models and systems for increasing the efficiency, availability and quality of medical care will also increase the cost-effectiveness of private health expenditures. The proposal before the Committee may be said to be a natural and necessary development in the evolving pattern of Government health programs. Each preceding phase-the establishment of the Public Health Service, the creation of the National Institutes of Health, and the enactment of the Hill-Burton legislation can be identified with a corresponding demand for increased manpower, the pursuit of new standards of excellence, heightened educational and administrative demands and increased need for expanding programs in keeping with intelligent decision-making and assignment of priorities. Now that grants and payments for health care services in non-governmental institutions comprise the largest and fastest-growing category of Government expenditures for health, it is natural to expect similar corollary effects. H.R. 6418 anticipates this eventuality by proposing programs that will aid health professions and institutions in the private sector to adjust to the impact of this intensified concentration of Government funds on health care services. The sudden and mounting influx of these funds is placing a severe strain on the existing framework of health facilities. There is a danger that the stress may impair the operation of the system and the quality of its services, thereby defeating, rather tha naccomplishing the purposes of these programs. Length of hospital stays, as the Report to the President on Medical Costs clearly indicates, is a critical factor in rising costs. Health services research could contribute to the solution of this problem and at the same time help ease the tension created by arbitrary utilization review requirements. For example, the present legislative proposal could provide assistance to the medical profession in establishing objective criteria for determining optimum discharge status. It could also aid in the further development of progressive patient care programs. Lack of facilities for subsequent stages of care after the need for acute hospitalization has ended is one of the chief factors contributing to lengthy hospital stays. Of utmost importance, health services research proposes to seek creative and positive methods of reducing costs and maximizing benefits through voluntary efforts on the part of health professions and institutions. In the absence of such efforts, actions, impelled by a natural and responsible concern, could be taken to curb excessive costs by imposing controls and restrictions. While curtailing costs, such actions, by themselves, might also inhibit the free exercise of profesional responsibility, imperil the quality of care and lead to dissension that could endanger the future of Medicare and related programs. In the meantime, large sums could be dissipated in the attempt to channel funds for these programs though the medium of an obsolescent system. Health services research, as envisioned in H.R. 6418, is an attempt to eliminate waste, while at the same time preserving the quality of care and stimulating voluntary solutions by the health professions and health care institutions. The scope of health services research extends beyond problems related to Medicare. It is also directed at basic and persistent problems of maldistribution of health manpower and malformations in the structure of services. The improvisatory and illogical character of present responses to health needs is dramatically illustrated by the spectacle of the emergency room of the metropolitan hospital. Demands for service come not only from patients suffering severe trauma requiring emergency care, but also from patients seeking services because they are without a personal physician or because their doctors' offices do not have the advanced diagnostic equipment which is available in hospitals. Straining emergency facilities to the limits of their capacity, this situation makes it extremely questionable whether either emergency cases or other patients receive adequate attention. Health services research could be directed at making advanced diagnostic facilities available in each doctor's office through the mode of modern communications technology as has recently been demonstrated by transmitting electrocardiograms over the telephone for diagnosis by a computer. Clearly, health services research should be directed toward increasing the productivity of physicians. It has been conceded that there is little hope of increasing the number of physicians in practice to a level that will even maintain the present ratio of physicians to population. Means must therefore be found to increase their productivity and concentrate more of their attention on the intrinsi 80-641-67- -24 cally professional aspects of practice. Such means include, of course, the frequently proposed delegation of some tasks to appropriately trained assistants and the increased utilization of advanced technological adjuncts to medical care, such as the autoanalyzer and computerized multiphasic screening. Since such research represents a new and highly complex field of study, there is little or no previous experience to draw upon. For this reason, the search for models and systems must be multifaceted and far-ranging. Imaginative and diversified approaches must be pursued to determine the effectiveness and potential of various alternatives. While such studies should deal with focused research, in the sense that they are aimed at specific objectives and problems, they should be speculative in terms of freedom to pursue a variety of avenues in attaining the objectives. I strongly urge passage of this legislation. Hon. HARLEY O. STAGGERS, PAUL M. ELLWOOD, Jr., M.D., PIMA COUNTY HEALTH DEPARTMENT, House of Representatives, House Office Building, DEAR MR. STAGGERS: I would like to comment on the proposed Partnership for Health Amendments of 1967 (S. 1131). These amendments would improve the Public Health Service Act including those portions which were included as comprehensive health planning in Public Law 89-749. I will comment on some of the more important and desirable features of the proposed amendments. 1. Continuity of planning and grants.-The authority in the existing legislation expires in 1968; the proposed amendment would extend the authorization to 1972. From experience, I can attest to the waste and inefficiency that occur in health programs that do not have a promise of stability for some years. Quality personnel can not be obtained and long term projects can not be planned. 2. Authorized funding.-The proposed amendment would increase the funding authorized for planning, grants to states, and project grants. The increases are not great and what may be allowed is still subject to the appropriations actually made. I have felt that the original bill was too conservative in the grant area. I would like to illustrate this with the provisions for Comprehensive Health Services. The grants called "block grants" to States supplant the present system of "formula grants" to States. They have been thought of as giving the State Health Department a degree of flexibility in meeting needs not provided for under formula grants. The presently authorized $62,500,000 would permit Arizona practically no increase over its present formula grants. And yet in Arizona there should be a preventive program in many fields where nothing now exists, yet preventive measures are known to save people from pain and suffering and premature death. 3. Community services.-The proposed amendment would put back the provision that 70% must go for services in communities of the State. This provision had been dropped out of PL 89-749 for reasons unknown to me. This provision helps to insure services reach the people, as is the intent of Congress. It helps guard against a cumbersome machinery which can eat up a disproportionate amount of funds. 4. Licensing of laboratories.—The proposed amendment would provide Federal controls of laboratories engaged in interstate commerce. An erroneous laboratory finding can be as fatal as prescribing a wrong drug. Thus controls for incompetent laboratories are required. Further there is the growing problem of mail order diagnosis which can be a vicious type of quackery. From the above, Mr. Staggers, you can understand my interest in this bill. I have some insight in the problems with 33 years of public health experience encompassing international, national, and local positions. Sincerely, FREDERICK J. BRADY, M.D., Director. NATIONAL CYSTIC FIBROSIS RESEARCH FOUNDATION, Hon. HARLEY O. STAGGERS, New York, N.Y., June 19, 1967. Chairman, Interstate and Foreign Commerce Committee, House of Representatives, Washington, D.C. DEAR MR. CHAIRMAN: The National Cystic Fibrosis Research Foundation would like to convey to your Committee our complete support of the objectives of Public Law 89-749, Partnership for Health Act of 1966, and H.R. 6418 (S. 1131), the Partnership for Health Amendments of 1967. We feel that Public Law 89-749 was a significant step in creating a more effective partnership among the Federal and State and local units of government in the field. One important provision of Public Law 89-749 was the authorization of project grants for studies to develop new methods or improve existing methods of providing health services (section 314e, clause 3). There is an urgent need for the development of new methods to improve the existing methods for the prevention and control of chronic diseases. Of particular concern to our Foundation, is the problem of chronic respiratory diseases of children, including the pulmonary manifestations of cystic fibrosis. It is our feeling that developmental project grants can make a significant contribution to the solution of these grave health problems. We note that, by the terms of H.R. 6418 (S. 1131), this clause is stricken from Section 314e and transferred to a new Section 304 of the Public Health Service Act. It would be our interpretation that the new language dealing with "development of new methods or improvement of existing methods of organization, delivery, or financing of health services," is intended to cover developmental projects related to the prevention and control of chronic diseases. However, we are concerned that this language may not be sufficiently explicit to assure the availability of project grants for this important developmental work. We therefore recommend that the language of the New Section 304 be made more explicit in this regard, or at least that this meaning be spelled out by the Committee in its report accompanying the Bill. We also note that the new Section 304 established a ceiling of $20 million on funds to be appropriated to carry out projects under this authority. It appears that this ceiling might make less money available for necessary developmental projects than might have been available under Clause 3 of Section 314e. In view of the urgency of the problems of the prevention and control of chronic respiratory diseases in children and other chronic diseases, we earnestly recommend that the Committee raise this ceiling. We would appreciate it if you would make this letter part of the hearing you are holding on the legislation. Thank you for your kind consideration. MILTON GRAUB, M.D., President. Hon. HARLEY O. STAGGERS, LOUISIANA TUBERCULOSIS & RESPIRATORY DISEASE ASSOCIATION, New Orleans, La., May 15, 1967. Chairman, House Interstate and Foreign Commerce Committee, House Office Building, Washington, D.C. DEAR CONGRESSMAN STAGGERS: We would like to add our voice to that of the National Tuberculosis Association, for whom Dr. Joseph B. Stocklen testified before your Committee on May 4, 1967, regarding the need for increased authorizations for project and formula grants for comprehensive health services. We understand that H.R. 6418 provides for an increase in authorization for each of the grant programs from $62.5 million to $70 million for fiscal 1968. In our opinion, the proposed increase in authorizations is not sufficiently large to assure the amount of support needed for maintenance of accelerated tuberculosis control-in accordance with the Surgeon General's TB Task Force recommendations of a couple years ago-and for increasing the number and scope of chronic respiratory disease programs, truly a serious need throughout the United States. We urge you and your committee members to give these programs the priority and attention they need. With many thanks for your interest and consideration, I remain, Respectfully, Hon. EDWARD J. GURNEY, W. FINDLEY RAYMOND, Executive Director. CENTRAL FLORIDA TUBERCULOSIS & U.S. House of Representatives, SIR: We strongly feel that the proposed increased authorizations for the Public Health Service grants programs, from 62.5 millions to 70 millions under H.R. 6418, are not sufficiently large to assure the support needed for maintenance of accelerated tuberculosis control and for increasing the number and scope of chronic respiratory disease programs. Our views are based on the recommendations of the Surgeon General's Task Force Report on Tuberculosis. We are in support of these recommendations for funds and believe they are consistent with the goals of our organization and are vitally needed to implement programs and maintain progress. Increased federal financial is also urgently needed for the initiation and expansion of activities to control other chronic respiratory diseases. We are in accord with the testimony presented by Dr. Joseph B. Stocklen on May 4, 1967. We request that our views be transmitted to members of the House Interstate and Foreign Commerce Committee. Sincerely yours, JOHN W. COLLINS, Hon. DANTE B. FASCELL, FLORIDA TUBERCULOSIS & RESPIRATORY DISEASE ASSOCIATION, Jacksonville, Fla., May 23, 1967. House of Representatives, House Office Building, DEAR MR. FASCELL: H.R. 6418 is currently being considered by the House Interstate and Foreign Commerce Committee. This legislation would provide for an increase in formula and project funds under the Comprehensive Health Planning Act (89-749) from $62.5 million to $70 million for fiscal 1968. If Florida is to continue with its intensive tuberculosis eradication program and initiate new programs for the control of other respiratory diseases, then it is vital that sufficient funds be authorized by Congress. As pointed out to you in earlier correspondence, the Florida State Board of Health has Special Tuberculosis Project Grants pending in the amount of $745,000 for fiscal 1967-68 and a $836,000 project for fiscal 1968-69. Tuberculosis is still a very serious problem in our state and it would be most unfortunate if the Federal support for these eradication efforts was cut at this time. By supporting an increase from $62.5 million to $70 million as requested in H.R. 6418, you would also be supporting the initiation and expansion of programs to control chronic emphysema and other respiratory diseases which are beginning to take a terrible toll among Florida's citizens, particularly among men in their most productive years. Emphysema has risen from the 15th cause of death in Florida in 1956 to the 7th cause in 1966. The number of deaths in 1966 in Florida was 1,257, and for every death that is directly attributed to emphysema it is reliably estimated that this disease is the secondary cause of two other deaths. Members of this association would be most grateful if you would contact your fellow Congressmen on the House Interstate and Foreign Commerce Committee and urge their support of this legislation which will mean so much to the health and welfare of Florida. Sincerely, R. A. CARUTHERS, President. HARVARD MEDICAL SCHOOL, Re: H.R. 6418. Hon. HARLEY O. STAGGERS, Chairman, Interstate and Foreign Commerce Committee, Rayburn House Office Building, Washington, D.C. DEAR CONGRESSMAN STAGGERS: I understand that you will be considering in your Committee the above noted bill. I sincerely hope and urge that in your consideration of Comprehensive Health Planning you will include a consideration of patients suffering from alcohol problems. As becomes increasingly evident the ramification of the serious complications deriving from unrecognized and untreated alcoholism, continues to multiply and increase in severity. Therefore, I believe no real Comprehensive Health Planning can take place until and unless alcoholism efforts are incorporated in this planning. Sincerely, MORRIS E. CHAFETZ, M.D., Director, Alcoholic Clinic and Acute Psychiatric Service; Assistant Clinical Professor in Psychiatry. HEALTH FACILITIES PLANNING COUNCIL FOR NEW JERSEY, Hon. HARLEY O. STAGGERS, Chairman, House Interstate and Foreign Commerce Committee, DEAR SIR: We understand that the House Interstate and Foreign Commerce Committee is considering amendments to the Comprehensive Health Planning Legislation, P.L. 89-749. Our purpose in writing is to invite your attention to the fact that there are some area wide planning councils operating on a statewide basis. Public Law 89-749 makes specific reference to metropolitan and regional planning councils but does not specifically refer to statewide planning councils. We believe that this is an oversight which should be corrected. We are enclosing a copy of our 1966 Annual Report for reference. It points out that one of the major efforts of the Health Facilities Planning Council for New Jersey, which is non-profit, has been directed toward the establishment of twelve regional planning councils. Ten of these councils are already incorporated and there is an active interest in the remaining two regions to form their own councils. If planning grants are to be made to metropolitan and regional planning councils only, to the exclusion of statewide planning councils, where they exist, it appears that this would be a disservice to the planning problem. For example, the twelve regional planning councils in New Jersey which we will soon have developed ostensibly could apply for and obtain planning grants under the Comprehensive Health Planning Legislation. This would, in our opinion, create duplication and the unwarranted expenditure of unnecessary funds. It is our intention in New Jersey to provide sufficient staffing on a statewide basis to make it possible to do the staff work for all or most of the regional planning councils, leaving the Boards of the regional planning councils to operate primarily on a policy level. This would make it possible to coordinate at one level sufficient staff, both in depth and professionally oriented, to do a commendable job. On the other hand, if twelve regional planning councils are to be supported by federal funds in New Jersey and if each of them applies for a grant-in-aid, it is conceivable to expect that they could not raise sufficient funds to provide adequate in depth staffing to effectively carry out satisfactory planning programs. Our suggestion is intended to direct your attention to the desirability of including statewide planning programs by name in the legislation. Statewide planning councils plan for every portion of the state, whereas metropolitan and regional planning councils are geographically limited in their planning and, in many instances, will leave large geographic areas of states completely unplanned |