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DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Statement by the Director, Regional Medical Programs Service
on

"Regional Medical Programs"

Mr. Chairman and members of the Committee, I welcome this opportunity
to appear before you on behalf of the Regional Medical Programs Service.

To effectively meet the responsibilities of Health Services and
Mental Health Administration in improving the delivery of health services
to the American public, there has been a longstanding need for coordination
of the efforts of providers to the end of improved economy, efficiencies
and modernization of effort. Regional Medical Programs Service, in
combination with Comprehensive Health Planning and the National Center
for Health Services, Research and Development, has increasingly been
fulfilling that role with a designed sensitivity to the needs and
strength of the present system of care. Its efforts have been expressed
through continuing education, improved design for intensive care, improved
access to care by patients and general coordination of information exchange
among providers of care. The individual consumer of health care services
= expect, as a result of these efforts and those of Comprehensive
Health Planning at State and area levels, to have a steadily increasing
opportunity to receive care of desirable quality. In addition to its
special focus on major disease categories, the Regional Medical Programs

Service administers the Public Health Service's National Clearinghouse

for Smoking and Health.
Concept of Regional Medical Programs

The initial concept of Regional Medical Programs was to provide a
vehicle by which scientific knowledge could be more readily transferred
to the providers of health services and, by so doing, improve the
quality of the health care provided. We believe, however, this to be
but the beginning of the responsibilities and potentialities of the
Regional Medical Programs Service.

The premise upon which the Regional Medical Programs Service is
based is that the providers of care in the private sector, given the
opportunities, have both the innate capacity and the will to provide
quality care to all Americans. Accepting this assumption, the issue
has become one of how best to develop and promote these opportunities.
We are pleased to report steady progress with accelerating rates of
good achievements.

What are our funds being spent for generally and what is the
community setting in which the Regional Medical Programs Service conducts
its programs? Mr. Chairman, I am pleased to report that of the funds
supporting the current 600 operational projects, over one-third
(38 percent) are for patient care demonstration projects concerned
with coronary and other intensive care activities, expansion and
improvement of ambulatory care in neighborhood health centers, clinics
and out-patient departments, and the expansion and improvement in
extended and home care activities benefiting 240,000 patients. An

additional 45 percent is used to support activities in the broad area
Soa oa Sone

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of manpower training and utilization which will lead to improved care
and expanded services. The training projects include the training of
nurses and other existing health personnel, including physicians, in
new skills as well as upgrading existing skills. Our manpower training
and utilization programs involve all of the various kinds of health
resources within communities--hospitals, clinics, neighborhood health
centers, specialized facilities and medical school health complexes,
but indeed are not limited in any way to the latter. Finally,
approximately 17 percent of our funds support projects concerned with
coordinating the activities of community institutions in order to
develop means of improving access to and the quality of available
health services. .

One way of describing the impact of Regional Medical Programs upon
our present health delivery system is to state that this year an estimated
30,000 physicians, or ten percent of all practicing physicians in the
country, will be involved in Regional Medical Program-supported training
activities. In terms of hospitals affected by Regional Medical Programs,
it is estimated that 1,470 hospitals presently participate in or benefit
from Regional Medical Programs. This represents 25 percent of all short-
term, nonfederal hospitals. Of the 1,470 hospitals mentioned, 860 are
the primary sponsors or sites of the Regional Medical Program activity.

To sharpen the focus of what happens when physicians, hospitals,
and other community health care providers, with the assistance of the
local Regional Medical Program, begin to translate into real life

situations their willingness to improve both the quality and the access
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@ to the care rendered to their patients and communities, I will cite

briefly but two examples chosen from scores of similar reports:

1.

In the Fields Corner section of Dorchester, a poor-area of
Boston near Roxbury, there now exists a new neighborhood

health clinic. With the help of modest funds from the Tri-
State Regional Medical Program, and with extensive Regional
Medical Program core staff guidance, supplemented by assistance
from the Permanent Charities Funds of Boston and the City
Department of Health and Hospitals, the necessary organizational
planning for the clinic became feasible. The clinic now has

its doors open and is providing health preventive and health
care services.

Approximately 750,000 people in a 15 county area in western
North Carolina now have available to them, in their communities,
coordinated programs for comprehensive and continued care of
stroke patients. The overall program embraces 18 hospitals

and seven nursing homes and recently was cited as one that
might serve as a national model. Regional Medical Program
funds were the catalyst which brought to bear the resources

of the North Carolina Heart Association, the State's three
medical schools and the State Board of Health on this serious

health problem.

Relationships With Other Health Programs

Mr. Chairman, the Regional Medical Programs Service cannot and does

not exist in isolation. It is closely linked with other Health Services
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and Mental Health Administration and Department of Health, Education, and
Welfare programs. Indeed, experience is teaching us that Regional Medical
Programs can best help to improve the overall effectiveness of the health
care delivery system by working with and contributing to related Federal
and other efforts at the local, State and regional levels. . Increasingly,
the Regional Medical Programs, with its strong provider links, is being
viewed and used as an important technical, professional and data resource
by State and areawide Comprehensive Health Planning agencies in their
planning for personal health services. In turn, Regional Medical Programs
are looking to Comprehensive Health Planning agencies to express the
health needs of the total community from the consumer's point of view

and to set priorities for the Regional Medical Programs Service efforts.

. Together, Comprehensive Health Planning and the Regional Medical
Programs Service provide an effective organizational framework for
identifying and utilizing community health resources which makes it
possible this year to institute further innovations in health care
planning and delivery systems. Communities and the health care providers
within them will be encouraged to establish carefully planned systems to
furnish comprehensive care to an identified population. The success of
this approach will exploit the strengths of Regional Medical Programs to
convene the key provider and consumer groups needed for planning and
implementation of these eritically important activities. In concert
with the evaluation efforts available from the National Center for
Health Services, Research and Development and with the Partnership for

Health program, we truly believe that the Regional Medical Programs have

the potential to meet even the most optimistic of expectations.
6} National Clearinghouse for smoking and Health
Smoking-related diseases are such important causes of disability

and premature deaths in this country that the control of cigarette
smoking could do more to improve health and prolong life than any other
single action in the whole field of preventive medicine. The Regional
Medical Programs Service administers the National Clearinghouse for
Smoking and Health which has the responsibility for developing and
carrying out a national program of information, education and research
into smoking control. With the help of the specific legislative actions
taken by the Congress, this program has resulted in a substantial
reduction in cigarette smoking by adults from 49,000,000 in 1966
to 44,500,000 in 1970 despite the growth of the population. Continued
reductions afford the prospect of reducing the total level of medical

@ care needs which now tax our resources.

I will be happy to answer any questions you and the Committee

may have.