(4) establishment, evaluation, and promotion of cooperative ar

rangements 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 adequate 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.

Part III

THE ROLE OF
GOVERNMENT

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

composed of five to seven qualified, full-time, well-compensated commissioners appointed by the President to serve for staggered terms of relatively long tenure, for example, six years. The Board would be supported by a qualified staff.

In fulfilling its responsibilities, the National Health Board would: (1) review the activities of State Health Commissions to assure their enforcement of regulations adopted by the National Health Board;

(2) actuarially determine the revenue requirements for health benefits that are tax-supported;

(3) administer the trust fund for specified health care benefits;

(4)

contract with prepayment plans and health insurance companies for the purchase of health care benefits financed through federal funds;

(5) coordinate at the national level the activities of voluntary organizations and governmental agencies with respect to their conduct of approval, accreditation, or certification programs; (6) maintain liaison with all federal agencies concerned with health-related programs; and,

(7) periodically assess the progress toward developing comprehensive health care, report to the President and Congress on the phasing-in process, and serve in an advisory capacity for legislative amendment.

The State Health Commission would be the agency responsible for seeing that Health Care Corporations conformed to the regulations of the National Health Board. The State Health Commission would consist of three or five qualified, full-time, well-compensated commissioners appointed by the governor to serve for staggered terms of relatively long tenure, for example, six years. The State Health Commission would be supported by a qualified staff:

The State Health Commission would evaluate the structure of Health Care Corporations to assure the adequacy and quality of their services and to determine their capacity to deliver compre

hensive health care; authorize their operation; and approve the rates charged for their services.

The State Health Commission, however, would have no responsibility for the internal operations of Health Care Corporations, leaving these to the governing board of each Corporation.

The State Health Commission would:

(1) prescribe conditions, consistent with the federal regulations, for establishing the geographic area to be served by each Health Care Corporation, including in the process consideration of the total population of the state, its distribution, local governmental structures, transportation facilities, existing institutions, and patterns of social organization, as well as existing resources for the delivery of health care;

(2) define the population group to be served by each Health Care Corporation;

(3) provide for the formation of Health Care Corporations for the entire state of compliance with the date specified by the National Health Board and then require existing Health Care Corporations to serve areas lacking such Corporations, authorize the establishment of new Health Care Corporations, or replace existing Corporations which fail to perform adequately;

(4) join cooperatively with the Commissions of neighboring states in approving the establishment of Health Care Corporations that span state boundaries;

(5) assure that policies offered by prepayment plans and health insurance companies operating within the state meet the uniform benefit requirements established pursuant to federal legislation;

(6) regulate the premium structures of prepayment plans and health insurance companies;

(7)

assure that Health Care Corporations comply with the regulations for quality and adequacy of service established pursuant to federal legislation and that health care providers

(8)

not participating in Health Care Corporations comply with these regulations. State Health Commissions would utilize existing voluntary organizations and governmental agencies in the approval, certification, and accreditation processes;

assure that essential planning functions would be carried out to coordinate activities among Health Care Corporations;

(9) issue certificates of need for the facilities and services of Health Care Corporations and/or their component institutions (the state should also require other institutional providers, not affiliated with Health Care Corporations, to obtain certification of need for facilities and services); (10) function as the administrative agency for government aid and loan programs, as for example, the Hill-Burton program; (11) assure that each Health Care Corporation, through its peer review mechanisms, fulfills its responsibility for auditing the quality of care and the utilization of services;

(12) function as a health data-gathering and reporting center for the state; establish requirements for the collection of data on fiscal operations of health services, utilization of services and other health-related data of Health Care Corporations and prepayment plans and private health insurance companies; and,

(13) establish appropriate mechanisms for appeals and review of disagreements in those areas for which it would have responsibility for the regulation of Health Care Corporations. All of its proceedings must be conducted within the usual requirements of legal due process.

The procedure of determination of eligibility of the poor and the near-poor should be established by federal regulations and administered by the appropriate state agency.