.11 ill * 0 1 0 0 W@'.@ZDZ TO W@'X,@4.U OF 'C'i l@), BILL li* list werald OUIctnga-u 0 bill Whic'.Ii does not occur at @,a present v@t @-c tl"-o z,.tw of @@*liza- tiouj, t--Oat2%ont, :recea.-dh, or traini.ncj.@ McCaw they r-clate to ozistinq ;tt p--e-=Pt tL@,, no a@,,,@uato or.int;s wl-@reay tl,,Ie $.n University md;.cal ecr.,tters c a bc,, t-o @4@ly in a Corvuvtity ea:,,er Assistance fr@ medical cc'hcols. but Clis cm%n!ot provide-U, @,l oxicting error Siva 'e@uplicat4@ou of eer-,:I@co;3 ar-4 is rudi=eAt=AY at b-*Zt, Vile PrAxvis@.,ons 02 tho bill would W=t -0 (a) o:a or Z'Z@, rQrriate LT-c@ical Ccl:ttero,* other I-,.Oalvil agci%cioz. (b) or,@,anizztiomat would provitlo, z-*rvicas ar,.d porepir@ ot,,her- visa avai@le irs, (e) Dia5=is ar,-d @-eatLrcnt. *,a at only a fc-.v lt>::ationz* ir. t,;oxo I)'-ac 2; and. by ,, ttoly traded act otitere avai@-ble to two (d) c@ roved zolection o..Il ro-@,,xch patiorts, who cai2ld be L-r,= tlto total tracer in the 400.1@==ity xztl,4c4o,*A., tI.-A@'t otiallor g=4p nov (0) Trz-I:Ln@. For* extensive ar.4 varied @ that nw-4 .Urwid-ed,, isir-co both a larz,,ac of patients a =or,* varied t of cixcmstances wmld be avai@l,e to t@ 2 iz tzxe @-i oZ I:-,ill to l@ a c@- 1,@-,ti= o,: t';,.o LD-4 of ca@ uoia@,a this i@r@@ortion to =.St I;nas pr ry Imrp=, o o: Ctm bill is to wait-* care rAo-"* @4 , widely wnil-ejle. To do @llis t@,-,%t t te- so-arch @"d natic.-ut car* b* The pw of 0, 5 f rv,;a to ti -M agid :C, XL@:n loca- tion to I=atitn@ . ri;aCicta zc'.-@oo:Ls -told @ a @c,,5 to assumed ,il,lcrea@ for care. At the same tir.4, corn ai@.7 Tiox@@itals woald @ ariec,,d to pzo,,tide .Cca Coz tr,@,nir@o, an@-I L-or tL, acw @^:re cb eo. ortions O-e- t=ini@14, t o-arcrr, v@uh@d bo i@, -zal the ticns of the ease to the others, @@14 be @i,. treat noa C-@,,md in @4y t@@ =iv"-sity OX@ c =ZVic@o. 30 is tit* relatitoe t.,!-tic.% tit* t pi the al@",ortt; *Z a Complox a* ccnt-4al @nialLnin,.7 azd machinery for too Of this prgxjzo,@-? The p@,:tr.@o the tltl lz to b.-iag @,t, by coordination @C" to @ =at4,d ca@7 aLn 'ty h@t.% a@CtiV4,tir@Z f*=o ly k,.,2z @r, posciblc,# To @ &,,o r ter,s,, cat4,,,j*ri@ x@,# and c@,.t=ity ttoop;Ltai 'dias@-tic ar4a trtatvart @tioriz 1,1, to in a wx4ld :Cai3. r4c& it ho need to et @czearo t.@ laV its t ark,.*. Its tremslal*'Cxs, ii,.to zcze xzrt, o,-, z@L-rca@es as to of a t-%-,@ ty l@c-ars SO zt.o can ialty crtro which @w. 1--@- to -in ti" -0 c@ aalar z=-d @ @or otl.,ter ot-b@,a.- @t,@eart ca:,.icor gae, ztr@.0- would 44%e 8ark4-*= cc-ZL@zal t@ select di==,Gz as @@r o@@4 irs t'.1i* co aL Ctz,.te@, racilits@s flat of I!D53, f:Lt ea.-4ily. irtoo th vza@ c=r,@ var@, =ch as ti@.0 @ri zed in t@,-,. 3'.rs a field, it ia doto ze; in e-r@. a @@@e fez lacart cancer are] atta@.s -L'O'j 64@zoazes Coula u@ll te radical 00@-I C,-.;r4c-,ral cou", des,@fIt. ta 2- f-ic To do uo* CZ tlmt a =ajor nati=a"@ zer-ri@ woulij I.,@ zoxvcd inuld be Z;o rlical or t@ @c@, lcal Z?.tlt@,or4* C-- .I oz zill r t 0 the c r.;, t S?C t C=O? ,uz nt @-ar t tbzl to ilia tlu=e @@AZ @@zLt-@ for the 'CILiical receaz;:It u:rtitz noW o@ 4-L, a Li in tl,,,m w%d io@i w =&4c, ? , Pleazcr 1-@- zed @-a tlil a t',,,.at c- wizi r-d to a w@,aold *Fresh ta as i@yl tax@- bill. the r-oz -doald di t of also wl@.- -L:@%,@ px@15or of @"Z!l to be Z,.!ar@ @.-z at, woor 4@t Bond t C.,4af" C4, to TI@ 4-CIIA Ix: sot C t A- 0 n the co, loz,- in -Z'Z or L7@c,@ 0 a, r tO VP all, oA@. 4t@X@ z c,t@@ @^d -a4od to of ti;-'.ti to @.4.0 tire I,-. t:.Zra e@ to d caucat' z X.-, 3 t-% e t;Lon of ical t and i;s It is @uo tL,.* I ti= eta a 0: Ile to 4aly @=.C ,@@sary 'c@ IC red 41 LIZ to ta ea t-4@l C3 I c ta 7A"4-. co of a ;L=- I 2 ti t C,i tj Taith tile Zf, a@,.r :;r, in ti QUFTION I WW @d ve giv* @rity &ttfAution to @,, Cancer and Stroke? U;,>Vat: 1. Theo* are tbo klUor disem".-71% of @that R@ DU@ 44% 16% U% that is In theme fields is nA @g applied today. T" bM does pmvido outeority for ina=ion., at the *ption of the aPP3.i@t,, of @ other disease fomd by the 5'wgeoa Decal to be of major sipuioozco to the holth of the NatILons The sue @ed iu *ravishing @o complexes wi3.1 be invaluamo an ve @o" usys sad of or@@g our 'blow ap to aWiou pft of othw typ"#, Does not the emphasis on the categories of heart diseases cancers and stroke as individual areas of action under the program run counter to the long term effort? 1. To develop the concept of and means for comprehensive care for the whole patient? 2. To avoid fragmentation of medical education and the teaching rocess? p As The importance and magnitude of the health problems in the area of heart disease, cancer and stroke demand special emphasis in arrangements to bring these diseases under control and to assure that the advances of research in these areas milk are broadly available. Thus these diseases can serve as the initiating point of a program whose.eventual culmination will be a general enhancement of health services and the quality of medical care on a broad basis. Thus, although the categorical identification pro- vides an appropriate beginning point,.the eventual objective is the kind of comprehensive care which is considered to be the best framework for the delivery of health-services. There is little danger that this approach will.contribute.to any fragmentation of the teaching process. Question. What major diseases other than heart diseaset cancer and stroke does the Department plan to include? On what basis would the Surgeon General and-the Medical Complex Advisory Council select other diseases as proposed in the bill? Answer. When, in the judgmentof experts in a field, it is determined that advances are be ilmade more rapidly than they are being applied (as is the case for heart disease, cancer and stroke) attacks upon these new diseases could well be launched through the organizational structure of medical complexes. In institutions having unique activities relating to other major triseases, the Surgeon General could designate other categories for specific support, To do so, under regulations, evidence that a major national purpose would be served would be required, r@,LT flON3 12at other diseases mieht be :Cound to be o:r wmjor ai,@iwmee to the hoalth of the iiatioe so as to be included i,,a the complexes established uader this bin. 1, following the precodeat of hoartm "near.. and stroke diso"e we wild onvions asaiotb-Lg the establishment of coi-aolexes for dis@" invol*Ug highly specialized aad elaborate* treatmmt, (sk4llaj, equipment fa4ilitios and predates), This might inaludi @oy disease. 21 it might c@ @ oover disease entities clo@ related to the @l Is, equipment @, necon,su7 for the treatzm-it of h@ dioo"o,, canaer,, and stroke. For @les. Bmip tvmors Lung disease invol to o@er stroce ishad, U,,-dcx this bill? @d postal. retardation qom@)le.,,c be establ 9 is v,,athority ja the bi3l for @clu-.3ioav &:t tlio optioA of t.,"o Thor gLp@li=at, any disease fouad by the @rcooa Goaarcl to bO Of 41major siL@i@ce to the health of the Natioii.11 There is no doubt Ua-t ==tal ret-ar,@tion is such a cUscazo.' Hot-iover, und I enacted in 1963 there is er ?.L. as-i64 for the est&blis@@t of =Uvers:lty affiliated miii@tta x,@@v,@ facilities and :Cor construction of mental rotardatio@"i co ity facilities. kloo,, states have mo,@icys =der P.L. 88-156 I/ for Planaing comrohonsivis actioa to combat mental retrLrdatioa. I'ho -zato@ =d child h@th ame-ad-raent;s Proposed by tl7,o i-, str this y@ would authorize $2.,750,000 v for 2 @ra @L-4 to follow up this pl@g. I/ The l@t@ and =d Realth "d X=t&l R@@tioa aa=iac, @,.dmc4lt@ of iio ZL Question. What would enactment of this bill accomplish which does not ts of organization, occur at the present time? What are the new elemen treatment, research, or train nsz? Answer. At the present time no adequate organizational mechanism exists whereby the highest quality medical care available in university medical centers can be brought to bear widely in a community. Community hospitals are eager for assistance from medical schools, but this usually cannot be provided by existing arrangements. Comnunity-wide planning, whereby expensive duplication of services and equipment is avoided, is rudimentary at best. The provisions of the bill would bring about: (a) Stimulation of appropriate health planning among medical centers, community hospitals, and other health agencies* (b) Organizational frameworks whereby medical schools would provide services and personnel not otherwise available in community hospita So (c) Diagnosis and treatment, now obtainable at only a few locations, in more places and supervised by adequately trained doctors not otherwise available to the community hospitals. (d) An improved selection of research patients, who could be selected from the total number in the community rather than from the smaller group now available through a university hospital. (e) Training more extensive and varied than that now provided, since both a larger number of patient s and a more varied set of-circumstances would be available to the trainee. lots 14hy is now Fedoral laZi:Aatioa necessaxY? ANSTd,mt The legislative authorities pres=tl7 available are directed tovard the SU.0@ separately of ease,-itial basic resources For health facilities.. @power, and kno,,iledZo. They do not lead the=olves to the spo@io @ gigantic task of interfratiag res@ch.. clinical care, and con@uirAg proteszioaal education tor a coo@-ated aituk on the three "Killer diaeaseall (heart, career, and stroke). Q. How much of the proposed program of complexes could be carried out under present authorities? A. The authority provided in S. 596 would allow the creation and support'of new mechanisms of relating research, professional education, and high-quality medical care. While all of these activities can be supported to some extent under existing authorities of the Public Health Service, no authority exists to provide for the planning of the complex organizational framework, and the effective linking of research and teaching-to diagnosis and treatment of heart disease, cancer, and stroke. What is the proposed use of the construction authority contained in S- 596 which pemits up to 90% matching by the Federal Government? How would this authority relate to the present proposal for extension and expansion of the Health Research Facilities program and the proposed new authority for nonmatching construction of research facilities for regional and national purposes? A. The construction authority contained in S- 596 -would be used to pay up to 90% of the costs of those additive facilities which are essential to the operation of the complex. We would not anticipate a large amount of new construction under this program, since in most cases the complex would link existing institutions and existing facilities. We would expect a larger number of applications to propose some modification of existing facilities, We would not intend to use the construction authority in S6 596 to provide construction funds which could be supplied under other grant mechanisms of the PHS. Should aproject receive help under this legislation if it QUESTION$ could be helped through normal uill.Durton p:rogr@ forhbogPit4l COIIIB@t'Lc*? O&O hove is to provide for the linkages and mechanisms Our purp through support to staff,, to assure the overall Program services and dewnxtration pratr@- THOD* specific 'tem @ch require ad4itiowl fund,* would bereforred to "i@atins mchanigms, ,QUUTION: What facilities and equ'Pmeat could be Provided under this legislation that could not be provided uAdOr Rill-BurtOn and U"ltb R"OOVCB Facilities legislation? This program is to establish a rlotwovk--thc PurPose of Program is not r-ougtw=tion alone. Construction would be secondary to the control @osso pywilaing UrAque, specialized or job,* fociliti" n@ for the purpos4 of otherwise Si this "usll Programs QUESTIONS AND ANSWERS CONCERNING REGIONAL COMPLMM FOR DISEASES) CANCER A.ND STROKE AS PROPOSED IN S. 596. What vould be the relationship of the heart disease, cancer, and stroke complexes to the present NIH program for the support of research and research training in the fields of heart disease, cancer, and stroke and other major diseases? A. The proposed program of medical complexes vould not displace present programs of research and research training supported by NIH. The complexes vould provide a means for more effectively relating the research and research training activities to clinical training and patient care activities. As the President's Co@ssion on Heart Disease, Cancer., and Stroke made clear., the extensive medical research programs vhich have resulted from the generous support provided by the Congress to the National Institutes of Health have helped cre@e numerous centers of medical excellence vhich can be the foundation stones of the proposed comp exes. Question. In whit ways would a regional categorical center (for example, a regional cancer center) differ from a clinical research center now spon- sored by the National Cancer Institute? Answer. Although cancer clinical research centers now supported by NCI exhibit a range of characteriptics--including many or most of the elements that one would expect to find in a regional cancer center--there are clear differences in concept and purpose. A regional Cancer Center would involve responsibility for improv g the quality and availability of cancer research, training, diagnosis, and treatment throughout a specified region. A dancer clinical supported does not have regional respo'n- research center as now sibilitie6 and is limited in function to clinical research and research training only. The designation "cancer clinical research centers" refers to a specific limited clinical research component of an existing'iiisti- tution. (Perhaps ten beds with staff and supporting facilities in a cancer research institute, university hospital or similar medical institution.) However, the designation "Regional cancer centerit would apply to a broad'clinical facility involving an institution as a whole; or a major organizational segment of such an institution. tion. would the research and training functions of the complex financed through other (including construction of research facilities) be t and operation of a medical sources than the grants for establishmen complex? Answer. Research and research training projects carried out by investi- gators within the complex could be supported under individual research project grants from appropriate PHS or other granting sources. Similarly, support for a categorical clinical research center approved for incor- poration within a complex might be supported directly by a categorical Institute. The pattern in this respect is apt to vary depen ing upon a variety of institutional funding and cooperative arrangements* Q. What would be the role of the categorical institutes and the categorical advisory councils? A. The categorical institutes would continue to provide support for research and research training in their respective fields with the 'advice of their Advisory Councils. It is anticipated that this support would continue to go to the component institutions of the proposed complexes. Individual investigators within these institutions would still apply for research support th rough present mechanisms and their proposals would be reviewed for scientific merit and for relevance to missions of the institutes. The proposed program of support for medical complexes would not supplant the categorical institutes as the primary providers of research and research training support in the fields of heart'disease, cancer, stroke, and other major diseases. Q. Would present categorical or general clinical research centers be absorbed into these complexes? If so, would they continue to be financed through the categorical institutes or DRFR? i A. NIH would continue to support general categorical or clinical research centers through present mechanisms. It is likely that many applications for gkants under the proposed program of medical complexes would be received from institutions which currently receive NIH support for a general categorical or clinical research center. It would be appropriate for such applications to indicate how present research centers would be related to other parts of the proposed complex. If the present center were included in a complex, support might still be provided through the categorical institute or DRFR; however, the further development of the complex might include financing of the basic core support of the research center through the grant for the complex CL"lt cl 10 fo_ of to i@ll-Lat Liiid of or oth@ .,io @.cXit aLc.-i,llly -,,.To uj- d1 'bi t L a t to aasis@ Ziere i-iould )rob@.bly ba cea,,ral thmtieh t7.ke @iYL@Lcaa"4j, u t ed oA bazis o:C -a@,da of the Could a local healt4- re C.L 0 prov:Lcle the l@, 'ZLember.-, O:f !L,-.e etc. t a4,d treat U0 -aa a iLiit o-6' a hQ o::- o-'@ ity k,.?iiieh co-a:Ld i@@clwie a -IC, Z,, hos.-jital -zot b@ @l oesalt have a medical zchool, bu health iQUrz$TIOI.i: fly state d t we have a departme@,., a good ;@,emeriol ard a few nu-@rin- 'tip@s. a. EDw &to the folL@s i,.% vj to be benefited by this bill? b. ep.3 wa do t o becoza l@z: IC A lq,"X an,-' t could be itt rc,c@:. I,.ospitals. @.is irt tL"Z-a Can be to the mr-@,diczl in an odlo,@tti,-,S or nearby stnte t,-,crcby ir,,nroviaz the cuality of care. b. T.%e mediV-.-I pro;E@.-,ion and the health take the itiative 4.a c i@orias possible relatioazlli Z lAt,71 c@=t@- iu offer states. 1. What qualitative consideration will be involved in the review and approval of applications for grants for the establishment and operation of regional medical complexes? 2. Will not such centers inevitably mean that these grants will -o to the institution and location already capable and well-serviced in respect to research, training, and demonstration capabilities 3. How will this program help the institutions and areas of the country that do not now have such capabilities? AO 1. The major qualitative considerations bearing upon the review and approval of applications for grants under this program will be the potential of the proposed program for accomplishing the purposes being sought through the concept of regional medical complexes. Many communi- ties throughout the country have diverse capabilities for improving the quality of services in these critical areas and for establishing relationships between existing research and teaching institutions. What is needed is the plan and the funds to support the cooperative and coordinate relationships which comprise a regional medical complex. 2. While it is probable that the initial awards will involve institutions and proorams based upon existing capabilities, a major objective of the program will be to encourage and assist the development of such capa- bilities on a widely distributed geographical basis. 3. An important part of the concept of the program of the President's Commission is effort directed towards enlarging the number of centers of medical excellence and capability throughout the country. Coordinate use h as the of other support progra= of tne Public Health Service suc General Research Support Grant, the Health Professions Educational Assistance Act and the research and training grant progra@ will be utilized to advance'and geographically equalize capabilities requisite for the development of effective regional medical complexes. d recognized Question. If regional medical complexes must be built aroun centers of research, training and care competence in the three disease ar ram help to bring quality care to persons living eas, how will the prog in regions where this competence isn't now found? Answer. It is probably trud,that the first regional complexes will be set up where the largest population concentrations and the required insti- tutional competence coincide geographically. But the program is a national one; and its benefits will not be reserved for heavily urbanized or other- wise favored regions. The Public Health Service, as program administrator, will constantly seek the broadest national access to program benefits. How many regional networks will be required for full national coverage is not clear now; and one can only guess at how long full program implemen- tation will require. (Perhaps ten to twenty years.) But throughout this period--and for most if not for all parts of the country--there should be reasonably steady gains in the quality and accessibility of medical,care. The program will promote these gains in several ways. For example, program.implementation requires systematic and continuing assessment of institutional competence (both research and care) in relation to local or regional population needs. The resulting profile of national categorical competence becomes a most useful planning document: categorical strong points become possible components for new or extended regional complexes. Potential strong points logically become the focus of joint local and PHS efforts to raise institutional competence the needed fraction more. ap areas--if sufficiently serious--can pin point the need for concerted local and national action, possibly including the establishment of new develop- mental programs. Q,@4 TIOil: !low is the term "re-ion!' used Lit @.his logislatio-,i" I-,'a e,,ivizion that such raZioiis Ily a population of Lvo to 3 million persons. located in a conti-@as a-za4, @,kich mi,,,,ht be Lntez- or intrastate or ot-*%er subdiv4-.64-on. QIJESTXO,N: Ilauld 'you describe the rea4 on to be served by ou,-h a comploul ANST=: Tne a,@,,31icarLt must describe the goo,,-vaphlc region Pl@ - population base. la any cns^- t@iiz uould have to bO a BP-Oaraphic area of sufficient size a,.v4 population to hold resources necessary and as3,,r,-- their effective utilization. Thus, a region might be part of Greater Ilf-v York, t",,,e ent re metropolitan Washington, D. C. area, or a portion of ZeatueL-y extending from ti%e univeroirj ical school. Question. Will there be a single medical complex for a specific region* with component institutions responsible for categorical specialization? or will there be separate complexes, at least for each of the three major disease categories? Answer. Each regional medical complex is expected to have (or to develop) component institutions with the necessary competence in the three major disease areas. Separate networks for each disease category would raise administrative costs; might lead to unnecessary duplication of facilities; would increase competition for trained manpower; and tend to unnecessarily fragment provision of quality care for sick persons. It should be recognized, however, that these regional complexes must build on existing categorical competence; and few regions initially will be equally well served in the three disease areas. Therefore, it s POs7 sible that some networks may at first cover just one disease category* For largest metropolitan areas, with several medical schools and associated hospitals and a number of institutions with required categorical competence, more than one complex may be set up if the need for this is shown. Question. What are the criteria for evaluating institutions to go into regional complexes? Answer. There are two over-riding criteria for inclusion of institu- tions in medical complexes recognized competence in one or more of the three major disease areas'; and (2) willingness to cooperate in a regional framework to make high quality care regionally available. Typically, the regional categorical centers will be drawn from those institutions that are heavily involved in relevant clinical and pre- clinical research and r"V training, as well as'patient care. Such institutions generally will be found in-major university medical centers or associated with them. On the other hand, the prime location for diagnostic and treatment stations is:in community hospitals to which the largest number of patients.and local physicians have access. Q. would the regions to be served by these medical complexes and regional medical centers.be.,determined solely by the inclinations and desires of the applying institutions or would some specification. or plan be worked out nationally for this purpose? A., At t'ne beginning of the program the original definitions would reflect the initial plans and capabilities of these institutions ready to propose the establishment.of medical complexes. As this program develops very positive effort would be made to assure equitable geographic distribution of'medical complexes.- The eventual objective would be the evolution of a national network of medical complexes to assure the availability of the-benefits of scientific medicine to all population groups and areas of the nation. Question. To what ext4@@,;a would these me(,.--al complexes be locally controlled and locally run? Answer, Regional r, .cal complexes woul@- 'or the most part encompass non-Federal instit- .ons, whose participi-,-;@,n in the complex would be supported by grAn@. Thus, independent responsibility and local initiative would not be diminished by that relationship. Specific arrangements for local control--including the distribution of responsibility among component institutions--will tend to vary among regions. They will also tend to change through time, as one 'or another administrative problem develops, or more effective forms of cooperation are found. Initial arrangements for local coordination and control must be spelled out in the grant appli- cation for the complex. Prerequisites for grant approval probably would include: assurances that a properly constituted local advisory group-has' been set up and is functioning, that key local agencies, professional groups and institutions have been consulted in setting up the complex, and-that cooperating institutions understand and agree to local arrangements*, ,QMTION: Will Ovs'rY P*rtiOD Of the United States be covered? The ultimate objective is to assure that every person have Person have -access to the best in @ical services- This does not mean gaturati= the country worth complexes-- for we have neitTaor the manpower nor resources to do to. f developing techniques" stim- We view this program as One 0 lating'broader coverage in all related services and facilities-- vith the complexes wwrZLzU4 like demonstrations in a vider co@ty. How long It take to develop a national network? Decades @UL@TIONT where would responsibility for this program'* administration lie within the Public Health Service? ANSWIM: tn developmnt of our plan for administering this program it is our intent to utilize c@. otenetes found,,'Ln various coMancate of the Public Ite4lth Service. Assig t to an organizational unit will be made after the plan has been move fully developed. During the developmental phase the Office of the Surgeon General will *$sum* the responsibility. QUESTXOII: Could not provision for continuing education in heart disease, cancer oW stroke be made under the educational iMr t &rents proposed In the Ilealth Professions BducatLonal Assistance @ments of 1965? ANS14ZRs The 'Realth Professions Educational Asolistance Act and the proposed amendments eve des @ ed to give primary emphasis to the education of students. This proposal would aghasixo the continuing education of the practicing professiomt, Question. What effect will the proposed categorical approach have on the curricula of medical schools and on undergraduate medical education? Answer. The complexes will have relatively little effect upon undergraduate medical education. Greater availability of excellent teaching cases, the increased volume of research,and the greater rigor of diagnostic and thera- peutic methods all will improve medical education, but only secondarily. The great educational impact of the complexes will be on graduate specialty training and upon the continuing education of community physicians. qwstion.- You are propos@ to i;upport staff. UUt proportion of the staff of a reSaar teaching tiocp@l or medical school are y,ou go@ to @port umler this biU If they have specialists in cardiology 4nd canc6r ym golM to pick up their saJ-arles? Aren't you w*i us somewhere else to give basic support @ts to radical .,Oehwla? and luproved grants too? @ers Only those additional pto-ferolonal wA technical vernotmel necessary to operate the components of the "mftoal @lse be @rted order this bill. The mjor aWbasio be on contimiation education for for Coastline @iei= other proiessiomi Peraonuel., QUR,STION: What will be the impact on manpower--now available or being developed? WILL this further dissipate our resources? ANSMT The complex to a scheme designed to got service* to people effectively and efficiently. Thus, altliouah new kW* of medical spetiolist--teathers will be developed, this will be balanced b7 personnel econom"o in Improved Vey* of mobilizing service resourc"6 The cwplex arrangement will co@inly accelerate the coordination .&ad effective use of existing Manpower and improve Its quality. Alsog the rate of developwnt of Manpower will influence rate of 4*velopmat of three progrea. The program would seem to greatly increase the requirement for medical and paramedical personnel. How will these needs be met and where is the manpower coming from? A. This program will indeed increase the demands for medical and other health personnel. This increase, of course, is reflective of the level of health manpower that this Nation requires to provide high quality and truly effective health services. Present shortages of manpower will obviously affect the pace and magnitude of the initial efforts under this program. However, the plan of the President a Commission calls for specific efforts to enlarge health manpower by continued support and increase in level of training programs, initiation of new training programs at both professional and subprofessional levels, and the expansion and support of health educational institutions and programs. Specific effort to support and enlarge the medical and dental educatiorkl as a part of this program is encompassed in legislation now before the Congress. qUESTZON*o What will be tho relation of the complex to aroo-wide hospital planning under the Rill-Burton program? ANSW]MT The applicant will be required to thov the relationship to local plannitia activities; further, these sr* anticipated to be silvatk consideration throu Sh the ma@tomw ai the ,applicants *dviisory committ". @tiont Is the pro6rma, then, another aul)ect of reaioud or comiunity plwmin,z for health? Now -wcaibl it dA@ffor fmn areavide hospital pl p@rsg commity wa@'L Health centers, :ror e,xauple vUeh a" p",oentlv authorized? @e.ri @uis on contin@ eduaatiori--rapl4ly @oang specific knovUUe In treatiaent. Not mq on* of those Zr as 1:inits researchp training# wA latient "",nu does require reu ionship vith ww wtivities QUESTION: Aren't you really talking about developing cm=nity plans for service here? Isn't that the big void to fill? Vo sees to be doing a lot of this constructing, restarch, and training vith other support. AN$ M i Community planning for service can subsequently be related. This program is concerned vith the quality of health service In c ties--by bringing to bear the advances within teechLog and research centers to the commnity services,, through the c ty hospital end the practicing professional. omtiorit Aren't you really t4alking about I money @ effort here? I)on't you bave Pede@ ai4L for 4LU theme things If you could =4 join them toaother by pl=ane:l No,, ve don't bave an the pieces--we are avare of gaps,, of deC,mes,p in mww amvs,, Tl)ls progrw p3mvides $or p @s the orgmizatioral linl,.ages @ elwento of the netvozka that @ in@inatitutioml) ete-p and that lint the @essima Practitioners to the research mA tJA admatioma system$ QU@TIONI HOW is dt 90i@;) l,'Gdr@@rtil share jus-tifi.,)d In this pro&,,Tan an cOntrastod to other i'll,j Urs.@@4t prog@? Atl,j'WL,Ut The hieher Federal share is Juatified by the urgency of the nood to lau.,ich a coiicortsd attack on those And the necessity, of rapid develop*@ica-b of oyatems for provision of high qwaity patient care so that resoar@ kaowlodf,,* can be applied as rapid4 am possible to @ple. Coleatioft: Mat share of the funds would be used for construction? Here A @r poft:Loa mu In the earliest phase of the pro I:t VW Om* @ex becom established. Question. What will the t nonies be used for, e.g., Professional gran staff, ancillary staff, equipment, renovation, new construction, patient care? In what proportion? Who will decide? Answer. Grant f.unds will be used for professional staff, ancillary staff, equipment, renovation, construction and patient care, but the latter only for care, allocable to training, research or demonstration. The proportions would be as set forth in proposed budgets by the applicant institutions. Such budgets would be reviewed, both by medical scientists'and by administra- tive specialists, and would be subject to regulations similar to those promulgated fo r the clinical research units now operated through the NIH. r,u Tiatit nou do you contaVlate usiug 450 millioa in thi;s first year? A14.@@fate We en@ioii the astablishTiaent ofbur such complexes in the first year of operation ranrSing in cost from @10-15 million wwh, RougUy,, us believe this rmy be distributed as fol2ovot 12,1 mMioza per complex., generally as followas 42.5 aMion - for the ad.-,.Tii@.itrative aetuork anti com=icatiori liaos of the modical coate'r, $5.0 a M ion - for basic support of ape @ ic activities in heart disease, cancer and stroke. 45.0 million to establish 20 diagnostic and tre4t,-moat stations in local and commity, heath f&OUities. ($250,,OOO @er station) aMian QUESTIOIls Km would the coWlex" help the practicing phyeiclim who to not otherwim* associated vith a medical school, teaching hospital. or other sponsoring institutions A@# Three ways are @sionedi (1) he has access. through his local affiliations to the program of continuing education carried out by the complex. and (2) he had recourse to consultation *v4 assistance (3) he way tsfor his patient to the sector, Q. The bill provides for the payment by the patient or a responsible third party, for the services rendered under this program except when such services are incident to research teaching or demonstration. Who will be the recipient of and what will be the disposition of such collected fees?. 2. Should they not.be used to offset, reduce or,otherwise reimburse the Federal expenditure? What arrangements will be made for this? A. Fees received by institutions comprising a medical complex for services rendered under this program will be received by the normal collection framework of such institutions and will be used to reduce or reimbur se for the Federal expenditures made in support of the program of the medical complex. Accounting arrIangements will be worked out which will provide for appropriate allocation of costs under this program between the Federally supported activities and those constituting the normal operating costs of the.participating'institutions. and these' pattewswill be used to allocate income received for services.rendere4,to provide for proper reimbursement for Federal expenditures. @stions ViU the costs of transporting patients to regional centers be p"d for under +,his prof,@? AAsvert In specific situation where essential to the pu*oaes of the TOO its* for "search,, train@p or demonstration purposes @est:Lont How =ad o "demonstratioe patient be differentiated from one @ fte an ordi@ pationti Aw"ri A 'domonstratlojo patient Is a variation ou a teaebina I*tionto also a Motion of a research @-ject. .@ vou]A be booplUUzed vnder @ements clearly ident:lWng his status. @t to "Uaal caVlazo RegUar-patient co" costs WV to@bom b7 @er afthanime volunt"7 Q"Gtims Ym eV Ym an wt p@ to m patient care costs excel those incident to trainim, reaftmhp or d @stration activities. ilw do you jWge whether a patient is being used for tra,i,nin Fiscal @er: If hospitUt@ oay for teaching @ses yes. txtra costs Om It hospital stay veft ad for 0 rw Ur$ to i*@Utato ""Una O*ationt You b"e stated yetiont care will be provided =4 for dew=tmtion@ trairAng) or ronearch., Won't thin mean flooding elemnts of the ompl" vith persons o@ing Vaity service? ri ftft of the @leant's @tted program will include ptwedures to I* established to meet tlda problem.. Nuch as At our Noti@ CliMcal Cmterp aLUgibi.Uty vtU be t@@ed for either resea=h., training or 0, trati one,, it vM not bd a *on or cozw@ operation. @h *@ex vM d"ondne :Lts om "fe*r4 o"tft. O* ke7 to tma astm 10 tbo @ticing @CIOA* QUISTIONs At* you going to sor" more patients (if to--how? and ow MNLI) or just r&SA* the quality of tare of patients tow being s@t IANOMS both. This.pmgrm will be providing samthing that is not attainable am except In so= arose. The patients who he" those diseases will have access to better #M wro Intent" .ear*. More o@to will be available to then with their p@LeLons @n$ available to them better Womms mA @oultttioa.