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While there were occasionally members of the governing board who provided social services to the poor, there were seldom any instances of poor folks becoming members of HSA governing boards. Few boards had anyone serving with an income less than $10,000 and even fewer had anyone selected to the board because of their membership in an organization composed of poor folks.

(3)

COMPOSITION OF HSA STAFFS:

Although we were unable to acquire precise information on all of the staffs of the HSA's surveyed, the available information which we did gather showed blacks, other minorities, and women were underrepresented by an even wider margin on the staffs of the health systems agencies. Beyond the clerical ranks, the employment of blacks and women was a rare event.

These findings were released in the middle of last year in a report entitled Placebo or Cure? State and Local Health Planning Agencies in the South. I am submitting copies of the report for the record. It is important to note that our work does not pretend to be a substantive assessment of the decision-making which HSA's carry out. At the time of our study, few decisions had been made and little planning was actually underway.

Our research does stand as a warning that the method of

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selection and the composition of the governing boards and staff of HSA's do not reflect accurately or broadly the elements of the local population in which they exist. Our preoccupation with selection and composition is based upon the view, seasoned by our experience and confirmed by other governmental regulatory systems, that a decision-making procedure that affects so many people directly can work best when most representative.

Questions of selection and representation must be weighed with the recognition that the delivery of health care in the South and elsewhere has been the most deadly problem of the poor, blacks, other minorities, and women. While I need not inform this committee of the enormous body of information which substantiates the peculiar and direct problems of health for these affected groups, their meaning needs to be reiterated. For folks who have had substantial and sometimes unique problems in receiving health care, the best way to insure that decision-making includes their interests is to include them proportionately in the decision-making itself. This principle must be upheld in fact by precise language and exact, high standards requiring the representation of these identifiable groups in proportion to their population in the areas where HSA's operate.

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Beyond the disparity between the local population and HSA's board composition, the rationale for an exact standard of representation is also supported by the actual procedures

and influences which exist in most HSA's.

Because of the

absence of blacks, other minorities, and women in the ranks of medical professions, these groups are seldom represented as medical providers on governing boards of HSA's. Because of the dominance of professionalism and expertise at this stage of health planning, there is also a likelihood that the views and influence of these affected groups will be

further diminished.

There are other obstacles to the participation of consumers
especially those representing groups of minorities and the
poor. Many of the meetings of deliberative committee and
sub-committees of the governing boards are held during the
daytime when consumers find it difficult to attend. For
others, there are distances which extend to almost 200 miles
and which must be travelled to attend meetings.

Reimbursement

is not always available. Also, there is seldom any clerical assistance available to individual board members.

The reality of how the health systems agencies actually work and the impediments which they include offer further reasons to establish by legislation a precise standard for the direct representation of the poor, blacks, other minorities, and women.

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The conclusions which we reached in our study and which we urge upon this committee today should not be read to discount every decision which a health systems agency has made under the 1974 legislation. Obviously, there is much that should be maintained and there have been decisions which are the products solely of reasoned discussion. Still, unless Congress insures that these agencies are selected in the manner which is representative and are composed of representatives reflecting the various segments of their communities, the agencies will fail to meet the most vital needs of health care for our citizens. The South and this country

have learned painfully the failures and calamities which we suffer when groups are excluded or grossly underrepresented. I hope that this committee will heed that lesson today.

Thank you, Mr. Chairman.