1 Includes capital outlay as follows: 1965, $61,000; 1966, $55,000; 1967, $77,000. 2 Selected resources as of June 30 are as follows: Unpaid undelivered orders, 1964, $594,000; (1965 adjustments, $4,000); 1965, $4,382,000; 1966, $4,382,000; 1967, $4,382,000. Mr. FOGARTY. Dr. Wharton, are you going to justify this appropriation? Dr. WHARTON. Yes, sir. PREPARED STATEMENT Mr. FOGARTY. Go right ahead, or if you like we will put your complete statement in the record and you can summarize it. Dr. WHARTON. You would like to have a summary? Mr. FOGARTY. Yes. (The statement follows:) DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE STATEMENT BY CHIEF, DIVISION OF COMMUNITY HEALTH SERVICES, PUBLIC HEALTH SERVICE, ON COMMUNITY HEALTH PRACTICE AND RESEARCH Mr. Chairman and members of the committee, private and public health services today face two nearly overwhelming challenges. These two challenges are the expanding demand for services, which races ahead of resources for their provision, and the explosive productivity of laboratory and clinical research which so often waits too long for maximal effective application. To meet these two challenges we must swiftly and surely increase both the quality and quantity of services delivered to the patient. At the same time, this must be done realistically with respect to national health resources. COMMUNITY HEALTH MANPOWER One of two major keys to increased quantity and quality of delivered services lies in more manpower and more efficient use of it. A significant start has been made through implementation of the Health Professions Educational Assistance Act Amendments of 1965, of the Nurse Training Act of 1965, and of recommendations of the President's Commission on Heart Disease, Cancer, and Stroke. The President's Commission called for a major national effort "on a scale never before attempted, to recruit and educate physicians to serve the health needs of the Nation." In addition to the need for more physicians, we must supply personnel for the entire health services team. As new and more complicated methods are developed for saving lives and preventing disease, we find the doctor occupies a role similar to that of the airplane pilot. The ultimate responsibility is the pilot's, but his effectiveness is dependent to a great degree on the ground crew, mechanics, navigator, and new instruments. Similarly, we can significantly increase the effectiveness of the doctor by improving the supply and qualifications of other members of the health services team, such as nurses, physical therapists, medical records librarians, laboratory technicians, and health aids, and by the development of new instruments. Expanding present training programs is necessary, but this alone will not do the job. The Commission has defined the work which must be done: "The health professions must reexamine and restructure their patterns of work. They must experiment boldly with new kinds of teamwork between highly skilled and lesser skilled workers, and then work closely with the educational forces of the Nation to design training programs to attract and prepare whole new groups of people for service to health." Another vital element of manpower effectiveness lies in constant updating of skills and knowledge. Most practicing physicians completed their medical education 10 to 20 years ago. It is imperative that we develop and maintain the best possible nationwide program of continuing education for physicians and for their teammates. In 1966 we have intensified our program efforts to develop new and better health manpower, and started projects to improve continuing education for physicians. We are analyzing numbers and types of the assisting professions and technicians. We find scattered examples of new and better teamwork, and are working to identify service gaps requiring new types or combinations of manpower and instrumentation. We are exploring new ways and means of extending and improving health care. We are analyzing and experimenting with more efficient and effective communications and continuing education to physicians and their teammates. This is only a beginning. In order to accelerate programs to increase the supply and improve the quality of the whole range of health services manpower, we are requesting increased support for expanded programs of basic educational improvement grants, scholarship grants, and traineeship grants, and are requesting funds to initiate a special educational improvement grant program. ORGANIZATION OF COMMUNITY HEALTH SERVICES The second significant key to better health services is improving the organization for provision of services. New and imaginative methods must be developed, and new partnerships between Government, voluntary agencies and private practitioners formed, if we are to maximize the use of available resources. Cities are faced with problems of near-crisis proportion. Health manpower, Our work facilities, and supporting services will continue to be in short supply. with Armed Forces rejectees and school health programs has shown that even where substantial health resources exist, we still face the problem of effectively linking services and patients. These problems have forced communities and States to see that there is an overriding need for establishing comprehensive urban health planning and action programs. In 1967 we plan to initiate pilot projects to develop such plans and programs in selected urban and rural communities. This interest in total community health programs and the recent growth of research on these problems will, with appropriate support, result in breakthroughs similar in impact to those achieved in clinical and laboratory research. We have requested increases for research grants and research training grants to support further work in this area. MIGRANT HEALTH Finally, we plan to improve the effectiveness of our program for domestic agricultural migratory workers. These mobile people without community identity often lack even minimal health services. The recently enacted amendment to the Migrant Health Act of 1962 authorized an expanded effort in this program with particular emphasis on providing necessary hospital care. We are requesting the full amount authorized to implement this program. This will assure that curative and preventive care investments in people will not be lost when additional hospital care is required. In summary, we are requesting a total of 370 positions and $103,228,000. This represents an increase of 25 positions and $25,674,400. Mr. Chairman, I shall be glad to answer any questions you may have about these programs. GENERAL STATEMENT Dr. WHARTON. We believe that the major problems facing the delivery of health services to people now can be met most effectively through two means; one of them is to increase the effective manpower pool for the purpose, the other is more effective organization of health services in the community at the point of delivery. INCREASE OF THE MANPOWER POOL A significant start has been made toward the increase of the manpower pool through the recently enacted Health Professions Educational Assistance Act amendments. We see very significant progress in this area. In order to make these primary health professions more effective, however, it is also necessary that we supply personnel for the entire health service team. This will require that there be newly developed types of personnel and quantities of personnel to support the primary health professions in their actions. ORGANIZATION OF HEALTH SERVICES IN THE COMMUNITY In addition we believe that it will be necessary to accomplish much better organization of the private, voluntary and public actions in rendering health services in order that we may gain substantially in the available time for professional persons so that they may provide care to patients. We also believe that it is necessary to expand the activity of comprehensive health service planning in urban communities for this purpose. We are requesting that an increase of funds be allowed to provide hospital care to migrant agricultural workers and to expand existing programs for them. In summary, we are requesting a total of 370 positions and $103.228.000. This is an increase of 25 positions and $25,674,000. Mr. Chairman, I shall be glad to answer any of the questions that you may have. BUDGET REQUEST Mr. FOGARTY. Your adjusted appropriation for 1966 is $77,554,000. The request for 1967 is $103,228,000, an increase of $25,674,000. EDUCATIONAL IMPROVEMENT GRANTS By far the largest increase is $19,518,000 for educational improvement grants, from $10,482,000 to $30 million. This is a new program authorized by the Health Professions Educational Assistance Amendments of 1965. I think you ought to take a little time and tell us the need for the program. Describe the basic grant program and special grant program and tell us how the funds are allocated and what the school is required to do to qualify for grants, and so forth. Dr. WHARTON. Yes, sir. The ratio of the primary health professions to the population has scarcely changed in the last 30 years while the demand for services has increased enormously. This enactment is for the purpose of strengthening the capacity of the schools which teach the primary health professions so that they may improve both the quality and quantity of personnel in these primary health professions. Mr. FOGARTY. What do you call primary health professions? Dr. WHARTON. For the purpose of this discussion I was referring to those which are eligible for support under the Health Professions Education Assistance Act; medicine, dentistry, osteopathy, optometry, pharmacy, and podiatry. Pharmacy is not included in this particular portion of this support. it. Mr. FOGARTY. What about the veterinarian services? Dr. WHARTON. They are not included in this enactment. Mr. FOGARTY. There is legislation pending, I think, in the Congress. Dr. WHARTON. I have heard that there is. I am not familiar with Mr. FOGARTY. Go ahead. FORMULA UNDER BASIC IMPROVEMENT GRANT PROGRAM Dr. WHARTON. This particular enactment provides, through the mechanism of the basic improvement grant, a formula amount which would be available to the schools each of which on the basis of eligibility would apply. The basic improvement grant is available only to schools which are accredited, are nonprofit schools, which give reasonable assurance of an increase in enrollment and give reasonable as surance that the non-Federal expenditures in those schools will at least equal the average of the previous 3 years. The formula for this purpose in the current fiscal year is $12,500, plus the product of $250 times the full-time student enrollment. The formula for next year as authorized is $25,000, plus $500 times the full-time student enrollment. BUDGET BUREAU REDUCTION The authorization for the current fiscal year is $20 million and for the next fiscal year is $40 million. Mr. FOGARTY. What are you asking for? Dr. WHARTON. We have asked for $30 million. Mr. FOGARTY. $10 million under your authorization? Dr. WHARTON. Yes, sir. Mr. FOGARTY. Did you ask the Bureau of the Budget for $40 million? Dr. WHARTON. We did, sir. Mr. FOGARTY. It was a Bureau of the Budget cut? Dr. WHARTON. It was cut at that point, yes, sir. LEVELING OFF OF RESEARCH GRANT PROGRAM Mr. FOGARTY. While the research grant program shows an increase of $1,378,000, this is just leveling the program off, is it not? Dr. WHARTON. Sir, the research grant program for which we have requested funds would permit continued support to about 51 research grants and a support to new grants at the same level as we were able to carry out last year. Mr. FOGARTY. It is just leveling off? Dr. WHARTON. This would represent 44 new grants, sir. Mr. FOGARTY. How many did you have in 1966 ? Dr. WHARTON. In 1966 we had 44 new grants. Mr. FOGARTY. The same? Dr. WHARTON. Yes, sir. Mr. FOGARTY. That is not progress, is it? Not the way I look at it. Dr. WHARTON. We believe that we can make some progress. Mr. FOGARTY. You are not doing any more in 1967 than you did in 1966? I will put it that way. Dr. WHARTON. We believe that we can make some progress with these 44 new grants. Mr. FOGARTY. How can you make more progress with the same amount of grants from year to year? Dr. WHARTON. We will be able to support more continuations this year than we did last year. Mr. FOGARTY. But new grants are the same number? Dr. WHARTON. That is right. Mr. FOGARTY. How do you get progress out of that? Dr. WHARTON. In this year we will Mr. FOGARTY. What did you ask for? Mr. HAMBLETON. $5,614,000 to the Bureau of the Budget. Mr. FOGARTY. What is this total now? Mr. HAMBLETON. This totals now $5,194,000, a reduction of $420,000. |