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It is in anticipation of this impact that we have established in the Public Health Service a program to deal with medical care adminis

tration.

The purpose of this new program is to improve the quality and expand the availability of medical care, especially to older persons, in all settings-the hospital, the clinic, the physician's office, the home, and in extended care facilities.

To make home health services more readily available, a new grant program is administered by the Public Health Service to offer assistance to States in the development of home health services under the health insurance program.

This new program also includes standards setting, coordination of the health insurance activities with other State and local medical care activities, and other activities related to the providers of medical services.

Under new legislation in the 1967 budget, we propose to reorient support of health activities to provide effective coordination between Federal health programs and those of State and local groups.

The purpose is to achieve more effective utilization of scarce manpower and other resources through cooperative arrangements among the Federal Government, the States, local governments, and nonprofit agencies.

Grants would be available for comprehensive State and local area planning for services, facilities, and manpower. Several of the existing categorical grant programs would be converted to provide a more effective base for support and stimulation of comprehensive health service.

Under this new legislation we would also propose to support new programs aimed at improving the quality and efficiency of medical services by developing new ways of providing them.

HEALTH FACILITIES AND MANPOWER

If we are to fulfill the promise of recently enacted legislation for expanded health services, we must insure that the facilities and trained manpower are available to make this possible.

The Hospital and Medical Facilities Amendments of 1964 expanded the hospital construction program and authorized a far-reaching new grant program for modernization or replacement of existing facilities, particularly in urban areas where the greatest need exists.

The first of these modernization grants was awarded recently. In 1967, we are requesting the maximum authorization for all parts of the facilities construction and modernization program.

FUNDS REQUIRED

Senator BARTLETT. How much money would that be?

Mr. KELLY. Under the hospital and medical construction program as presently authorized in the law we are talking about $270 million. Mr. GARDNER. One of the most pressing needs we have in the provision of health care is for substantial growth in the number of trained medical and paramedical personnel. It was to meet this need that Health Professions Educational Assistance Act was enacted ago and expanded last year.

It is our goal under this act to provide partial support for the creation of 20 to 25 new medical schools over the next decade. We hope to increase the number of new physicians each year from the present 8,800 to 12,700 by 1971.

In 1967, we are requesting a very substantial increase for construction of health educational facilities for medical, dental, public health, nursing, and other health personnel.

The response to this program far exceeds the amounts available; we have already approved grants to aid in the construction of facilities for eight new medical schools. In the health research facilities program of the National Institutes of Health we will give first priority to those facilities required by new and expanding medical schools. The largest increase in operational support for health education requested in 1967 is in the grants for improvement of education quality. Health professions scholarships were newly authorized in the 1965 Health Professions Amendments, and we are requesting a program expansion in 1967.

Under proposed legislation, we would begin an education and training program to overcome existing critical shortages of medical technologists and other allied health professionals.

Also under new legislation, we propose to convert the existing student loan programs to guaranteed loan programs utilizing private capital, retaining all the special features of the present programs.

PUBLIC HEALTH SERVICE HOSPITALS

Turning to our own medical services programs, our long-term goal is to convert the Public Health Service hospitals into centers of excellence. Our 1967 budget request will enable us to move in this direction by providing additional funds to plan for modernizing the facilities, to improve staff-patient ratios, to expand the training capability of the hospitals, and to develop their operational and clinical research capability.

Mr. Chairman, I would now like to touch briefly upon some of our health programs aimed at specific problem areas.

HEALTH OF MIGRATORY WORKERS

Migratory workers represent a group with inadequate access to health care services. For this reason, the Congress established the migratory workers health service program in 1962. This program was extended last year and expanded to include for the first time necessary short-term hospital care.

Our 1967 budget includes a substantial increase for this program. Senator HILL. What would that include?

Mr. CARDWELL. I do not have that figure.

Senator HILL. Would you supply that for the record?
Mr. GARDNER. It is about $4 million.

MENTAL RETARDATION

I have already mentioned our program in education of the handicapped including the mentally retarded. We have also included in the 1967 budget funds to continue the program of grants to States to assist in the development of comprehensive community programs to combat the problems of mental retardation.

We have already made the initial awards for construction of mental retardation service facilities, and this program is expected to enter the full-scale construction phase within the next few months.

We have also received a large number of requests for assistance in the construction of university-affiliated mental retardation facilities; with the 1967 budget request, a total of 16 such centers would be supported by the end of 1967. The complementary professional training program administered by the Children's Bureau will be initiated in 1967.

MENTAL HEALTH

In the field of mental health, we have already awarded 14 community mental health center construction grants; we are requesting in 1967 a continuation at the same level of support as in 1966.

By the end of 1967, construction assistance will have been provided for community centers throughout the country. The 1967 budget also includes a sizable increase in support for staffing these centers, as well as for staffing new services in existing mental health centers.

REGIONAL MEDICAL PROGRAMS

The Heart Disease, Cancer, and Stroke Amendments of 1965 authorized a new program of project grants to assist universities, medical schools, and research institutions to develop and disseminate new techniques for the diagnosis and treatment of heart disease, cancer, stroke, and related diseases.

This program will emphasize regional planning and coordination of medical resources, continuing education for doctors and other medical personnel, and the rapid distribution of new knowledge and techniques.

We are beginning to implement this program with a 1966 supplemental appropriation; in 1967 we are requesting almost a doubling of funds.

Senator HILL. How much would that be?

Mr. CARDWELL. It would go to $45 million in 1967 from $25 million in 1966.

Senator COTTON. What relationship does this bear on the NIH activities?

Mr. GARDNER. It is administered by the NIH and it will be something of a new development for them.

Senator COTTON. In other words, it will all be coordinated by NIH? Mr. GARDNER. Yes, sir.

HEALTH RESEARCH

I would like now to discuss the other programs of the National Institutes of Health.

Thanks to the interest and support of this committee, the appropriations for the National Institutes of Health have grown from about $70 million in 1954, the first year after the Department was created, to about $14 billion in 1966.

And with these funds an organization of excellence has been created. Our health research expenditures have been credited as being among the most worthwhile of all Federal expenditures.

We have made every effort to continue the forward progress of recent years by applying the 1967 increase selectively. Our budget of

over $1.3 billion for NIH will permit a considerable degree of progress in our health research effort.

The largest single increase for NIH in the 1967 budget is for research grants. This includes an increase in the regular research grant program to finance continuation projects, and increments of new and supplemental projects.

The 1967 budget request for special research grants includes increases for the general research support program, the animal resources and primate center programs, and for multidisciplinary research and training centers to study the possible toxic effects of drugs on man.

The NIH training grant and fellowship programs will be increased in the 1967 budget, particularly in the area of mental health.

Direct operations also receive a higher level of support in the 1967 budget, with the largest single increase for the intramural research program.

GRANTS FOR CONSTRUCTION OF HEALTH RESEARCH FACILITIES

Senator HILL. Last year we doubled from $50 to $100 million a Federal fund or grants for the construction of health research facilities.

How much do you have in this budget?

Mr. CARDWELL. $21 million.

Senator HILL. Last year you wanted us to double it from $50 to $100 million and this year you come in and ask for only $21 million? Mr. GARDNER. I want to emphasize what we have not really talked about today, that we constructed this budget under the very severe pressures and responsibilities of this Government in many areas and we had to ask ourselves with respect to any given expenditure what would be the cost to the program of deferral of this expenditure, not eliminating it but deferring it, which programs would suffer the least, and we felt in this case deferral of the construction activities that were not related to training and the new medical schools could be accomplished.

Senator HILL. How much did you ask the Bureau of the Budget for? Mr. CARDWELL. We asked them for $50 million.

Senator HILL. It was the amount we had been appropriating in the past.

Mr. KELLY. This was part of an exploration made of the entire Federal Government to look at construction and construction-grant programs as related to Federal expenditures, particularly in connection with Vietnam and also in relationship to the impact that large capital expenditures have on inflationary pressures.

REDUCTION IN PROGRAM

This is the only construction-grant program in the Department that was reduced in such a way, but this was only because of the urgent need for health care facilities and for providing for expanded enrollments at educational institutions that there were not further reductions made. It was the urgency of these that kept them from being held back. As the Secretary indicated, it did appear that among all of our construction programs, this could be deferred.

Mr. CARDWELL. I'd like to correct what I said earlier, Senator Hill, if I may. Our request to the Budget Bureau was for $100 million. Senator HILL. Last year you asked for an increased authorization from $50 to $100 million. Last year you wanted $100 million, and we passed the legislation to authorize $280 million in the aggregate over 3 years.

Mr. KELLY. I think, Mr. Chairman, it is only fair to say that the professional people who are administering these programs will still feel that a level of $100 million would assist in providing the facilities that would further expand research. It is not because these facilities are not needed that they are not in this budget, but rather, in the light of the overall fiscal situation, it appeared that they could be deferred.

Senator HILL. That is quite a cut from your position of $100 million last year to $21 million this year. This is right, Mr. Kelly? Mr. KELLY. Yes, sir.

Senator HILL. And then you had the $50 million in the previous year; is that right?

Mr. KELLY. Yes, sir.

HEART, STROKE, AND CANCER PROGRAMS

1967 BUDGET REQUEST

Senator COTTON. Referring to all of the programs involving heart, stroke, and cancer, and not just construction, but all of them, am I correct in my understanding that the total is about the same in 1967 as in 1966?

Mr. KELLY. I think in the aggregate we would have to say a substantial amount of the $78 million increase in the National Institutes of Health would relate to heart, stroke, and cancer. Over $20 million of the increase relates to the regional medical complexes which were authorized as a result of the De Bakey Report on Heart, Stroke, and Cancer, and have this as their principal interest, and then increases are provided in the Heart Institute and in the Institute for Neurological Diseases and Blindness which have their emphasis on stroke. The cancer level is held substantially to the level in 1966.

Senator COTTON. When you refer to the recommendations of the medical people involved, do you mean your medical people or outside? Mr. KELLY. Last year, you will recall, the President appointed a committee headed by Dr. De Bakey that made a report on heart disease, stroke, and cancer and this resulted in amendments, including the medical complexes, to carry out their recommendations.

Senator COTTON. But this group did not receive the approval of the Bureau of the Budget on their full recommendations for fiscal 1967; is that right?

Mr. KELLY. I think the recommendations of the Commission, if all of them had been carried out at the levels they recommended, would cost much more than we have in the budget in 1966 and 1967, but their recommendations were reviewed and acted upon, and I think it is fair to say that both the 1966 and 1967 budgets are larger in these areas than they otherwise would have been because the recommendations are being partially implemented.

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