8 percent which is now going to college, we would get a lot of people out of poverty.

PRESENT PROGRAM ENROLLMENT

In addition to that, we would increase the trained manpower of the United States by a real quantum jump.

As I say, we have 23,000 kids in this now. The program is uniformly applauded by educators both at the high school and college level. We have a very distinguished group of advisers who work with it. Dr. Flemming is the head. I have never heard any criticism of Upward Bound that was substantive criticism. We would like to have a much bigger program but are limited by money. That is our third major program for youth, at least teenagers.

COMMUNITY ACTION PROGRAMS

Now in addition to those programs for youth, there are a whole host of community action programs which are in my judgment extremely significant programs, not just because they affect the poor but because I think they may end up by affecting the whole country; in fact, they already have. Let me just start off with the medical program.

NEIGHBORHOOD HEALTH CENTERS

About 2 years ago we started some new programs called neighborhood health centers. The idea of this was that poor people in our country don't get health services at all. Even in a major center of medical research like Boston there were pockets of people who never saw a doctor at all, the mothers who never had prenatal or postnatal care in the delivery of children, thousands of youngsters who never went to a dentist, right within sight of the Harvard Medical School.

FAMILY SERVICE FOR IMPOVERISHED

The concept was created of putting in that poverty pocket a neighborhood health center capable of providing health services to a family, not to an individual but a whole family; create in substance what the old family doctor used to be; and to help that family make its way through the medical profession of the Nation. What it boils down to is this: A mother and father come in with their family to a neighborhood health center in Boston or where we have them, and they can get the whole spectrum of services. There are pediatricians there for the children, dentists, et cetera, so you don't have to go from one clinic, let us say a TB clinic or mental health clinic, to a well baby clinic, to some other clinic.

Senator PASTORE. How do you select these facilities?

Mr. SHRIVER. Anybody who lives in that area who comes in the door, if he needs a doctor, gets served. After the service we find out their names and all that kind of thing. In other words, we do not have people staggering in the door needing an appendectomy and we ask them first if they have $150 for the operation or whatever its cost is. Anybody in that area is qualified.

I would like to get Dr. Joe English on this because he is the man who runs it. We do have a followup to make sure people are not cheating in other words, some rich people who live in that area are not coming in and getting free medical service at the taxpayers' expense. This

us;

is Dr. Joseph English at the end who is the associate director of our program.

Senator JAVITS. I would like to ask one question.

When the doctor testifies I would like to have him relate the health centers to medicaid in such States where there are effective medicaid programs.

COLUMBIA POINT HEALTH CENTER, BOSTON, MASS.

Dr. ENGLISH. Columbia Point in Boston has the program which Mr. Shriver was talking about; that is, a health program. It used to be the city dump; it is a peninsula created by the city after having a dump there for years and years. On that old city dump was built a housing project. The health centers care for the whole population that lives in the housing project. It was such an undesirable place to live there was nobody practicing there. The neighborhood health center is in a couple of apartments in the housing center. Everybody in this center, by virtue of the economic level they have to have to qualify for public housing, is eligible for services under the poverty program.

DETERMINATION OF MEDICARE PATIENTS

Now in other areas where there are people above the poverty indexes each center works out a way of certifying, as simply as possible and in a way that does not keep people waiting, whether patients meet the eligibility for the poverty program indexes, or whether they meet the State's medical indexes, which would determine the payment under title VIII-B or title XIX that Senator Javits has just raised. The point he raises shows the cooperative and comprehensive relationship between this program and the social security amendments administered by HEW.

FACILITY AND PHYSICIAN PROVISION

As you know, those amendments primarily allow payment for the medical care of poor people but in many areas of the country you have an inadequate number of physicians; you have an inadequate number of hospital facilities. What the neighborhood health center does is to make sure that there is a system of care in a poor community to which the title VIII and title XIX people can come.

Senator PASTORE. How do you get the doctors to come?

Dr. ENGLISH. That is an interesting thing. Part of the reasons why doctors have left these areas has been because it has been impossible to practice high-quality medicine there. The doctor in a private, solo practice is helpless in a situation in some of these urban areas and there has been a flight of physicians from these areas.

CENTER ESTABLISHED BY SOUTHERN CALIFORNIA SCHOOL OF MEDICINE AT WATTS

In the Watts area there was 0.45 physicians per thousand people in the area. The Southern California School of Medicine started one of these neighborhood health centers in an area where 350,000 people live. In Watts there is absolutely no hospital at all; people have to travel 10 to 12 to 20 miles to get medical care. They have to pay a $3 cabfare to get there. It costs $7 when they get there-to the Los Angeles County Hospital. The medical school has come in there and set up in the middle of Watts one of these neighborhood health cen

88-092-68-2

ters. Time magazine wrote about it; called it "Miracle in Charcoal Alley."

HIGH-QUALITY MEDICAL PRACTICE

They have been oversubscribed by physicians from the locality and from the Los Angeles area first, because it represents the highest quality of medicine under the supervision of the medical school faculty; second, because the doctors work in teams-they have the help of nurses, help of neighborhood people, help of all kinds of social services built in as part of the program; and

COMMUNITY ACCEPTANCE

Third, because the community's acceptance of the program is so great, the community participates in the program through a neighborhood health council. There are jobs there for neighborhood people. There is a system of training which has been developed.

All these kinds of things make the practice of medicine in that area so attractive that doctors come into it. One of the interesting things about the program is that it is developing around the country in 41 communities now. It seems to be reversing the flight of physicians from these areas.

ESTABLISHMENT AND PAYMENT OF DOCTOR FEES

Senator PASTORE. How do the doctors get paid?

Dr. ENGLISH. The doctors at Watts are paid by the University of California School of Medicine, which is the grantee for the program. Mr. SHRIVER. We pay them. We give them the money.

Senator PASTORE. How do you set these fees?

Dr. ENGLISH. What we do is have a study done in the area of what comparable academic or other kinds of salaries are. On the basis of that study we review what the dean of the medical school thinks he needs to have to attract good physicians and we try to come as close to that

as we can.

LEGISLATIVE BRANCH

ARCHITECT OF THE CAPITOL

STATEMENT OF HON. WALLACE F. BENNETT, U.S. SENATOR AND MEMBER, MADISON MEMORIAL COMMISSION

JAMES MADISON MEMORIAL BUILDING

Senator PASTORE. Will you indulge me in an interruption. Senator Bennett has a statement to make.

Senator BENNETT. Mr. Chairman, I am a member of the Madison Memorial Commission which is charged with the responsibility of developing the third building for the Library of Congress. There is a request in for $2.8 million to get started on the plan.

PRESENT RENTAL PAYMENT

The Library is now spending $800,000 a year for rental. The longer we keep that up the more expensive it is going to be. I recognize you are in a very important consideration. I would just like to submit the statement for the record.

Senator PASTORE. We will have that inserted in the record at its proper place.

Senator BENNETT. Thank you very

you very much.

EXECUTIVE OFFICE OF THE PRESIDENT

OFFICE OF ECONOMIC OPPORTUNTY

HEALTH CENTER- -HEW COORDINATION

PAYMENT FOR MEDICARE PATIENTS TREATED AT HEALTH CENTERS

Senator PASTORE. Senator Javits.

Senator JAVITS. Does medicaid actually pay for medicaid clients who attend the health centers and does that go into the funds of the OEO? Dr. ENGLISH. Yes, sir. Mr. Shriver and Secretary Gardner have signed an agreement of coordinated funding of HEW and OEO health services programs which makes possible the reimbursement, assuming the State agrees to this, of the neighborhood health center. What we do is give the community the money to set it up and after they get it set up the center becomes eligible for reimbursement.

HEALTH CENTER-DEPARTMENT OF HOUSING AND URBAN

DEVELOPMENT COORDINATION

Senator JAVITS. Are there any other programs which you coordinate? I think it is very important for us to be sure that this is not a proliferation of effort.

Dr. ENGLISH. Yes, sir. We coordinate with the Department of Housing and Urban Development. In Louisville, Ky., the health center is being built in a multipurpose neighborhood center.

HEALTH CENTER EFFECTIVE FEDERAL AND STATE COORDINATION

Senator JAVITS. Will you insert a statement showing the fact that the health centers handle the whole coordinating aspect of their activity in the Government, Federal and State, in an effective way?

Mr. SHRIVER. I will be happy to; yes.

Senator JAVITS. I think it is very important, Mr. Chairman, because I have heard these charges made that this is just another layer on all the others.

(The statement follows:)

The Neighborhood Health Center supplements existing resources within the community for the provision of Health services to individuals where such services are unavailable or inaccessible. Title XIX programs eliminate the financial barriers to providing health services, however, this program cannot be effective for those communities and persons where services are either non-existent or very deficient. The OEO program aids in the effective utilization of Title XIX funding support by providing a service setting accessible to persons eligible to Title XIX coverage.

In addition to this, both Title XIX programs and programs of the Children's Bureau, Maternal and Infant Care and Child and Youth programs fail to cover services for a large segment of the poor population. Their eligibility criteria are very limited. The Neighborhood Health Center fills this grap in services coverage within the target geographic area.

Administrative coordination at headquarters helps assure that this program is not an additional layer of service. Recently, an agreement was reached between the Children's Bureau, HEW, and OEO staff to include the following specific steps where there are joint programs operating in the same geographic areas:

(1) There will be joint OEO, DHEW review of new project proposals for these programs.

(2) In all areas where there are joint programs, the two agencies will move toward a common funding date. This will relieve some of the financial and administrative burdens placed on grantees due to differing financial reporting dates.

(3) There will be joint on-site program appraisal whenever this is possible. The first such joint site visit will take place in early January at the Denver Neighborhood Health Center program which also has an operational Maternal and Infant Care program and a Children and Youth program. Thus, the Neighborhood Health Center program provides an effective service base target for populations where medical services are unavailable or inaccessible and complements existing community and Federal programs in the target, geographic area.

HEALTH CENTER ACCOUNTING PROCEDURE

Senator PASTORE. Does the money which is paid into the offices of medicaid augment their funds, or have you worked out a system to prevent undue enrichment?

Dr. ENGLISH. We have a very careful system insuring that ours is the last dollar given to the program. We give them the money to set up a center to attract physicians to get underway. Then each year we review with them the other sources of funds which come into this program. In that way we subtract from their grants the reimbursement they should receive. Part of the problem is that there are so many different pieces of legislation that supply money for health services. We look at it from the viewpoint of the poor family, part of them don't get health care because fragmentation is manifested in