICAL POWER.

 

 

THEY CAN’T TAKE PART IN OUR ” INTEREST GROUP” STYLE OF

POLITICS.

49
AT THE MOMENT THEY HAVE ONLY A FEW STRONG ADVOCATES LIKE
SONIA REIG, DIRECTOR OF THE FEDERAL MIGRANT HEALTH

PROGRAM, THERE MUST BE MORE.

HUMAN COMPASSION ASIDE, WE MUST REALIZE THAT WE ARE
BECOMING PART OF A WORLD ECONOMY AND FOR MODERN
AGRICULTURE TO SURVIVE AND COMPETE WE NEED A HEALTHY AND

PRODUCTIVE MIGRANT AGRICULTURAL WORK FORCE.

50