allowed to meet the requests for registration made by individuals. not assigned to it or who reside outside of its geographic area, as well as recruit such persons. Registrants would be free to register with the Health Care Corporation of his choice if there were two or more Corporations in his community, or register with a Corporation in another community or area following the open registration period. Wherever economically feasible given existing or anticipated resources, opportunities for registrants to choose among Health Care Corporations should be encouraged. Physician participation is fundamental to the Health Care Corporation. Therefore, the Health Care Corporation must: (1) (2) (3) implement the principle that medical judgments related to health care must be made by or under the supervision of physicians; assure that the physician's responsibilities and professional relations are defined in accordance with rules and regulations adopted by the Health Care Corporation and its component institutions; assure that judgments pertaining to the practice privileges of physicians should be made after peer review of their training, experience, and professional competence; and, (4) afford the opportunity for all physicians, within the limits and capacity of the Health Care Corporation, to affiliate with a Health Care Corporation and provide incentives to attract physicians to practice within them. Physicians practicing within the Health Care Corporation should be required to participate in management by serving on committees for budget, planning, utilization, and patient care. Based upon their management qualifications, physicians should have the same upward mobility in the management structure of the Health Care Corporation as professional administrative personnel. Health Care Corporations should develop policies and programs designed to encourage supervisory and professional personnel to 62-090 0-76-27 participate in management decision-making and review processes. Based upon their management qualifications, these personnel should have equal opportunity for advancement in the management structure of the Corporation. Every individual shares a responsibility to protect his own health, and proper discharge of the responsibility will reduce the incidence of illness, disease, and injury. In order to encourage individuals to take care of themselves to the maximum extent possible, programs of education to teach people how to exercise this responsibility must be developed, conducted, evaluated, and maintained. The Health Care Corporation would be responsible in behalf of its registrants for participating in communitywide educational activities sponsored by voluntary and governmental agencies and for providing adequate information services concerning the availability and use of health services. It would have a responsibility for actively encouraging the responsible use of services by its registrants. The Health Care Corporation must maintain peer review mechanisms as part of the overall program of quality assurance for services of the Health Care Corporation. The Health Care Corporation and its component institutions should establish a program to review and validate the qualifications of personnel. Health Care Corporations should be responsible for: (1) identifying and setting performance standards, in conjunction with its component institutions, for health care personnel; (2) assisting the educational system in the setting of educational standards for health care personnel; (3) providing adequate clinical opportunities for the education and training of health personnel; (4) developing effective means for measuring the quality, use, and economic delivery of each of the five components of comprehensive health care; (5) through such measurements set priorities of services, taking into consideration, among other factors, the age, occupation, mobility, and size of the population served; differing patterns in the use of each health service, and the adequacy and availability of these services; and, (6) conducting research in the delivery of health care services, including the organization of services, to evaluate and then utilize patterns of service organization based on their effectiveness, cost and quality. To use the nation's health manpower resources more effectively, Health Care Corporations should: (1) (2) encourage and support the development of health care personnel with skills to augment those of physicians in the diagnosis and treatment of illness; encourage and support programs to assist members of minority groups to become health professionals; (3) develop and maintain policies and programs designed to promote career mobility and advancement; (4) utilize acceptable substitutions of capital resources for health manpower; and, (5) identify and implement acceptable alternatives to present concepts regarding patterns of distribution and use of health manpower. A program for providing the public with competent health manpower resources in sufficient number should be coordinated by the National Health Board and the State Health Commissions and Health Care Corporations. The principal objectives of this program should be: (1) identification of health service manpower requirements for given geographic areas; (2) establishment of a national program to coordinate and supervise the collection of uniform health services and manpower data: (3) establishment of study centers, including universities, health planning agencies, and Health Care Corporations, to conduct manpower planning and demonstration projects; and, (4) establishment, evaluation, and promotion of cooperative arrangements within and among educational institutions and agencies for basic and continuing education of health service personnel. National standards for the measurement of competency of professional and technical health personnel should be developed and/or improved to verify professional and technical education or training, with specialty training for physicians, nurses, and others to be certified by specialty boards or bodies. Alternatives to existing licensure provisions should be identified, demonstrated, and evaluated and they should be adopted if they provide for improved delivery of health care services. Basic educational preparation for health personnel should increasingly become a responsibility of the nation's secondary schools, institutes, colleges, and universities. Programs for the continued training and education of health personnel should increasingly become a shared responsibility of the nation's educational institutions and health care providers. The educational system, with the support of health providers, should be responsible for: (1) assuring an alequate number of skilled teachers for basic and continuing education programs; (2) developing a knowledge of and sensitivity for the special problems, needs, and value systems of various ethnic and minority peoples; and, (3) preparing health personnel to perform more effectively in the provision of services directed to the prevention of injury and disease. Society must assure the availability of adequate funds for the establishment and maintenance of education and training programs for health manpower. Private funding resources should supplement the basic governmental investment in education and training which is conducted under the auspices of educational institutions and Health Care Corporations. 9 Part III THE ROLE OF Government's ultimate role would be to assure the fulfillment of the basic principle that health care is an inherent right of all the people of the United States. Federal legislation should establish a National Health Board, create. a uniform benefit package and state the scope, standards of quality, and comprehensiveness of health services. The legislation must also require state legislatures to enact, by a specified date, laws establishing State Health Commissions, newly constituted and independent agencies, to assure that the federal regulations were properly met. The federal legislation and the regulations developed by the National Health Board should specify in sufficient detail the responsibilities and administrative structure of the State Health Commission to permit a reasonably uniform operation of the regulatory processes throughout the United States. Federal legislation should include provisions for funds to support. the operation of the State Health Commissions. The legislation. should also include provision for funds to support the costs of organization, start-up, and initial operation of Health Care Corporations. Additional federal legislation would be needed to help overcome legal and other barriers and impediments to the formation of Health Care Corporations within the states and spanning state, territorial, and district boundaries. A principal objective would be to permit the inclusion of physicians in such corporate organizations; another would be the removal of barriers to the sharing of services and facilities by health care institutions. The National Health Board would be the nation's primary agency responsible for the continuing assessment of the effectiveness of the delivery of health services. It would be an independent agency |