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I would like to express my appreciation to you and the other members of the Committee for giving me this opportunity to present to you a programmatic overview of the Health Services Administration.

The Health Services Administration (HSA) is comprised of the Office of the Administrator and four Bureaus: the Bureau of Community Health Services (BCHS), which operates its programs through project and formula grants to States and to private non-profit groups and institutions; the Bureau of Health Personnel Development and Service (BHPDS), which is the newest of our bureaus, most of its programs having been recently transferred from the Health Resources Administration, and which supports service oriented health professions and nursing education programs; the Bureau of Medical Services (BMS) and the Indian Health Service (IHS). These latter two bureaus operate direct delivery systems of medical and preventive health care through hospitals, clinics, and contract care providers. Although the Indian Health Service is one of the four bureaus operating within HSA, its appropriations request is considered by the Interior and Related Agencies Appropriations Subcommittee.

The Health Services Administration is a very large organization. Under the fiscal year 1981 Continuing Resolution, this Agency will employ 20,125 people, over half of whom are in the the Indian Health Service. Because this Agency is a services delivery organization, most of these people are employed in the field--where the actual delivery of health care services is taking place. Approximately 9 percent of the people working in HSA are located in either the field or regional offices, with only 5 percent in headquarters positions.

Primary Health Care Centers

The Primary Health Care Centers program is made up of three activities: Community Health Centers, Primary Care Research and Demonstration, and Black Lung Clinics.

The Community Health Centers activity provides project grants to public and nonprofit private organizations which support the development and operation of ambulatory health care centers. These centers provide basic, family-oriented, out-of-hospital care and make referrals for specialized or institutional care. Their target populations are rural and urban groups which are medically underserved. Funding priority is given to projects that serve areas having high infant mortality rates; large numbers of people over age 55; large numbers of individuals living in poverty; and shortages of health care personnel. We are currently supporting 872 community health centers. Of this number, 573 are located in rural areas providing services to approximately 2.5 million people, and 299 are urban projects which serve about 2.5 million people. The 5 million people served by the Community Health Centers are located in about 983 counties throughout the nation.

Primary Care Research and Demonstration projects provide grant support to develop or demonstrate new and innovative methods for the provision of primary health care. In fiscal year 1980, 55 projects were supported, all of which were located in rural areas.

The Black Lung Clinics activity provides project grants to support clinics located in areas where there are significant numbers of active and disabled coal miners. These clinics build upon existing community health centers or other resources in order that they may serve the specialized needs of black lung victims. Fifty-six (55) Black Lung Clinics are currently being supported, of which are rural and 12 are urban. The rural clinics are providing services to approximately 25,000 individuals, and about 4,000 people are being served by urban projects. The program emphasizes outreach, education, and follow-up to assure that victims of black lung disease receive care that is timely and appropriate.

Migrant Health Care Centers

The Migrant Health program supports the establishment of health delivery systems to provide health care services for migrant and seasonal farmworkers and their families. Project grants are made to public and nonprofit private entities to establish and support centers which serve the health needs of migrants and seasonal farmworkers. Priority is given to projects in areas heavily impacted by migrants and seasonal farmworkers and where local health resources are inadequate to handle the additional seasonal demand for services that the migrants require.

There are currently 129 projects being supported by this program. These projects provide services to 581,000 people, of which 219,000 are migrants and 352,000 are seasonal farmworkers. The services provided by these projects include primary health services such as physician services, diagnostic, laboratory and radiological services, preventive health services, emergency medical services and transportation services, as well as outreach and limited hospitalization.

Maternal and Child Health

The Maternal and Child Health (MCH) program is comprised of four major sub-activities: Grants to States, MCH Training, MCH Research, and Supplemental Security Income Disabled Children's program.

The Grants to States activity provides formula grants to States for maternal and child health services and for services to crippled children. Services include maternal and infant care, children and youth services, intensive newborn care and specialized diagnostic and treatment services to prevent or correct crippling conditions. Special grants for projects of regional or national significance are made to develop innovative activities such as improving pregnancy outcome. Assuring prenatal care and reaching high risk patients are essential to achieving reduced levels of infant mortality. Priority is given to reaching rural and economically depressed areas. In fiscal year 1981, 28 Improved Pregnancy Outcome projects, 13 Improved Child Health Care projects, and 3 Accident Prevention projects are being supported.

The Maternal and Child Health Training activity provides project grants to institutions of higher learning to train personnel in the delivery of health care and related services for mothers and children, particularly mentally retarded children and children with multiple handicaps. During the past year, 21 University Affiliated Centers and 11 Pediatric Pulmonary Centers provided training for 5,025 health professionals, and 28 Allied Health Disciplines supported training for 2,297 health professionals.

The Maternal and Child Health Research activity supports applied research relating to both clinical problems and health services delivery issues. The Research program supports the identification of methods for improving the delivery of health services in such areas as adolescent health, child trauma and congenital malformation.

Research is of an applied nature in contrast to the basic laboratory research conducted by the National Institutes of Health. In fiscal year 1980, 50 research projects were supported by this program.

The Supplemental Security Income Disabled Children's program (SSI) provides formula grants to States for the delivery of medical, social, developmental, and rehabilitative services to SSI disabled children who are under seven years of age or who have never attended public school. The SSI program also provides for counseling, the development of individual service plans, and referrals and monitoring of the service plans for SSI disabled children under sixteen years of age. We are currently providing services to 70,000 children under the auspices of this program.

High Blood Pressure Control

The High Blood Pressure Control program supports the establishment, through State health authorities, of programs for the screening, detection, diagnosis, prevention and referral for treatment of hypertension. Project grants are awarded to State health authorities to assure that systems exist to make blood pressure screening available and accessible to high risk populations and to provide referral linkages and follow-up with patients' physicians. All 57 health authorities are supported by this program, providing screening for 5.4 million persons.

Genetic Services

The Genetic Services program provides education, testing, counseling and referral services with respect to genetic diseases such as Down's syndrome, cystic fibrosis, hemophilia, sickle cell disease, and other genetic diseases for those who voluntarily request to receive such services. In addition, the program provides treatment to individuals suffering from hemophilia. In fiscal year 1980, this program was conducted through 3 areawide genetic networks serving 2.5 million people, 11 sickle cell clinics serving 150 thousand people, and 23 Hemophilia Treatment Centers which provided treatment to 5,000 patients.

Sudden Infant Death Syndrome Program

The Sudden Infant Death Syndrome program provides project grants to public and nonprofit private entities to create a nationwide awareness of the nature and scope of the SIDS problem, to ensure the provision of specialized, informational and educational training required by persons in health professions and by police, fire and other emergency personnel, and to ensure counseling for families affected by SIDS. Information and counseling services are currently provided to 5,500 families through 12 SIDS projects.

Family Planning

The Family Planning program operates through grants and contracts to public and nonprofit private entities, some of which

operate on a Statewide basis, to provide comprehensive voluntary family planning services to low-income and high-risk clients, including adolescents; to develop educational and informational materials; and to conduct demonstration studies concerning improvement of family planning services delivery. This program supports all methods of voluntary family planning, including sterilization, prescription, non-prescription and natural family planning. The program also supports infertility projects that provide more accessible and affordable services to couples in need and serve as a resource to deliver basic infertility services. During FY 1980, 3.8 million patients received services in clinics partially funded by this program.

Emergency Medical Services

The nation has been divided into 303 EMS regions which cover the total population. The purpose of the program is to assist communities in the planning, organization, establishment and improvement of emergency medical systems. Communities may seek to achieve a Basic Life Support System or an Advanced Life Support System. Both types focus on communications, transportation, education, training and the establishment of service agreements between hospitals to optimize efficiency and effectiveness and to reduce duplication and competition. The advanced systems also include telemetric patient monitoring on site or in transit and rely on paramedics trained to a higher level. Fifty seven (57) regions, with a population of 39.9 million, have completed advanced systems, and regions with a population of 53.9 million have completed basic systems.

Next, I would like to discuss with you the programs administered by the Bureau of Health Personnel Development and Service.

National Health Service Corps

The National Health Service Corps (NHSC) provides medical and dental services to people in urban and rural communities which are designated as health manpower shortage areas. Usually the areas have less than one primary care physician for every 3,500 persons. There are currently 1,855 areas in the nation which are designated as primary care shortage areas, and 881 dental shortage areas. During fiscal year 1980, the National Health Service Corps had 2,058 health professionals, including physicians, dentists, nurse practitioners, physician assistants and other health care personnel serving in areas that have shortages of health manpower. Services were provided to 1.2 million people. Of the 2,058 NHSC assignees, 1,015 were scholarship recipients and 1,042 were volunteers.

National Health Service Corps Scholarships

The National Health Service Corps Scholarship program provides scholarship support to health professions students during academic training in exchange for a service pay back in health manpower shortage areas. Scholarship recipients provide one year of service commitment for each year of scholarship support received. However, a minimum of two years of service is required and can be met by serving either as a salaried member of the National Health Service Corps or by private practice in a health manpower shortage area.

The scholarship benefits provide for the payment to the school of tuition and required fees plus monthly stipends to the students for living expenses (adjusted annually to Federal salary changes). An additional amount is provided to cover other educational expenses such as: fees, books, equipment, and laboratory expenses. In fiscal year 1980, 5,118 students received NHSC Scholarships, of which 1,731 were new awardees and 1,387 were students already in the program who continued to receive support.

Health Professions Student Assistance

The Health Professions Student Assistance activity is comprised of three programs Health Professions Loans, Loan Repayments and

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Cancellations and Exceptional Financial Need Scholarships.

The Health Professions loan program authorizes long-term, seven percent interest loans up to $2,500 per year, plus tuition, to health professions students (MOD/VOPP). These loan funds are given to schools which in turn make awards to students with limited financial resources. Since 1955, this program has made approximately 37,000 loans to students. Through the Loan Repayment program, we are able to attract health professionals to health manpower shortage areas in exchange for repayment of up to 85 percent of their educational loans. The Exceptional Need Scholarship program provides financial support to persons with limited resources during their first year of education in a health professional school.

Nursing Student Assistance

The Nursing Student Assistance activity is comprised of three programs Nursing Loans, Nursing Scholarships, and Loan Repayments and Cancellations.

The Nursing Student Assistance loan program authorizes long term, low interest loans of up to $2,500 per academic year. The program assists nursing students (who are either full or half-time) having need for financial assistance in undertaking a course of study leading to a diploma, associate degree, bachelor's degree, or graduate degree in nursing. Loans are repayable over a 10-year period following completion of training. The Nursing Scholarship program provides scholarships of up to $2,000 per academic year to students who have exceptional financial need. The Nursing Loan Repayment program provides for up to 85 percent repayment of loans in exchange for service in shortage areas.

I would like now to discuss with you the programs administered by the Bureau of Medical Services.

PHS Hospitals and Clinics

The PHS Hospital and Clinic system, which consists of eight general and surgical hospitals, 27 urban freestanding outpatient clinics and a network of contract health care providers, provides health services to American Seafarers, active duty members of the Coast Guard, and commissioned officers of the Public Health Service and National Oceanic and Atmospheric Administration who are statutorily entitled to health care services. On a reimbursable basis, health care is also provided to beneficiaries of other Federal agencies, foreign seamen, and community groups. In 1980, this program provided for 543,800 inpatient days and for 982,500

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