FOREWORD

The statement set forth in these pages is the official policy position of the American Hospital Association on the provision of health services. The first step in the active development of this policy was the appointment of a special committee to study this matter. The committee was given a broad charge and submitted its recommendations to the Board of Trustees in November 1969. The Board studied those proposals and recommended that the concept be adopted in principle by the House of Delegates. The House took this action on January 27, 1970.

The Board recognized that more detailed study of such a sweeping proposal was necessary before the Association could take final action and a second special committee was named by the Board to receive comments from the membership and other interested bodies. This committee, in turn, made recommendations to the Board of Trustees. After detailed analysis, the Board proposed to the House of Delegates adoption of the policy statement printed herewith. The House debated the matter at its meeting in Chicago and on August 24, 1971 approved the policy statement.

This is now the official policy and supersedes all other Association statements on this subject.

EDWIN L. CROSBY, M.D.

Executive President

JACK A. L. HAHN
President

October 1971

Part I

GOALS AND PROGRAMS

As a nation we must provide better quality, more convenient health care for all the people, at reasonable cost, and in a manner in keeping with human dignity. This must be done because we accept one basic, irreducible principle:

Health care is an inherent right of each individual

and of all the people of the United States.

(1) it is a function of health care to enhance the dignity of the individual and to promote better community life for all;

(2) it is a function of government to assure the preservation and maintenance of the health of all the people;

(3) each individual shares the responsibility for protecting his own health and for obtaining health care when required;

(4) health care must be available without regard to any person's ability to pay and without regard to race, creed, color, sex, or age;

(5) health services must be so organized and located that they are readily accessible to all.

This basic principle and its corollaries can be best and most rapidly implemented through a new nationwide system for the delivery of health services, uniting all the health resources of the United States for better care.

The following specific goals are endorsed:

1. A system for the delivery of health services must be developed which has as a primary objective the optimum health care of each and every person. Untreated illness in the community must be sought out and treated.

2. The system for the delivery of health services must focus on individual needs, must be personalized through the skills and

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humanity of health personnel, and must preserve the dignity of the individual.

3. The system for the delivery of health services must assure that no person becomes financially dependent or suffers loss of dignity as a result of illness or accident.

4. The system must assure that all children are provided with preventive health care and that no child suffers from untreated illness.

5. The system for the delivery of health services must provide comprehensive health care. It must be able to provide the following components of care to each individual as needed: health maintenance, primary care, specialty care, restorative care, and health-related custodial care. Comprehensive health care must be developed as rapidly as possible.

6. The system must be oriented to the maintenance of personal good health and to the prevention of illness rather than being primarily oriented to the treatment of illness after it becomes acute.

The system must include financial incentives for keeping people well and, if they are ill, for making them well as soon as possible.

7. The system must include financial incentives for encouraging utilization of ambulatory facilities, extended care and nursing home facilities, and home care programs, rather than reliance predominantly on hospitalization.

8. The system must support only those providers that meet standards of effectiveness, quality, and efficiency.

Providers rendering good quality care in the most economic manner must be continued and developed, providers not providing such care must be assisted to do so; and providers unwilling or incapable of providing such care must not be supported.

Measurements of the quality of care should be incorporated in the system.

9. The system must, in order to maximize the potential of health resources, encourage innovation and preserve the benefits of alternative choice through a multiplicity of health care providers with varied types of ownership and organizational forms. The predominant concern and mission of all health care institutions and providers must be the public interest regardless of ownership.

10. The system must be designed so that from the outset it provides care for persons suffering from alcoholism, drug abuse, and acute mental illness.

The system must also be designed so that long-term mental health care, nonhealth-related custodial care, and institutional care provided by all federal, state, and local governmental hospital systems will be integrated into the total system within a reasonable time.

Programs to resolve sociological and environmental problems that affect the health of individuals must be coordinated and integrated with the system for the delivery of health care.

The failure to resolve acute sociological and environmental problems adds to the cost and amount of necessary health care of individuals. It must be realized that the pace at which these problems are addressed and solved affects directly the organizational burdens and total effectiveness of the health care system.

To accomplish the goals, the existing system for the delivery of health services must be substantially restructured, including both the methods of delivering and financing health services. Priority should be given to the accomplishment of these goals, and the hard choices made of where scarce fiscal, organizational, and manpower resources should be allocated. Attainment of the goal of comprehensive care for all people will require significant expansion of the system's resources.