Hollander, Neil, vice president of health care services, Blue Cross Association and Henry A. Diprete, second vice president, group operations, John Hancock Mutual Life Insurance Co., a panel__ Prepared statement Jirka, Frank Jr., M.D., vice-chairman, board of trustees, American Medical Johnson, Archie, M.D., American Medical Association, prepared statement__ Prepared statement_. Martin, Richard, manager, Health Services Industry Relations, Goodyear Mott, Anthony, executive director, Finger Lakes HSA, Rochester, N.Y.; Prepared statement McMahon, John Alexander, president, American Hospital Association; accompanied by Leo J. Gehrig, M.D., senior vice president; and Paul W. Earle, vice president; Frank J. Jirka, M.D., vice chairman, American Medical Association Board of Trustees; accompanied by Archie Johnson, M.D., member of AMA's Ad Hoc Committee on Planning and practicing physician from Raleigh, N.C.; and Harry N. Peterson, director, AMA legislative department; Michael Bromberg, director, Federation of American Hospitals, a panel.. Page 981 986 593 601 948 951 853 736 747 586 644 Prepared statement_. McGarrah, Robert E., Jr., public policy counsel, public policy analysis department, American Federation of State, County, and Municipal Employees, AFL-CIO, Washington, D.C.--. 957 Prepared statement 980 Pitts, Hon. Terrance, Supervisor, Milwaukee County, Wis., on behalf of the National Asociation of Counties, accompanied by Mike Gemmell, NACO associate director for health and education____ 534 Seidman, Bert, director, department of social security, AFL-CIO, accompanied by Richard Shoemaker assistant director__- 881 Prepared statement 886 Semmel, Herbert, director, Consumer Coalition for Health, Washington, 142 Prepared statement 152 Service Employees International Union. AFL-CIO, Washington, D.C., 938 190 United Auto Workers, Melvin A. Glaser, director, social security department. prepared statement_. 972 Wisniewski, Stanley, research director, Service Employees International 934 Prepared statement.. 938 ADDITIONAL INFORMATION Articles, publications, etc. : Actions Approved by the National Steering Committee on Voluntary 726 Amendment Proposals to the National Health Planning and Resources 670 708 1057 Articles, publications, etc. :—Continued Computed Tomography and the Quality of Radiation Therapy, by J. Consumer Guide to Local Health Care Planning, from the Association Cost of Planning Under Public Law 93-641, Current Experience and HSA Governing Body Composition Analysis of Region II, by Herbert Minimally Funded and Rural Health Systems Agencies statement of Placebo or Cure? State and Local Health Planning Agencies in the South, by Wayne Clark, director, Southern Governmental Monitoring Project, Southern Regional Council__ Page 1059 340 767 317 1061 809 198 186 Proposed Amendments on Composition of Health Systems Agencies, 539 Proposals for Amendments to Public Law 93-641, from the Consumer 179 Study of Single HSA States and Section 1536 States, executive 790 Communications to: 53 374 583 Kennedy, Hon. Edward M., chairman, Subcommittee on Health and Scientific Research, from Governor Richard D. Lamm, chairman, Task Force on Health Planning, National Governors Association (with enclosure), Feb. 8, 1978---Kennedy, Hon. Edward M., chairman, Subcommittee on Health and Scientific Research, from Herbert Semmel, president, Consumer Coalition for Health, Feb. 23, 1978 (with enclosure) __ Kennedy, Hon. Edward M., chairman, Subcommittee on Health and Scientific Research, from Michael K., Gemmell, associate director, National Association of Counties, Feb. 24, 1978 (with attachments) -Kennedy, Hon. Edward M., Chairman, Subcommittee on Health and Scientific Research, from James H. Sammons, M.D., executive vice president, American Medical Association, Chicago, Ill., Mar. 10, 1978 Shapiro, Stuart, professional staff member. Subcommittee on Health and Scientific Research, Committee on Human Resources, from Walter L. Robb, vice president and general manager, medical systems division, General Electric Co., Feb. 14, 1978 (with enclosures) _______ 1047 Selected tables: 611 Public officials on governing bodies. 86 Results of the HSA project review process, August 1974 to February 854 Status of certificate of need and section 1122 programs in the States 136 HEALTH PLANNING AMENDMENTS OF 1978 THURSDAY, FEBRUARY 2, 1978 U. S. SENATE, SUBCOMMITTEE ON HEALTH AND SCIENTIFIC RESEARCH, Washington, D.C. The subcommittee met, pursuant to notice, at 9:55 a.m., in room 5302, Dirksen Senate Office Building, Senator Edward M. Kennedy (chairman of the subcommittee), presiding. Present: Senators Kennedy, Pell, and Schweiker. Also present: Stuart Shapiro, M.D., professional staff member; Robert Wenger, J.D. counsel; Peter Harris, professional staff member; David Winston, professional staff member; and Polly Gault, professional staff member. Senator PELL. The Human Resources Committee will come to order. The chairman of our subcommittee, Senator Kennedy, has asked that I open the hearing in his behalf since he is presently testifying on the full employment bill. He will be here shortly, but as a matter of courtesy to the witnesses and for the sake of expedition, he asked me to get the ball rolling. We will now insert Senator Kennedy's opening statement in the record. [The statement referred to follows:] OPENING STATEMENT OF SENATOR EDWARD M. KENNEDY Senator KENNEDY. I am pleased to open a series of hearings on S. 2410, "The Health Planning Amendments of 1978" which I introduced last week along with Senators Schweiker, Javits, Randolph, Pell, and Chafee. These amendments build and strengthen the "National Health Planning and Resources Development Act of 1974," and should help us achieve a rational system of health planning so that every American will be able to receive quality health care at a reasonable cost. When the Congress enacted that historic legislation in 1974, it made. the finding that "The achievement of equal access to quality health care at a reasonable cost is a priority of the Federal Government." Tragically, with the rapidly escalating cost of health care, we are perhaps further from that goal today than we were 3 years ago. National health expenditures tripled between 1965 and 1975. In fiscal year 1977 over $160 billion was spent on health care. Health expenditures now account for 8.7 percent of the GNP. The rate of increase was approximately twice the CPI for the same period. The costs of medicare and medicaid went up billions last year and the total Federal share of these health expenditures has now reached almost $50 billion. (1) Unfortunately, these increased costs, which come out of the pocket of every American, have not produced an adequate supply or distribution of health resources, and consequently have not made possible equal access for all to such resources. During the last session of Congress, the Human Resources Committee ordered reported S. 1391, "The Hospital Cost Containment Act of 1977, which included a short-term revenue limitation that would. in part, accomplish the deescalation of hospital costs. Unfortunately, movement on this important bill has slowed, but I am hopeful that early this year the revenue limitation portion of that bill will pass the Senate and then become law. At the time the health planning law passed in 1974, I don't believe that anyone claimed that it was perfect. Some charged that it hadn't gone far enough-for instance by not extending the certificate of need requirements of expensive equipment to all sites. Others feared that it went too far-by allowing, for example, HSA's to exercise control over the use of Federal funds in their respective areas. Now, after 3 years of experience with the law, we are in a position to say what has gone wrong and needs to be corrected and what has proven right and needs to be encouraged even more. The hearing today and the subsequent hearings will be important. Throughout the drafting of S. 2410, compromises were made, and I expect that the bill will be modified as we hear from a variety of thoughtful witnesses. In drafting the bill, I adhered to a basic belief that the planning process can work and thus have attempted to strengthen this processnot disrupt it. The past 3 years have been full of turmoil for those involved in planning for health care. It has taken more time than we anticipated for the health systems agencies, the State health planning and development agencies, and the State health coordinating councils to get themselves fully organized and functioning. The Department of Health. Education, and Welfare has been negligently slow in promulgating the required regulations and some of the working relationships between local and State agencies are still unclear. The bill that was introduced has purposely not mandated changes in board composition of the IISA's or the SHCC's for fear of slowing down the process further. Unless there are very compelling reasons to tamper with those boards, I am not inclined to disrupt what have become, in most instances, stable relationships. The bill contains a number of provisions that will strengthen the role of consumers and the Governors alike. The requirements of the State health plan have been significantly modified and the Governor of each State and the consumer dominated SICC must now both approve this plan. Once approved, this plan will be the foundation on which certificate of need decisions are based. This will foster closer coordination in the planning and review process and should help reduce the past arbitrariness of many certificate of need decisions. In like manner, the due process requirements have been strengthened to reduce potential discrimination against particular providers. Nationwide it has been estimated that we have as many as 100,000 unneeded hospital beds costing well over $2 billion a year. In order to equitably address this concern, the bill establishes a program that encourages hospitals to close, merge, or convert unnecessary facilities and services. This would be an entirely voluntary program and includes incentive payments to encourage planning, development and delivery of long-term care services, and other alternatives to hospital care. At these hearings, I also hope to hear other suggestions on ways to modify title XVI of the planning law in order to provide funds to insure that there are adequate private care centers, outpatient departments, and inpatient services in urban and rural poverty areas. There is no question in my mind that if planning is to work it must be generously funded. Without an adequate financial base, the local and State agencies will not be able to carry out their already extensive responsibilities. The bill provides this financial base and makes it easy for the HSA's and SHPDA's to get these funds. The HEW regional offices are already short staffed, and to change the funding formula from a per capita base to a discretionary project grant, seems to me to be giving more authority to the regional offices than they have the capacity to handle. I am hopeful that the witnesses today, and at subsequent hearings, will discuss constructive improvements in the planning process. The time for nay-saying rhetoric is past. Let us move forward in strengthening the planning process so that all Americans can have access to quality medical care at a reasonable cost. [The bill S. 2410 referred to follows:] |