However, we share this responsibility with many other agencies and organizations, Federal, State, and local, public and private as this committe well knows. (We shall go into these multiple relationships later in these hearings.) Health protection, of course, has never been the exclusive responsibility of any one group or agency. It is primarily a State and local responsibility. However, many public health problems cut across State boundaries or are beyond the normal resources of individual States and communities. The Public Health Service exists to deal with just such problems. At such times, the Service becomes an active partner with the States in health programs. The Federal Government, through the Public Health Service, serves this partnership in two major ways: It provides a wide array of technical services to assist the States in improving their health services, and it makes funds available through grants to pay part of the cost of health services in the States and local communities. II. MAJOR SERVICE FUNCTIONS This presentation, in the time available cannot possibly do justice to every program the Service operates. We have, however, tried to present information on all of our programs in the background material in the committee print, to which you referred, Mr. Chairman. Consequently, I have adopted an approach for this presentation which we can call an "analysis of functions." This approach permits some basic groupings of activities which I hope will more readily inform the committee about what the Service is and what the Service does. The two groupings I speak of are these: The means by which the Service carries out its responsibilities, and the objectives that it seeks to achieve. Basically, there are only five means available to, and used by, the Service in carrying out its responsibilities: (1) Direct operations. These are the things which our staff does directly: Medical care to certain beneficiarie sof the Government, research in our own laboratories, field studies and other investigations, and the executive and administrative tasks of operating the Service. Charts A and B previously provided will help you to assess their magnitude. (2) Financial assistance. These are funds appropriated by the Congress to support activities outside the Service: To support research or training in educational institutions, to support operations in State and local health agencies, to support construction of health facilities, and to support disease control activities. It is in this area that our growth has been so rapid in recent years. About three-quarters of our annual budget goes to finance projects conducted by institutions and agencies outside the Federal Government. (3) Setting standards. This means is useful in many areas; for example, standards for safe public water supplies, limits on pollutants in the air, and requirements for the safety, potency, and purity of biologicals. These standards may have the force of law, or they may simply be guidelines which often are widely adopted by State and local governments or by other groups. (4) Regulatory authority. We have this type of authority in biologicals for human use, in preventing the introduction of certain diseases into this country, in interstate quarantine, and in water pollution_control. In the latter instance, this basic authority resides in the Secretary, Department of Health, Education, and Welfare, working through our staff. (5) Leadership. The fifth and last means is more difficult to define. Leadership is many things, including how well the Service is operated, and how well it meets the objectives the Congress has set. Here, however, I refer particularly to our continuing assessment of the health needs of the Nation and how we devise ways of meeting those needs. Federal action may or may not be needed in solving individual health problems-but the problems must be identified, called to the attention of appropriate authorities, and action taken if warranted. A good example here might be our studies of present and future needs for health manpower. In some instances, this has led to Federal action, in other instances, it has not. We will hear more about this later. The second way in which the functions of the Service can be grouped, as I said earlier, is by objectives, the end results to be achieved. This concept broadly stated, as it is in our research authorities in section 301 of the Public Health Service Act, is to investigate "*** the causes, diagnosis, treatment, control, and prevention of physical and mental diseases and impairments of man." Or, objectives can be more specifically defined-the control of air pollution, the prevention of accidents, the conquest of cancer, heart disease, mental illness, and so on. The framework I shall now use to describe the Service is actually a combination of means and objectives. A. PROVISION OF MEDICAL CARE The law provides that certain groups in our population are eligible for medical and dental care, and for preventive health services at Federal expense. I would like to describe these functions first since they were the functions for which the Service was primarily created, and they still constitute an important part of our activities. We estimate the population which is eligible for medical care to total about three-quarters of a million people. These fall into four distinct groups: (1) Approximately 371,000 Federal beneficiaries as follows: 117,000 actively employed merchant seamen; 44,000 active and retired officers and enlisted personnel of the Coast Guard, Coast and Geodetic Survey, and commissioned personnel of the Public Health Service. The remaining 210,000 include persons afflicted with leprosy, Federal employees injured in the line of duty, and dependents of Coast Guard, Coast and Geodetic Survey, and Public Health Service commissioned officers. (2) Three hundred eighty thousand American Indians and Alaska natives. (3) Twenty-four thousand inmates in Federal prisons. (4) Five thousand Peace Corps volunteers. Each of these groups receives health services through systems that are largely separate, although Public Health Service personnel in each system are interchanged freely. This separation results because the health services must be provided where the beneficiaries are located, and the required services often differ among the various groups. Group 1, merchant seamen, officers, and enlisted personnel of the Coast Guard, et cetera: This group receives service through 15 hospitals and about 135 outpatient facilities located in most instances at major port cities. The number of beds available totals 5,930. One of these hospitals, at Carville, La., is the only facility in the continental United States devoted to leprosy. It will accept any patient within the United States who is afflicted with the disease. Two hosiptals, at Lexington, Ky., and Fort Worth, Tex., were established primarily for treatment of Federal prisoners who are narcotic addicts, but voluntary patients are admitted on a bed-available basis. The 12 remaining hospitals provide general medical, surgical, and dental care. During fiscal year 1962, the inpatient admissions totaled over 51,000; 948 babies were born; the daily inpatient census averaged 4,801; and outpatient visits approached the 1,300,000 mark. Group 2, American Indians and Alaska natives: This responsibility was transferred from the Department of the Interior to the Public Health Service in 1955 by Public Law 568 of the 83d Congress. Medical care and preventive health services are provided through 50 hospitals, 26 health centers, 16 school health centers, and over 200 part-time clinics. In addition, we provide a wide sectrum of preventive health services, including programs to improve water supply and sanitation facilities on the reservations and in Indian communities. This population has unique health problems. Their levels of health are considerably inferior to non-Indians. It is our objective to raise them-and much progress is being made. Group 3, Federal prisoners: More than 30 years ago, the Congress directed the Service to assume responsibility for comprehensive medical services in the Federal prisons. There are 23 hospitals and 7 infirmaries for 24,000 prisoners. Group 4, Peace Corps: By interagency agreement, the Service staffs and operates the medical program in the Peace Corps, including care of the volunteers who are assigned overseas. Forty-five professional people are currently assigned to this duty. Chart C, which has been passed out to you, shows the location of the facilities we have just been discussing. It also shows the location of our quarantine stations, which will be discussed later. (Chart C is as follows:) Dr. TERRY. The chart on page 29 in the committee print shows the budget involved in these activities. Roughly 13,000 of our staff are involved in the provision of medical care. This is nearly 40 percent of all Public Health Service employees. On the other hand, these programs account for only about 7 percent of our total budget. I want to point out that these programs have importance for the Service which extends far beyond the direct services they render. They constitute a most significant device to attract young professional people into the Public Health Service, some of whom later go on to positions in other parts of the Service. I, myself, and many of our top staff, came into the Service through Public Health Service hospitals. These programs also have major training activities, and a growing research function which benefits not only the Service but the Nation as well. One of the most widely used methods of inducing anesthesia during childbirth was developed at our Staten Island hospital. At the same institution, it was first shown that penicillin would cure syphilis. This was a major breakthrough and revolutionized the attack against venereal disease. The sulfone method of treating leprosy was developed at our hospital in Carville and is being used worldwide today. Mr. Chairman, this is a very sketchy and incomplete description of these important programs. With your permission, I would like to submit a more complete statement for the record. Mr. ROBERTS. Without objection, that will be inserted in the record. (The statement referred to is as folows:) BUREAU OF MEDICAL SERVICES The hospitals, clinics, health centers, and other health services operated by the Bureau of Medical Services are in 250 locations on land and on the sea-the Arctic and Antarctic, in the United States and in foreign countries, on the Atlantic and on the Pacific. Almost 13,000 personnel are engaged in activities of the Bureau of Medical Services, providing direct health services to a variety of Federal beneficiaries. The purpose in building marine hospitals many years ago was to care for merchant seamen who became ill or suffered injuries on their long voyages and could not go back to their homes and families on reaching port. Today, medical and hospital care for American seamen, and other direct health services to safeguard the Nation's strength, are provided by the Bureau of Medical Services. Millions of travelers-U.S. citizens and people from other countries-arrive here each year from foreign points; through the foreign quarantine program, they are checked against any doubt of contagious disease. American Indians and natives of Alaska are given comprehensive health care through the Indian health program because they are not yet ready to provide it for themselves. Protection of the health of the officers and men of the Coast Guard and the officers of the Coast and Geodetic Survey has long been a responsibility of the Bureau. Members and retired members of the Armed Forces and their families receive care at hospitals and clinics of the Bureau where more convenient than military hospitals. In turn, commissioned officers of the Public Health Service may receive care in military facilities. Medical and hospital care for civilian employees of the Government who are injured on duty or become ill from causes related to their jobs is administered by the Bureau. In another program, the Bureau operates health units for Federal departments and agencies that have requested this help in protecting the health of their employees. A special hospital is devoted to treatment of leprosy. addiction is offered in two neuropsychiatric hospitals. Treatment for narcotic sible for medical and hospital care in all the Federal prisons and correctional institutions throughout the country. |