I guess Amarillo was selected to come here because of our success with our emergency medical services plan. It required a lot of time. As a matter of fact, I feel, and have received national recognition for it, that it is one of the better plans in the United States. Ten years ago we started out making some plans. We trained five people as EMT's to start with, through the cooperation of the colleges in the area, the fire chief, the police chief and the sheriff in the area. And now we have 30,000 people, men and women, who have been trained in cardiopulmonary resuscitation in the area. The region's neonatal mortality rate has decreased by 34.5 percent since 1977. The mortality rate for myocardial infarctions has dropped by 18.2 percent in the last 2 years, no question about it but that lives have been saved.

The planning took a long time. The implementation of it took a long time. Just to establish the network of radio communications and telecommunications between the hospitals, the ambulances, and so forth took several years. And then the implementation finally came about when the planning commission set up the HSA and there were funds available to get it all geared up. There is not anyone in the entire area that is more than 5 minutes away from medical care. I mean by that if you are 150 miles out in the wilderness in the Panhandle someplace here is an intensive unit ambulance service that can reach that person within 5 minutes. I know that given time, and let the plan work, this planning and implementation is going to succeed. We are now working in a resource development with rural help which we hope will provide primary health care to 23 of our rural counties. Federal funding for initiating this project has been approved, and we look forward to positive results.

Now this matter of funding, of course we are a minimally funded organization. $175,000 has been allotted to us. We have a staff of five professionals and one administrative assistant. Really, one of the tasks which is the appropriateness reviews, it is going to be almost impossible for us to advance on with that small staff. It could be done. I think just like the emergency EMS system started out with no funds, the planning and so forth, it finally became so important that we did get funds, this probably could be done too with solicited help from the hospitals and the doctors and so forth.

I think that really it would be money well spent to allow some of the agencies to share some of the unused funds from the other funded agencies who receive more than they need. That is just a comment about that.

We are also working on what we consider to, well, we are calling it a wellness clinic. That will, we hope, be our next resource development. A wellness clinic, the idea of it is that people will learn to take care of themselves instead of having to run to a doctor every time they have something. We feel that that will be a great financial savings in the medical field.

Mr. Loudder might be able to tell you a little bit more about the funding as far as the categories are concerned, but we feel that the funds are available and we have viewed the HEW categorical funding programs as a major resource development tool. But we have problems in this area.

Some of the funds are categorically directed towards structures that are not responsive to local needs. We recommend not increased funding for resource development but rather a shifting of funds from categorical programs to developmental programs which can be more directly applied to HSA planning efforts and more responsive to the local needs and priorities.

In conclusion, gentlemen and ma'am, there is no question but that health planning does work. With continued support from you I know that it will continue to work and we will be saving money for people and also providing good health care to them.

Thank you.

[Testimony resumes on p. 487.]

[Mr. Kolander's prepared statement and attachments follow:]

STATEMENT Of Jerry KolaNDER, PRESIDEnt, Panhandle HEALTH SYSTEMS AGENCY

Mr. Chairman, Distinguished Committee Members and Guests, I am Jerry Kolander, Chairman of the Panhandle Health Systems Agency.

The Panhandle Health Systems Agency is a subdivision of the Panhandle Regional Planning Commission and is responsible for health planning for a 25-county area of approximately 25,000 square miles in the Texas Panhandle. This expanse of Plains farmlands and rolling grasslands is larger than 10 of our states. The Amarillo Standard Metropolitan Statistical Area is centrally located within the region. Its population of approximately 150,000 represents approximately 45 percent of the region's 335,000 population.

As a predominately rural area, we are confronted with many health care problems such as medical manpower shortages, maldistribution of health care services, and lack of accessibility to quality health care. Five of our counties have no physicians, eight counties have no longterm care facilities, and 13 are designated as Medically-Underserved Areas or Critical Dental/Medical Shortage Areas. Both our Health Systems Plan and our Annual Implementation Plan address these problems and our Resource Development efforts have been directed largely toward solving them.

Our HSA is one of 20 agencies throughout our country that are part of regional planning commissions. Our working relationship with the Panhandle Regional Planning Commission has been very good and productive. It provides us with immediate access to data, regional development plans, personnel services and broad consumer representation that would be difficult for a minimally funded HSA to otherwise achieve. Historically our agency's application for conditional designation and eventually full designation grew out of the experience and expertise of the Health Council which was designated to be a B Agency, but was not funded due to the passage of P.L. 93-641.

One point we want to stress today is, "effective health planning and resource development require time." Many of the objectives in our first AIP are related to our Panhandle Emergency Medical Services System which has received national recognition for excellence. We began planning for an effective emergency medical system several years before P.L. 93641 was enacted, and its results are gratifying. Over 30,000 volunteers have been trained in cardiopulmonary resuscitation techniques. We have reduced the region's neonatal mortality rate by 34.5 percent since 1977, and our mortality rate for myocardial infarctions has dropped by 18.2 percent in the last two years. The entire population of our region has access to EMS services. We believe the reassurance provided through this program is positively affecting the health status of all residents. We could go on and on about these results, (attached Progress Report) but the point is our emergency medical system which took seven years in planning

and implementation is working, and given time, health planning will be equally effective in other areas as well.

Another area of resource development in which we are making real progress is the development of a rural health initiative program which will serve five rural counties and hopefully will be expanded to provide improved primary health care to 23 rural counties. Federal funding for initiating this project has been approved and we look forward to positive results. Effective resource development demands cooperation with area providers which in turn requires a long-term congressional commitment of support. Our present high cost, high technology and sophisticated acute care curative health care system did not develop overnight! The problems of availability, accessibility, affordability, and quality will not be solved on a year-to-year basis.

One problem confronting us as a $175,000 minimally funded agency is the approach of appropriateness reviews. This is a major undertaking, and our staff of five professionals and one administrative assistant is already expected to fulfill all the functions of planning, review, resource development, public education and information, and agency management assigned to other agencies with as many as 50 staff members. Increasing our staff is not possible without increased funding, and while our Governing Body members are dedicating many hours to effective health planning, it is unrealistic to expect them to carry the additional burden of appropriateness reviews. Please remember that the volunteer members of our HSA Governing Bodies, providers and consumers alike, are dedicated, intelligent citizens who are genuinely concerned about health care problems and resources. The amount of time they have been willing to give to health planning and resource development activities is remarkable. They deserve our thanks and continued support.

Many additional comments need to be made about effective resource development. First, Title XVI, Area Health Services Development Funds, if available would provide HSAs, especially minimally funded agencies, with a creative resource for plan implementation. Second, the present health care system should be expanded to include wellness, or health maintenance components which encourage individual responsibility for health and reduce the demand for hospitalization. Such efforts should prove in the long run cost effective. Third, present funding policies are inequitable. Larger agencies in our region report having turned back to HEW amounts equal to our own HSA's total government funding. Yet minimally funded agencies are not eligible for "sweep up" funds.

Resource development requires adequate funding. While our HSA has viewed HEW categorical programs as a major resource development tool, this approach is not without its problems. Categorical programs reflect priorities which are not directly related to the HSA planning structure and may not be responsive to local needs. Also, categorical programs tend to maintain a status quo which has not been cost effective. What we recommend is not increased funding for resource development. We do recommend a shifting of funds from categorical programs to developmental programs which can be more directly applied to HSA planning efforts and more responsive to local needs and priorities.

In conclusion, Mr. Chairman, we would like to express our appreciation for this opportunity to relate briefly some of the positive results stemming from the health planning effort in our region. We are firmly conviced that health planning does work. With continued support and the confidence of our congressional leaders, we can develop an expanded health care system which will provide "equal access to quality health care at reasonable costs" and improve the health status of our people.