The AACHP is concerned with environmental health and personal health, which ...ludes both physical and mental. It is concerned with prevention of illness d disability, as it is with health care. Within that framework, the organ1ation and cost of the health care system has become a priority national issue, with a variety of legislative initiatives being considered.

The time for change in the health system is now: That is the consensus of Loth Congress and Administration. The focus of federal concern is on controlling costs and on readying the system for changes in the methods of scope of financing health services.

ISSUES AT STAKE

1. What is the future for comprehensive health planning as presently constituted?

2.

Should planning agencies be responsible for resource allocation? What
resources? How?

5.

should they also be given regulatory power?

If not, who assumes the responsibility?

How are multiple responsibilities to be met and structured in community,
area, state, and nation?

II. TRANSITION

The Association believes the transition to an improved community management system for health must be responsible and orderly; and should build on the strengths, experiences, accomplishments and structure of the comprehensive health planning process. The Association offers the following principles as

best suited to achieve that transition and an effective health care system.

1.

2.

CHP community management and planning capacity is present; and will be
improved by the time legislation is enacted and implemented. The Federal
agency assessment and technical assistance program has been launched as
a key factor in upgrading the capacity of comprehensive health planning,
along with the Association's "Agency Improvement Program".

Comprehensive health planning agencies are the only vehicles established with the responsibility to, and perspective of, the entire health system.

Volunteers and staff of comprehensive health planning agencies have
developed insight and acceptance in the present system and its problems;
and have developed a steadily improving information base.

To achieve the public interest in health affairs, comprehensive health
planning agencies are uniquely committed to the effectiveness of the
role of the consumer; and have provided a structure for accomplishing that
role, including strengthening the quality of health policy decision-making.

3.

3.

4.

5.

6.

7.

Human environment must be considered an integral part of the preventive component of the health care system. Human environment must be approached as a community management responsibility. The goal is to minimize adverse environmental impact on man's health, well-being and comfort and maximize human potential; thus reducing costs in the health care delivery system.

Any method of governing the health system must assure public accountability in the governance. Comprehensive health planning agencies are committed to, and demonstrate, public accountability through:

Involvement of elected officials.

An open-to-the-public process.

Public disclosure of all its proceedings

and accounts, with an opportunity for
feedback.

Involvement of large numbers of the

community-the public-in its activities;
and maintenance of consumer majority
in its policy direction.

Preparation, publication and revision of plan
documents and criteria for systems

development and project review and
certification.

A structured system for performance monitoring.

The system of governance must provide checks and balances, (beyond legislative-executive-and judiciary), while at the same time providing for effective inter-relationships, among:

areas and states

arcas and states, and the federal government
governments and private agencies
consumers and providers

Every state and territory should establish certificate of need (or certification of conformance) statutes, whereby every health facility-whether owned by government or private corporation or individual--must be certified and recertified as to its conformity to comprehensive · health planning.

Barriers to quality and to effective, acceptable, available and accessible care must be removed. They can and should be removed in part through cost containment efforts for facility and operational expenses and investments; but other efforts should be pursued. Achieving improved quality and effectiveness, and greater availability, acceptability, and accessibility will cost more. Their achievement is of cqual concern to this Association.

There are other ways of achieving cost containment
beyond price/capital controis; which must be also
pursued: such as, providing ambulatory and home
care in lieu of institutional care; budgetary in-
centives; or environmental management programs which
reduce illness or disability.

a. The Association reaffirms its December 1972 (See Attached) position, calling for national health policy establishment through:

b.

C.

d.

*An annual Presidential Report on the state of the
Nation's lealth.

*A council of Health Advisors.

*A joint Congressional Committee to receive the Presidential Report.

An independent operating unit within the Federal government at a
high enough level to impact national health policy through effective
comprehensive health planning of national health-related programs,
including federal programs. That unit or agency should assist
national health policy development by presenting to the Congress
and to the Executive planning output on health needs, resource
requirements, d rogram alternatives. Likewise, it should receive
Congressional Executive policy determinations for incorporation
and interpret tio into federal health planning. Such actions and
responsibilities require assurance of public accountability.

Responsibilitie. Include monitoring and coordinating the performance of the states; ication of federal funds in accordance with the national health; and should facilitate interstate cooperation where needed.

Federal functions should reflect reciprocal relationships in assessment, evaluation, and technical assistance.

Federal funding should be adequate to do the job; and should provide
the basic operational fleor. Funding should be matched with local
and state funds, and in-kind contributions whica recognize voluntary
effort, indicating the local community's commitment to the local
and area health planning and development responsibilities and endeavor.

Development of comprehensive health plans for the state, incorporating and compatible with arcavide health plans and planning.

3.

5.

b.

C.

d.

Monitoring, coordinating, and evaluating areawide planning processes
and plans.

Development of state health policy, in collaboration with state
legislatures and executive departments.

Surveillance and monitoring the health systems in the state and
their performance.

Collection, maintenance and distribution of health information
systems, coupled with areawide health information systems and
needs.

Functions carried out through an independent instrument of state
government at a high enough level to influence policy, maintain
objectivity and credibility to the private as well as public sectors,
and assure public accountability. Receives and acts upon recommendations
from areawide planning and development agencies.

Such state agencies and instruments should have the involvement of
consumers, providers, and public officials, with consumers in the
majority on state boards.

Statewide resource allocation.

With the exception of areawide development funds, the holding and
disbursing of federal and state funds should be a state function.
State activities thus include resource allocation planning and
distribution in collaboration with federal systems of resource
allocation and in accordance with areawide health plans.

Regulatory Responsibilities:

Licensing and credentialing health service personnel.
Licensing and credentialing health facilities.

Under certification of need or certification of
conformance procedures, the state government issues
the formal "certificate", employing uniform standards
compatible with areawide standards and plans. However,
it cannot override area determination or certification.
without demonstrating due process provisions that
will assure public accountability.

Analyzing costs and systems of reimbursement; and establishing cost
containment procedures, such as rate-setting and methods of
reimbursement.

Areawide Health Planning and Development Agency:

a.

Responsible for:

Planning

The areawide health plan is the coupling device: for quality
assurance, need determination, regulation, and certification,
and resource allocation.

6.

b.

including innovation and implementation (allocates development
funds coordianting proposals according to plan).

Determining conformance to areawide health plan in certification
process.

Designing and applying health criteria for engineering and conserving the natural and man-made environment.

Education of consumers, providers, and local public officials for effective participation in arcawide health planning and development. Evaluates resources available and the results of resource allocation, determining their conformity to areawide health planning. Develops and employs formal procedures for effectively influencing the decisions of the resource allocators.

(The areawide agency should receive developmental dollars to be utilized to stimulate, initiate and execute innovative projects which have been identified as high priorities by the local planning process. But the holding and allocation of other state and Federal funds to the local health system should be the function of the state agency. Allocation by the state agency should be initiated by recommendations coming from the areawide agency based upon the local/areawide health plans).

c. The agency should be independent, publicly-accountable, non-profit corporation. Its governing board should be composed of consumers, providers, and local elected officials. Consumers should be in the majority on the governing board.

d.

The area should have within it, or provide for, the whole range of services the population needs, such an area will be large in terms of population, geography, and resources. Thus the structure for areawide health planning must provide for linked localized or subarea planning.

e. Definition and Designation.

f.

The definition of manageable boundaries should be the product of local, state and federal determination. The procedure for designation should facilitate interstate cooperation where needed.

Those presently functioning arcawide health planning agencies (who are already a product of an intense local, state, and federal designation process), that are determined to have the capacity for this expanded health planning and development role following a thorough evaluation by local-state federal assessment teams should be given first consideration in the designation of the proposed arcawide health planning and development agency.

Because the arcawide health planning and development agency is keyed to the national effort, it should receive federal fooding adequate for the job to be done; and such funding should provide the basic operational flour. Federal funding should be matched with local and state funds and in kind contributions, which recognize