Tentative allocations to States for construction of hospital and medical facilities for fiscal year ending June 30, 1963 Total Alabama Arizona Arkansas. California. Colorado 2,111,589 350,000 575,363 8,750, 022 1,847, 433 1,264, 389 $170, 000, 000 $100, 000, 000 $70, 000, 000 $20, 000, 000 $20, 000, 000 $20, 000, 000 $10, 000, 000 5, 196, 887 3,085, 298 200, 000 840, 684 1,619, 758 1,015,798 1, 015, 798 507,89 188,039 1,017, 865 118, 165 188,039 100,000! 188,039 94,020 308,783 333.067 50,000 50,000 314.30 245,057 164.50% 127.359 2,659, 028 Louisiana. 1,819, 849 519,957 519,957 4, 528, 546 519, 957 259.978 2,688, 516 Maine. Maryland. Michigan 1,840, 030 525, 723 525,723 1, 193, 886 525, 723 262.861 2,318, 304 Massachusetts. 3. 431,648 1,576, 335 138,599 69,300 269, 134 269. 134 134.56 199.192 351.544 1,422,635 Mississippi. 4, 224, 663 406, 467 203.234 2, 508, 106 Missouri 3,992, 430 490,445 245,222 Montana. 740, 805 Nebraska 50,000 81.962 50.000 373, 671 1,967,075 50.000 192,325 4,862, 002 66,738 475.367 4, 160, 884 406,818 516, 923 4, 175, 029 50.541 408,201 1,683, 361 164,586 188, 546 1,058, 595 1,058, 595 94,273 529,297 452, 569 2, 400, 517 350,000 100, 000 100,000 100,000 50,000 10, 460, 727 553, 981 3, 146, 165 6, 210, 344 616, 940 284, 910 2, 800, 089 1, 339, 875 469, 407 234, 703 108, 328 54, 164 307,607 607,198 60,319 100,000 50,000 273,770 2, 405, 391 262, 004 131,002 Wisconsin. 139,622 Puerto Rico. Wyoming. Virgin Islands. 427, 291 213,646 100,000 100,000 50,000 2,764, 824 15, 058 540, 644 7.529 270.322 65, 105 38,652 7,558 3.779 PREPARED STATEMENT Senator HILL. Dr. Haldeman, we will be glad to have you proceed in your own way. Dr. HALDEMMAN. Thank you, Mr. Chairman. If I may, I would like to submit my statement for the record and try to confine my remarks to just the highlights. Senator HILL. All right, Doctor, your statement will be inserted in the record at this point. (The statement referred to follows:) STATEMENT BY CHIEF, DIVISION OF HOSPITAL AND MEDICAL FACILITIES, ON HOSPITAL CONSTRUCTION ACTIVITIES, PUBLIC HEALTH SERVICE Mr. Chairman and members of the committee, the purpose of the Hill-Burton program is to assist the States in providing adequate hospital and medical facility services to the people. The basic methods used in operation of the construction program have not changed. First, State agencies must develop a comprehensive plan designed to meet the hospital and medical facilities needs of the States; secondly, construction projects are approved in the order of priority. Research and demonstration studies are carried out as a means of developing new organizational patterns of providing hospital services and improving the operation, utilization, and design of health facilities. In addition, the Congress broadened the research program during the last session to authorize a program of grants for experimental and demonstration construction and equipment projects. 1963 ESTIMATE The total request for hospital and medical facilities construction, for the research, demonstration, and experimental construction programs, and for salaries and expenses is $176,220,000. This amount will provide $100 million for construction of hospitals and public health centers; $70 million for the construction of nursing homes, diagnostic and treatment centers, rehabilitation facilities, and chronic disease hospitals; $4,200,000 for research and demonstration studies and experimental construction; and $2,020,000 for salaries and expenses. PROPOSED PROGRAM FOR 1963 Construction.-The $170 million requested for construction purposes will enable the States to start the construction of approximately 700 health facility projects involving over 22,000 hospital and nursing home beds and almost 250 units for various types of outpatient care. This projection is based on the assumption that State agencies will program the construction of the different kinds of health facilities during 1963 along the same lines as construction was programed during 1959 and 1960. Substantial progress has been made during the last 15 years in reducing the deficit of general hospital beds and facilities, particularly in rural areas. At the same time, however, State agencies report that many areas require additional general beds and facilities and that the demand of communities for Hill-Burton assistance for general hospital facilities is still acute. While a portion of this need and demand may be attributed to the annual population increase of 3 million persons, it seems quite clear that a deficit of general hospital services and beds still exists. The same substantial progress, however, has not been made in the construction of other health facilities, such as long-term care, rehabilitation, and outpatient facilities. For this reason, the full amounts authorized to be appropriated for nursing homes, chronic disease hospitals, diagnostic or treatment centers, and rehabilitation facilities are included in this budget request. Your approval of this request will continue the effort being made to bring long-term and outpatient care facilities into better balance with general hospitals. Facilities and beds constructed under the Hill-Burton program.-As of December 31, 1961, approximately $1.6 billion in Federal funds had been committed to 5,888 projects costing a total of more than $5 billion. Of these projects, 4,381 have been completed, are in operation, and are serving their communities; 1,249 are under construction, and the remaining 258 are in the preconstruction stages. Completion of these projects will add 248,809 hospital and nursing home beds, and will result in the construction, expansion, or remodeling of 1,014 public health facilities, 427 diagnostic or treatment centers, and 202 rehabilitation facilities. Research. The amount of $4,200,000 is requested for the expanded research program. A portion of these funds will be used for the construction of units in health facilities which are experimental in nature and hold promise of improving the functional layout or operational efficiency of such facilities and reducing the costs of construction, maintenance, or operation. However, the bulk of the funds will be used for continued research, experimentation, and demonstration studies relating to hospital services, facilities, and resources. These research activities are necessary to bring the physical plant, equipment, and organizational and operational aspects of our health facilities up to peak efficiency. We place great emphasis and a high priority on our research and demonstration program because we are convinced that these activities will eventually lead to dramatic improvements in hospital organization, operation, and design. For example, these funds have supported major studies regarding progressive patient care and the concept is rapidly being accepted as an improvement in hospital organization. While additional research remains to be done in the field of progressive patient care, it gives promise of improving the utilization of scarce professional skills and at the same time improving the quality of patient care. HIGHLIGHTS OF PROGRAM PROGRESS AND PLANS As the number and complexity of health facilities increase, it becomes more and more apparent that the planning of health facilities should be given greater attention. As a first step in providing the leadership necessary to improved planning, five ad hoc committees, composed of outstanding hospital and health authorities, have been established for the purpose of developing general planning principles. The report of the Surgeon General's Ad Hoc Committee on Planning for Mental Health Facilities was published in January of 1961. The report of the Ad Hoc Committee on Areawide Planning for Hospitals and Related Facilities, which was jointly sponsored with the American Hospital Association, was published in July of 1961. The three ad hoc committees established to de velop planning principles for long-term care facilities, rehabilitation facilities, and tuberculosis hospitals have not yet completed their work. The reports of the two committees which have completed their work represent milestones in the fields of areawide planning and planning of mental health facilities, and we are confident that the reports of the other three committees will be of equal significance. The committee reports, however, represent only the first step in updating planning principles. These general principles must be reduced to detailed operating procedures and guidelines if they are to be of maximum usefulness to States, are planning councils, and communities. Accordingly, we have given a high priority during 1963 to this program as a means of making the greatest impact on the need for comprehensive and coordinated planning for all types of health facilities. In my opinion, this activity will have a profound impact on health facility planning and construction for many years, and represents a forward step in insuring that Federal funds are expended only for those facilities which are needed and of the highest priority. OPERATIONS AND TECHNICAL SERVICES The amount of $2,020,000 is requested for salaries and expenses. These funds will provide 24 additional positions which are necessary for the following purposes: 1. Providing the basic staff necessary to regional office operation. We have delegated responsibility to our regional offices for the (a) review and approval of applications, architectural drawings, and equipment lists, (b) review of State plans prepared by State agencies, (c) maintenance of surveillance over such matters as the payment of prevailing wage rates to construction workers and the inspection of construction, and (d) certification of construction payments to the Treasury Department. In addition-and perhaps of greater importance from the workload point of view-regional personnel must provide technical assistance and consultation to State agencies and communities regarding the planning, design, and construction of all types of health facilities. In a recent survey made of various regional offices we found that, in several offices, the workload was beyond the capacity of the present staff, if we are to carry out the basic requirements of the regulations and administer the program efficiently. Accordingly, several additional positions are requested to provide the basic staff necessary to regional office operation of the program. This survey also showed that an insufficient Hill-Burton workload existed in our Denver regional office to maintain the several professional competencies required for program administration. For this reason, we transferred Hill-Burton activities in Denver to the San Francisco regional office which enables us to use scarce professional personnel on a more efficient basis. 2. As indicated previously, we have assigned a high priority to improvements in the planning of health facilities during 1963. Additional staff is required to refine general planning principles for the various kinds of health facilities and reduce them to detailed operating procedures and guidelines for use by State agencies, area planning councils, and communities. In addition, we plan to assign additional personnel to regional offices and, in some instances, to State agencies, as a means of stimulating and encouraging the greatest amount of State and local effort in improving the planning of health facilities. 3. Additional staff is also requested for the purpose of developing new and updating existing guide material relating to the design, construction, equipping, and operation of health facilities. Guide material contributes significantly to the success of any Federal-State program, and in a construction program, such material is a key element to successful program administration. The extensive utilization of these guide materials both here and abroad adds additional emphasis to the necessity of keeping them up to date. REQUEST FOR HILL-BURTON FUNDS Dr. HALDEMAN. Mr. Chairman and members of the committee, the Hill-Burton program continues to make a significant contribution to the health of our people. Our request for 1963 is $176,220,000. This amount will provide $100 million for the construction of hospitals and public health centers; $70 million for the construction of long-term, ambulatory, and rehabilitation facilities; $4.2 million for our research and demonstration study program and for experimental construction grants; and $2,020,000 for salaries and expenses. The $170 million requested for construction purposes will enable the States to start the construction of approximately 700 health facility projects, involving more than 22,000 hospital and nursing-home beds and almost 250 units for outpatient care and rehabilitation. PROGRESS IN CONSTRUCTION Substantial progress has been made in the construction of general hospital beds and facilities, particularly in rural areas. The same progress has not been made, however, in the construction of long-term, ambulatory, and rehabilitation facilities. For this reason, the full amounts authorized to be appropriated for nursing homes, chronic disease hospitals, diagnostic or treatment centers, and rehabilitation facilities have been included in our request as a means of continuing our efforts to bring these facilities into better balance with general hospitals. HOSPITAL RESOURCES ADDED As of December 31, 1961, more than $1.6 billion had been committed to 5,888 projects costing a total of over $5 billion. Completion of these projects will add 248,809 hospital and nursing-home beds, and will result in the construction, expansion, or remodeling of 1,641 public health, ambulatory care, and rehabilitation facilities. EMPLOYMENT ON PROJECTS The Hill-Burton financed facilities are also making a significant contribution to our economy. The 5,800 projects will employ an estimated 230,000 persons and contribute an estimated $1 billion annually to the gross national product as the result of payroll and plant operations. 81716-62-pt. 1- -39 RESEARCH AND DEMONSTRATION STUDIES The amount of $4.2 million is also requested for research and demonstration studies relating to health facility operation, utilization, and design, and for the construction of experimental units of health facilities. We recognize that research is not the only answer to problems of more efficient organization, operation, and utilization of health facilities. At the same time, however, we believe that research in this area will lead to significant changes which may have a direct impact on the spiraling costs of hospital care. A large number of hospital officials have requested applications for grants under the new experimental construction program as authorized by the Community Health Services and Facilities Act which was passed during the last session of Congress. SALARIES AND EXPENSE Finally, a request is made for $2,020,000 for salaries and expenses to administer the program. This is an increase of $248,000. These funds are needed to carry out a three-pronged attack on improving the administration of the program. First, we recently surveyed our regional offices and found that the workload in several offices was so heavy that the staff was unable to give adequate technical assistance and consultation to States and communities, and in some instances, were forced to give less than adequate attention to the review of State plans and project applications. Second, we have assigned a high priority to improving the planning of health facilities. To accomplish this objective, staff is required to develop detailed operating procedures and guidelines for use by State agencies and communities, and in some instances, for assignment to States. Third, additional guide material relating to the design, construction, equipping, and operations of health facilities must be developed, and of equal importance, existing guide material must be updated. The extensive use of these guide materials, both here and abroad, makes it essential that we focus considerable staff time on this problem. Mr. Chairman, I shall be glad to answer any questions you may have concerning this program and the budget request. FUNDS FOR RESEARCH AND DEMONSTRATION PROJECTS Senator HILL. You have $4.2 million for research and demonstration projects. That is under the authorization for the $10 million, is that right? Dr. HALDEMAN. That is correct, sir. Senator HILL. And what was the full amount we gave you for this year? Dr. HALDEMAN. Congress appropriated $10 million for research and demonstrations. Senator HILL. That is what I thought. There were reserves of how much? Dr. HALDEMAN. Approximately $1,800,000. |