The Southern Governmental Monitoring Project, a special project of the Southern Regional Council, was established in 1973 by the Carnegie, Babcock and Rockefeller foundations to investigate the effects of the New Federalism on minorities and the poor and to assist community groups to understand and cope with government

decentralization.

During the summer of 1976, SGMP investigative interns were located in Southern communities selected to include most state capitals, and a range of large and medium-sized cities. While some

of the investigative interns listed below concentrated on New Federalism programs other than health system agencies, all contributed reports of first year operations under the National Health Planning and Resource Development Act of 1974.

Health Systems Agency Surveys for 1976 came from:

PUBLICATION

the SOUTHERN REGIONAL COUNCIL,

EWS

from

SRC the

75 Marietta St., NW/ Atlanta, Georgia 30303 / (404) 522-8764

PLACEBO OR CURE: State & Local

Health Planning Agencies in the South

by Wayne A. Clark (March '77)

The National Health Planning and Resources Development Act of 1974 has brought
about significant changes in the field of health planning. Implementation of
the Act is beginning to affect virtually all consumers and providers of health
care. During the summer of 1976, SRC's Southern Governmental Monitoring Pro-
ject conducted a systematic assessment of Health Systems Agencies (HSAs) in
eleven Southern states. The study was conducted to obtain information on the
development of HSAs, the election and composition of their governing boards,
and the establishment of state-level regulatory bodies required by the Act.
One primary objective of the study was to determine the role consumer members
of HSA boards play in health planning.

The report deals with several aspects of health planning:

The relationship of HSAS to the state-level regulatory
bodies: the development and operation of the State Health
Planning and Development Agency (SHPDA) and the State
Health Coordinating Council (SHCC).

The report evaluates the ability of HSAs to follow the Congressional
intent of PL 93-641, i.e., lower health care costs, provide higher quality
health care, and reduce many of the inefficiencies found in the Hill-Burton,
Regional Medical Program (RMP), and Comprehensive Health Planning (CHP) pro-
grams. In addition, the report assesses the extent to which HSAs and the
state agencies have been able to overcome various organizational problems,
and meet their obligation to provide effective health planning.

(Orders for the report will be filled in March, 1977.)

- TO ORDER, send this form to:

Southern Regional Council/75 Marietta St., NW/Atlanta, Ga. 30303
ATTN: Publications

Ship order to:

Invoice to: (If different from

shipping address.)

Please send

copies of PLACEBO OR CURE: State & Local Health Planning Agencies in the South ($5.00; $4.00 Bulk rate of 10 or more) $ Postage & handling charges: 25¢- orders for single copy;

Payment enclosed

50¢

orders for 2 or more copies.
Please bill me

TOTAL

OTHER SRC PUBLICATIONS IN THE HEALTH FIELD

MEDICAID FOR THE YOUNG; The Early and Periodic Screening, Diagnosis and
Treatment Program in the South (1976) Gilliard, $3.00

Access by the Poor to Health Care in Southern Hill-Burton Hospitals (1974)
Crimm, $1.00

HEALTH CARE IN THE SOUTH: A Statistical Profile (1974) Anderson & Morgan,
$3.50

THE TEN-STATE NUTRITION SURVEY: An Analysis (1974) Carter, $.60
COMPREHENSIVE HEALTH CARE: A Southern View (1973) Anderson & Morgan, $.50

A complete list of SRC publications will be sent on request.

\nc.

May 1976

HSA GOVERNING BODY COMPOSITION

ANALYSIS OF REGION II

Herbert H. Hyman, PhD.
Public Health Consultant

This report is for information only and does not represent stated policy of the Public Health Service or the Bureau of Health Planning and Resources Development. It is one in a series of information reports to acquaint the reader with issues relating to the development and implementation of P.L. 93-641.

HSA GOVERNING BODY COMPOSITION
ANALYSIS OF REGION II

P.L. 93-641 and the Federal regulations are fairly precise with respect to the composition of the HSA's governing body. The Act offers specific guidelines of what is meant by a provider. All other persons in the health service area population who do not fall within one or more of the provider categories are considered consumers. It further states that consumers shall constitute a majority of the governing body, but not more than 60% and that its members "shall be residents of the health service area serviced by the agency who are consumers of health care and who are not providers.... and who are broadly representative of the social, economic, linguistic and racial populations" of the area. There is no standard identified by which the term "broadly representative" is to be measured and evaluated. One of the aims of this aralysis is to present empirical data about the first HSAs which have been conditionally designated for Region II with respect to the representativeness of the consumers on the HSA governing bodies.

The Act calls for a governing body of ten to thirty members, the majority of whom are required to be consumers of health services and who reside in the health services area. If the HSA decides to have a governing body larger than 30 members, it must have an executive committee of 25 or fewer members, the majority of whom shall be consumers.

It

The Act and its regulations are more specific with regard to defining who a provider is. It essentially divides providers into two basic categories: the direct providers and the indirect providers. mandates that among the providers at least one third shall be direct providers. In turn, it sub-divides direct providers into those who provide the direct service (physicians, nurses, etc.) and those who administer the medical facilities where such service is usually performed (hospital, HMOs, nursing homes, etc.). Finally, it sub-divides the indirect providers into six sub-categories such as trustees of medical facilities, health insurors and medical professional school staff. One of the aims of the analysis with respect to providers is an attempt. to identify the general composition and the potential degree of influence of the various sub-categories of providers. From this analysis, it is hoped that a clearer picture will emerge about the relative influences that can potentially be exerted by the categories of membership on the HSA governing bodies (GBs) in Region II.

This report will be divided into five basic sections. Section I will be an analysis of consumers; Section II, an analysis of providers