Senator JAVITS. Thank you very much, and thank you, Mr. Chair man. Senator CHAFEE. Thank you, Mr. Seidman. Next, we have Mr. Wisniewski, research director of the Service Employees International Union. We welcome you here. You have submitted your statement, I believe. STATEMENT OF STANLEY WISNIEWSKI, RESEARCH DIRECTOR, SERVICE EMPLOYEES INTERNATIONAL UNION, WASHINGTON, D.C. Mr. WISNIEWSKI. The statement that I am going to make represents the views of George Hardy, president of the Service Employees International Union (AFL-CIO) and Leon Davis, president of District 1199, of the National Union of Hospital and Healthcare Employees, Retail, Wholesale and Department Store Workers Union (AFL-CIO), and over 350,000 health care workers who are members of our two unions. Health planning as established in Public Law 94-641 supplies an orderly, rational approach to health resource allocation, but the interim period since the enactment of the Health Planning Law has not been problem-free. S. 2410 attempts to resolve some of these shortcomings and omissions. However, we feel that the proposed health planning amendments of 1978 could be greatly strengthened in several key areas. Our most immediate concern is with the proposed part G of title XVI, which seeks to assist and encourage the discontinuance of unneeded hospital services. As long as efficient utilization of all health care resources is the primary aim of the planning process, we feel that wasting health care. manpower resources is incompatible with proper health planning. Yet the new program outlined in part G is almost totally insensitive to employment problems it may create. Section 1642(a) (2) of the proposed amendment only goes so far as to suggest to an institution considering closing its inpatient facilities that it may use some of the incentive payment received under the program to provide for severance pay, retraining, or placement services for workers who are terminated. Given the list of alternative uses available for the incentive payment, the possibility that workers would receive even these meager considerations seems remote. Indeed, even the proposed amendment ranks this consideration last in the order of spending uses permitted for the incentive payment. Workers deserve a better break. The health care system deserves better planning than this if it is to claim efficient utilization of available health manpower. Voluntary severance pay schemes and tenuous promises of retraining are not acceptable manpower strategies in the health care industry any more than if these were the only approaches used nationally to deal with unemployment problems. It is about time that we realized that proper mannower planning in the health care industry means not only stimulating the supply of trained personnel when shortages exist, but also means dealing respon sibly with dislocations and temporary maldistribution problems when they occur. Part G of the proposed amendment should require more than just an evaluation of the impact on discontinuing services on the provision of health care as suggested in section 1642 (b) (2). We feel that an evaluation of the impact on the local economy ought to be required as well, with special attention devoted to the negative employment effects of proposed hospital closings. Such a requirement would bring health planning legislation into conformance with national employment goals and provide coordination of purpose with Federal manpower policy efforts. To that end, we recommend that section 1642 (b) (2) be amended by adding to that section the following: and an evaluation of the manpower effects of such discontinuance or conversion on health care manpower in the health service area in which such hospital is located. Evaluations of the manpower implications of discontinuance of hospital services should focus on, but not be limited to, an examination of the degree of potential unemployment and the costs of such unemployment to the health service area as reflected by unemployment insurance costs, tax revenues foregone, public assistance costs, retraining and/or relocation costs. Evaluations of the manpower implications of conversion of hospital facilities where no permanent unemployment is anticipated should focus on, but not be limited to, an examination of the costs of temporary unemployment associated with the lag between termination of old services and initiation of new services. Measures for dealing with the involuntary unemployment problem must be improved. The methods suggested in part G of title XVI would be inadequate if utilized, and further, there is no certainty that institutions would in fact expend moneys received as incentive payments in this manner. Therefore, we strongly urge the addition of another type of incentive payment which would be earmarked for handling potential unemployment problems. Part G of title XVI should be appropriately amended to establish an incentive payment to other hospitals in the health service area which are willing to accept displaced hospital workers in their facilities. This should be a reasonable incentive structure that, coupled with a strict attrition program, would, within a reasonable period of time, return the hiring institution to appropriate levels of staff. Tying the incentive payment structure to a strict attrition program would prevent permanent overstaffing. Furthermore, where immediate placement in other facilities in the area is impossible, these incentive payments should be expended for retraining and assisting displaced workers secure other suitable empolyment. These proposals would not totally remove the negative employment effects of discontinuing hospital services but would represent a positive program for efficient utilization of health manpower within the context of national employment goals. With respect to other portions of the bill, we heartily support the additional staff requirements listed in section 105 for health systems agencies, to assure expertise in financial and economic analysis and public health and disease prevention. The full potential of HSA's as planning instruments can only be realized if proper analysis of the economic impact of various health care decisions is carried out and if HSA's concentrate on plans for improving the "wellness" of the members of their respective communities, instead of merely looking at resources for dealing with illness. Greater involvement in health planning by major health care purchasers such as labor unions and corporations needs to be encouraged, in order that planning agencies may benefit from the expertise and experience of such groups. Recognition of labor unions and corporations as major purchasers of health care in section 110 should prove helpful toward that end. Additional labor and management health planning input is likely to be gained through the section 140 proposal to allow Senator CHAFEE. Mr. Wisniewski, could you wait 1 minute? Going back to your discussion about HSA's concentrating on plans for improving the "wellness" of the members of their respective communities, instead of merely looking at resources for dealing with illnessI take it that what you are touching there on "wellness" is improving the general health of the people, rather than just caring for them when they are ill? Mr. WISNIEWSKI. That is correct; rather than an after-the-fact approach, a before-the-fact approach. Senator CHAFEE. Well, I couldn't agree with you more on that. I just think that that gets short shrift in this country. All the attention-which is good-is on curing people, but I think we ought to have certainly one-tenth of that effort devoted to keeping people well. Go ahead. Thank you. Mr. WISNIEWSKI. Additional labor and management health planning input is likely to be gained through the section 140 proposal to allow consumers who serve on boards of other health organizations and agencies to be considered as consumers, rather than indirect providers. Many knowledgeable labor and management representatives currently fall into this category. In addition, the definition of indirect provider needs to be clarified. Current regulations interpreting the law would hold that an individual who receives, directly or through his spouse, more than onetenth of his gross annual income from entities or associations or organizations composed of entities or individuals engaged in the provision of health care or in such research or ins ruction is an indirect provider. The definition is too broad in that, carried to extremes, it could possibly eliminate many potential labor or management consumer representatives. It would be helpful in this case if the entities, associations or organizations were so defined as to classify their employees as potential indirect providers only if a majority of their composing entities or individuals were engaged in the provision of health care. We believe that section 113 which amends section 1512(b) (3) (c) (ii) to explicitly include nonprofessional health workers as provider members of the HSA governing body, is long overdue. It is about time that a group that represents a majority of the health care industry labor force had a voice in planning health care delivery. At the same time, we feel the consumers should constitute at least 60 percent of the membership of an HSA governing body. We recommend amending section 1512(b) (3) (c) appropriately. Finally, we strongly support section 141, which amends the planning law to broaden State certificate of need requirements to include expensive equipment with a value over $150,000, regardless of location, except where such equipment is utilized exclusively for patients of health maintenance organizations. Health care costs have been unncessarily pushed up by the increasing price and proliferation of new technology. The proposed amendment will be of great benefit in discouraging circumvention of the health planning process. Senator CHAFEE. Now, this would apply to physicians in their own offices, or groups of physicians, would it not? Mr. WISNIEWSKI. That is correct. We thank the committee for the opportunity to present our views on the proposed health-planning amendments of 1978, and we strongly urge you to consider our recommendations for strengthening the proposed legislation. Senator CHAFEE. Thank you very much, Mr. Wisniewski. Those were thoughtful-and, I might say, controversial, to some extentrecommendations, and they will provide us with a lot of help as we develop this legislation. There may be some questions that we will want to submit to you in writing, and if there are, we will send them to you. Mr. WISNIEWSKI. We would be happy to answer them to the best of our ability. [The prepared statement of the Service Employees International Union presented by Mr. Wisniewski follows:] |