A-5 with programs in the regions and states - for the development of health facilities and manpower resources, medical research and public and community health services. The Health Security Board would control expenditures from the Health Security Trust Fund, establish national benefit patterns, set standards of participation and develop policy guidelines. The Board would also have the responsibility to assure effective consumer participation and public accountability at all levels. The Board would also have responsibility for studying systems of paying for services and for planning new developments and improvements for health services. A commission on quality of health care would be established and charged with assuring the developing standards of care of high quality. Regional and Health Service Areas - At the second and third level of administration for the Health Security Program, 10 regional Health Security offices would be established within the regions of the Department of HEW and more than 100 health service areas would be established paralleling the natural medical delivery patterns in the United States. The health service areas normally would consist of a state or part of a state. Interstate areas would be established where the board found that patterns of health service organization and patient flow made an interstate area more practical for administration. Local - As the fourth level of administration, the Health Security Board would establish in each health service area a local Health Security office and any necessary branch offices. These offices would assist health service consumers and providers and serve an ombudsman function by investigating A-6 complaints concerning administration of the program. have informational and other administrative functions. of ways. States They would also States would participate in Health Security in a number They would participate in planning, training, coordination for quality controls and manpower increases, health, education, utilization review and the inspection of providers. The Health Security Board would establish appropriate payment arrangements with the states for services. To improve the supply and distribution of health personnel and facilities and the organization of health services, the board would work with state comprehensive health planning agencies. Existing Programs A number of major federal health programs would be superseded in whole or in part by Health Security. Medicare Everyone 65 and over would be entitled to Health Security coverage. Benefits would be broader than those offered under Medicare. Medicare would be terminated. Medicaid - The benefits of state Medicaid programs would be available under Health Security. Such benefits would be deleted from Medicaid, leaving it as a supplementary program to Health Security. States would claim partial reimbursement for services provided which exceed those available under Health Security. This would include long-term nursing home care, drugs and adult dental care. Workmen's Compensation - Because separation of the health service benefits of Workmen's Compensation programs from cash payments would unduly complicate the eligibility determination process, Workmen's Compensation would be unaffected by Health Security. A-7 Other Programs Maternal and Child Health Programs, Crippled - Children Programs, Office of Economic Opportunity Health Programs and Medical Vocational Rehabilitation provide a range of various services to specific groups. In addition to a personal health service component, each program covers other types of health and community service which would be continued. Future Plans In order to broaden the scope and benefits of Health Security to remove its initial limitations, the program would undertake various studies, including long-term care, coordination of Veterans Administration health care programs with Health Security, and the provision of Health Security benefits to U. S. citizens in other countries. Financing - Health Security would be financed through a trust fund similar to the Social Security Trust Fund. Fifty percent of the money would come from: a 3.5 percent tax on employer payroll; a 1 percent tax on the first $20,000 a year in wages and non-earned income and a 2.5 percent tax on the first $20,000 a year of selfemployment income. The remaining 50 percent would come from federal general revenues. If an employer's existing obligations for the purchase of health benefits for his employees are greater than 3.5 percent of payroll, the excess would be applied toward the 1 percent which would otherwise be withheld from an employee's wages. The first $5000 income for persons over 60 would be exempt from Health Security tax. The total of these taxes and the government matching funds would be the total available to pay for personal health services in each fiscal year. After setting aside contingency reserves and money for the development of additonal health resources, the remaining money would be divided among the ten regions of the country. This would done with regard for recent and current use and expenditure patterns for services covered by the program. be A-8 Initially, the Health Security Board would look to the latest expenditure figures available before the program starts, making appropriate adjustments among the regions for figures higher or lower than the average. After that, the allocation among regions would be guided by actual expenditures and estimates of what was needed to meet the program's obligations and objectives. The Board would budget funds for each of the new HEW regions in each category of covered service from the total sum allocated to the region. There would be authority for each region to determine its own needs and priorities in support of services. Cost and Quality Controls - The central cost control feature of the Health Security program is that the health care system would be anchored to a budget established in advance. The program's main quality control feature would be the establishment of national standards for participation both for individual and institutional providers. To develop and endorce such standards, a Commission on the Quality of Health Care would be established. It would be a quasi-independent board reporting to the Health Security Board, but with authority to appeal to the Secretary of Health, Education and Welfare if it believes the Board has failed to implement or enforce effective quality standards. Budgeting The Health Security Program would establish an advance budgeting procedure for the costs of personal health services. Each year an advance determination would be made of the total amount to be spent in the various bregions on physicians' services, institutional services and other categories of service provided in local communities. The cost of each kind of service and the overall cost of the program would be allowed to increase only on a controlled and predictable basis. A-9 The program would use the budgetary process not merely to control costs, but also to strengthen local, state and regional planning, stimulate more efficient institutional administration; and gradually reverse the current undesirable emphasis on inpatient hospital and other institutional services. This would be done by stressing preventive and early curative services and by making alternative levels and forms of care available outside of institutions. In approving budgets for institutions, the program would consider recommendations and decisions of state and other health planning authorities, administrative efficiency of the institution, scope of care provided and the need to achieve an equitable distribution of resources throughout the region and country. Wasteful duplication of services and facilities would be gradually eliminated by withdrawal of funding. Institutional budgets would be increased to allow for the provision of services needed for a balanced development of regional resources. National Standards The national standards for provider participa tion would be designed to upgrade the quality of care, encourage appropriate use of health manpower and promote orderly planning of facilities. Physicians, dentists, osteopaths, optometrists and podiatrists licensed to practice in a state when the program begins would be eligible to take part in the program as long as they met continuing education requirements. The Health Security Board would be authorized to establish national standards for professional personnel licensed after the program begins and to set requirements for their continuing education. Hospitals, skilled nursing homes, home health agencies, specified freestanding centers, medical or dental foundations and health maintenance organizations would be eligible to participate if they met national standards established by the Board. |