Mr. CARTER. I notice this bill provides that dentists may refer patients to some of the regional centers, and I want to say that I think that is very good. I am happy that dentists and oral surgeons are included.

Mr. ROGERS. Thank you.

Do you provide for patient care in hospitals under this program? Dr. MARSTON. Patient care costs must be limited to those which are incidental to research, training, education, or demonstration activities funded by the regional programs.

We consulted various hospital groups to get advice of how we would administer this, and their advice was that we should be very cautious about the actual payment of patient cost, so we have not spent much. Mr. ROGERS. Let me have a breakdown on what you have done and where it has gone.

(The following information was received by the committee:)

The Department of Health, Education, and Welfare has determined that the following patient care costs, hospitalization costs, have been supported with regional medical program grant funds :

(1) Missouri Regional Medical Program-$90,050.

Mr. ROGERS. Do you use consultants, and where are these used mainly as far as the regional medical program is concerned?

Dr. MARSTON. We have used consultants at the national program from just about every area of health-hospital planning groups included. We receive a grant request and we use consultants with expertise in the area covered by the request, on the site visit.

Mr. ROGERS. Who determines what the region shall be? Do you determine it?

Dr. MARSTON. Essentially, the Surgeon General must determine this.
Mr. ROGERS. Are they too large now?

Dr. MARSTON. Some are quite large, but I think it will change.
Mr. ROGERS. Are there any plans for changing these?

Dr. MARSTON. There is discussion during the planning period in every region regarding the extent to which the regional approximation has worked, and this is commented on in the grant applications that

come in to us.

I think there will be changes over time, but I think many areas are finding they want the advantages of the larger regions and yet the opportunity of breaking down into subregional groups, and we have not discouraged this.

Mr. ROGERS. What has happened in Florida? I don't think they have gotten off the ground there; have they?

Dr. MARSTON. They have a planning grant that was made this year. Mr. ROGERS. So you would anticipate a year

Dr. MARSTON. Yes. I take that back, partially. We have had an application from Florida since that planning grant asking for funds for a feasibility study, which the National Advisory Council allows under a planning grant. This application arrived on my desk yesterday.

Mr. ROGERS. I would like the status, if you could give it to us, of all the regions, the 53, what States they are in, when we can expect to see something get down to the local hospitals and into the medical profession there.

(The following information was received by the committee:)

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE STATEMENT ON THE STATUS OF REGIONAL MEDICAL PROGRAMS

As indicated in the table below, all Regions except Puerto Rico have embarked upon planning; and 41 of the 54 Regional Medical Programs have been engaged in planning activities for a year or longer. These planning activities have involved a large number of diverse health and health related professionals (e.g., physicians, medical sociologists, hospital administrators, epidemiologists, allied health personnel) representative of a wide spectrum of health institutions and organizations, including community hospitals, local and state medical societies, official and voluntary health agencies, and state hospital associations. These individuals are serving on planning task forces and local advisory committees as well as Regional Advisory Groups. In addition, a number of such individuals are also serving on the central core staffs of many Regional Programs.

Experience to date clearly demonstrates that the involvement of community hospitals and other local health resources, private practitioners, and other health professionals becomes more extensive and intensive as Regional Programs enter the operational phase. At that stage, for example, community hospitals become the sites for coronary care unit demonstration and training programs; local physicians and hospitals undertake the training of cardiopulmonary technicians needed in the community; private practitioners and their patients in rural areas benefit from automated EKG readings utilizing telephone lines; and programs to recruit and train sub-professional health aides required to staff extended care facilities, are initiated.

Initial operational grants have been awarded to 12 Regional Programs to date. Another 12 Regions have submitted initial operational grant requests which are now under review. Based upon the best information currently available, it is anticipated that the other 30 Regions will enter the operational phase before the end of fiscal year 1969. Thus, involvement and participation by community hospitals and private practitioners in Regional Medical Programs should become more widespread and increasingly evident over the next 12-15 months.

STATUS OF REGIONAL MEDICAL PROGRAMS (AS OF MAR. 30, 1968

Albany-Northeastern New York, portions of southern July 1, 1966 Apr. 1, 1967

Initial operational grant request anticipated in fiscal year 1969.

384, 244

$921, 510

707,033

Vermont and western Massachusetts.

$921, 510

Arizona-State of Arizona..

Apr. 1, 1967

119, 045

119, 045

Do.

Arkansas-State of Arkansas.

do.

360, 174

360, 174

Bi-State-Eastern Missouri, centered around St. Louis.do..

603, 965

603, 965

and southern Illinois.

Indiana-State of Indiana.

Intermountain-Utah and portions of Colorado, Idaho, July

June 1, 1967

See footnotes at end of table.

STATUS OF REGIONAL MEDICAL PROGRAMS (AS OF MAR. 30, 1968)-Continued

1 Initial planning grant application has been received and is under review.

2 Combined planning and operational grant; includes some $340,000 for planning.