cil's active role and its importance, the Council is provided with its own executive director, accountable only to the Council.

This will help to assure that the Council will be able to meet its responsibilities and maintain the independence envisioned by this legislation.

ADMINISTRATIVE PROVISIONS

There are some common characteristics of federal research and development agencies, such as the National Science Foundation, the National Institutes of Health, the National Aeronautics and Space Administration and the new National Institute of Education.

Because adequate administrative provisions are important to the functioning of an effective research and development health organization, the Committee has provided the Institute with the needed and necessary administrative provisions. These include the authority for a flexible personnel system; the authority to carry over unexpended funds from one year to the next; the authority for multigrant projects; and a specific direction to provide for the coordination of research and development activities in this field.

The Committee is particularly concerned with the problems of duplication and lack of coordination in the health field. The health efforts of the Federal Government are scattered over a dozen departments. and agencies. Each has an interest in health services and to some extent contributes to the federal research and development effort in health. There is little coordination of these efforts and the lack of common statistics preclude even elementary comparisons of efforts and results. A number of provisions are aimed at this problem. First, the Institute is directed to establish offices and procedures to coordinate its research and development activities with those conducted by other federal agencies and public and private agencies.

Secondly, the National Advisory Council is granted the specific assignment of examining and coordinating health care delivery efforts of the Department of Health, Education, and Welfare, and other federal agencies so as to avoid duplication. Thirdly, the President is granted for a two year period the authority to transfer to the Institute. any programs or personnel of the Department of Health, Education, and Welfare when he feels such action is desirable.

With the many priorities in the health and other domestic areas, the failure to coordinate and share the results of research and development between federal departments and agencies represents a serious loss. The Committee believes that these provisions will help to maximize resources and eliminate needless duplication.

DISSEMINATING RESULTS

It is not enough merely to produce significant results in health care delivery research and development. Such findings must not be allowed to remain on some shelf or in some federal storage room. They must, in order to be useful, be disseminated in a timely manner to the health care system and federal agencies responsible for health services. Health is a field in which change may occur rapidly and it is important that researchers and administrators be kept abreast of the current status of developments and not have to rely on information which may be a number of years old.

Accordingly, the legislation creates within the Institute, an Office of Health Care Delivery Information Services to facilitate the communication of the research results. This Office would provide, or arrange for, the provisions of indexing, abstracting, translating, or other services leading to a more effective dissemination of health care delivery information and undertake programs to develop new or improved methods for making such information available.

A variety of media could be used by the Health Care Information Services, including a computerized storage and retrieval system, microfiches and suitable periodicals or other publications. The Office might also publish or support a monthly Journal which would abstract both national and international literature bearing on health services. In addition, it would be useful for the Office to establish or to encourage the establishment of a high quality, timely publication service for research reports, monographs, state of the art papers, and other information in the field.

The Committee views the functions of this Office necessary not only to assure that promising improvements in the delivery of health care reach the proper individuals in a timely manner, but also to prevent needless duplication of research efforts and the waste of

scarce resources.

REGIONAL AND SPECIAL EMPHASIS CENTERS

The Committee's bill also authorizes up to eight Regional Centers and two Special Emphasis Centers, the Health Care Technology Center and the Health Care Management Center. The Regional Centers are designed to: (1) enable the study of the different health care delivery problems peculiar to the various regions of the country; (2) broaden and strengthen the nation's research and development base in health care delivery; and (3) link better research and development activities and actual practice.

The Regional Centers' locations will be determined by the National Advisory Council. In selecting these locations, the Committee expects the National Advisory Council, to the extent feasible, to bring about the broadest possible geographical distribution of such Centers. The Centers will be funded by the Federal government for an initial period of three years.

The Committee wishes to emphasize that the legislation authorizes "not to exceed eight regional centers". This number would result in a Center for the various regions of the nation. While this number may be ultimately desirable, the Committee is aware of the possible manpower constraints that exist and indeed, has directed the Institute to give the manpower problem a top priority. It is not the intent of the Committee that all eight centers be created initially. For example, two may be the maximum number of centers that could be started at the outset. The actual number to be established initially, and subsequently will be determined by the Director and the Advisory Council, giving due considerations to the manpower and other constraints. Clearly, these programs should be begun in an orderly and prudent manner, consistent with the effective use of the Nation's resources in this respect.

HEALTH CARE TECHNOLOGY CENTER

Two Special Emphasis Centers, a Health Care Technology Center and a Health Care Management Center are also authorized.

The Health Care Technology Center will focus on all forms of technology and its application in health care delivery. The achievements of this nation in technology, such as in space, electronics, communications, and data processing, have been truly amazing. Yet, much of the health care system continues to employ outdated manual procedures.

President Nixon, last year, both in his State of the Union Address and his Health Message to the Congress, emphasized the need to stimulate the application of science and technology to the solution of domestic problems. The President's 1972 Health Message specifically identified health as a "vital" area for exploiting technology.

The Health Care Technology Center will be expected to exercise leadership in mobilizing the involvement and investment of private industry for the successful development of such technology will depend on our ability to motivate the involvement of industry.

The Committee wishes to emphasize that the Center's purpose is to encourage the development of technology to solve the health problems of our citizens and our health institutions and not as a place to find markets for available technology.

Presently, there are only a small number of individuals concerned with such problems. The Health Care Technology Center is designed to remedy this situation and serve as a focal point for an accelerated research and development effort on both program and hardware development. This Center will also provide us with an opportunity to utilize the talents of some of the unemployed engineers and scientists. The Committee believes there is great potential for the use of technology in the health delivery area and that such utilization would result in enormous benefits to the public and the patient.

HEALTH CARE MANAGEMENT CENTER

The second Special Emphasis Center is the Health Care Management Center. This Center will focus on the improvement of management and organization in the health field, the training and retraining of health administrators and the development of leaders, planners, and policy analysts in the health field.

The job of Administrators and Managers in the health field is exceedingly complex. To carry out these responsibilities with maximum effectiveness health managers need a basic understanding of a wide variety of management skills. Some background in such areas as health, economics, computer technology, statistics and the management sciences are just samples of areas in which health managers should be familiar.

In practice, however, medical administrators are often elevated to positions without adequate preparation for their new responsibilities. Certainly American industry would ascertain that its top executives are adequately trained and the health system must do no less. The following comments from a letter of a health administrator illustrates the need for a Health Care Management Center:

"Practitioners of health care administration, among whom I am one, have been flying by the seat of their pants for too long. The nation

deserves better. There is currently no systematic effort I know of to reach decision makers in the health care field with the results of innovative research and to stimulate a research orientation to many of the problems we all face in the financing, organization, and delivery of services. There is moreover, an almost total neglect of more formal continuing education opportunities for health care administrators... After ten years or more in the field, many of us are in positions of responsibility and strong in experience but weak in understanding of fundamental advances in health care systems, e.g. the problemoriented medical record, how to organize a prepaid group practice, the use of television in medical diagnosis and treatment, computer applications to health systems problems, etc."

Dr. Kerr White of Johns Hopkins University at the Second Sun Valley Forum on National Health last summer similarly emphasized the importance of improved management in the health field when he stated: "Vastly improved managerial expertise is a prerequisite for any meaningful improvement in our health care system at the operating and geographical levels."

The Regional and Special Emphasis Centers have a separate authorization of $20 million for the initial year and a total of $75 million for a three year period. Support for a Center, other than support for construction, shall not exceed $2 million per year per center, except for the Health Care Technology Center. Federal assistance to such Centers may be used for research and development, staffing and other basic operating costs, training, demonstration purposes, and construction where the National Advisory Council deems such is

necessary.

CONCLUSION

The health care enterprise is the Nation's second largest industry. In the fiscal year 1972, health spending totaled $83.4 billion, or 7.6 percent of our Gross National Product. By 1974 health expenditures will exceed $100 billion and probably make health the largest single segment of our society. By 1980, it is possible that one out of every ten dollars spent in the Nation will go for health care.

The magnitude of health care expenditures alone argues for a strengthened research and development component in the health area. There is considerable public frustration and dissatisfaction with aspects of health care. The public is alarmed over rising costs, is concerned over the manpower and facility shortages as well as their maldistribution, and is distressed that the benefits of medical science are not reaching them. Change is already occurring in the health field. The pace of such reform is likely to accelerate in the years ahead.

The Committee believes that it is imperative that we strengthen our research and development capabilities in the health area so that we may make more intelligent choices and foster constructive changes. We desperately need to have advance warnings of approaching "crisis"; we badly need more information upon which to base decisions and make comparisons in the health area; we need to sharpen our capabilities to illuminate issues and to identify possible options and their implications; and we need better evaluation and monitoring of both experimental efforts and ongoing programs. In short, we need a framework for evolving health care policies for the long haul as we continue to deal with the short-term policies. The National Institute of Health Care Delivery will provide that framework.

The respected "Science" Journal in commenting favorably on the proposal to establish a National Institute of Health Care Delivery said: "A major tour de force is needed now-an administrative mandate backed by appropriate funding-to dramatize the importance of rational organization and planning services. . . if the magnificent benefits of American medical research are meant for all of our people then an effective science of health care delivery is as important as the medical research itself".

The Committee believes that the Institute and its Centers will provide this "major tour de force" to make health care delivery as important as medical research, and to help speed the benefits of medical science and the scientific discovery system to the people of the United States.

Section-by-Section Analysis

(Section) The short title of this Act is the "National Institute of Health Care Delivery Act of 1973".

(Section 2) States the findings of the Congress that:

1. the United States faces a crisis in health care;

2. health care costs have increased in the last five years twice as fast as the general cost of living;

3. there exists an acute shortage and maldistribution of physician and other medical manpower in inner city and rural areas;

4. millions of Americans do not have access to quality health care; 5. since World War II the United States has invested approximately $20,000,000,000 in biomedical research, and that this investment has resulted not only in wide recognition of the preeminence of biomedical research in the United States, but also produced many, often spectacular, advances in medical sciences;

6. during the same period comparatively few resources were invested to deliver the discoveries of medical research and technology to our citizens;

7. the American public is concerned with the gap between the knowledge and capabilities of medical science and what is delivered to the patient, and that this is a source of public discontentment and dissatisfaction;

8. significant changes regarding the health care system have been proposed and may be implemented in the near future;

9. the potential costs and benefits associated with the various proposals are largely unknown; and

10. inadequate attention, emphasis, and resources have been devoted to health policy analysis and health care delivery.

The Section also indicates that the purpose of this Act is to establish a National Institute of Health Care Delivery and regional and special emphasis centers to improve health care delivery and to help speed the delivery of the benefits of medical science and the scientific discovery system to the people of the United States.

(Section 3) Amends the Public Health Service Act by adding a new Title XII entitled, "Title XII-National Institute of Health Care Delivery".

(Section 3-New Section 1201) Defines health care delivery for purposes of this Act.