ACKNOWLEDGEMENTS This report was made possible by grants from the Carnegie Corporation, the Rockefeller Foundation and the Mary Reynolds Babcock Foundation. The work of the Southern Governmental Monitoring Project investigative interns formed the basis of the study. They performed their tasks with persistance, dedication, and considerable skill. G. Gail Gessell, President of Atlanta Analytics, Incorporated, served as consultant to the overall project. Peter J. Petkas, former Executive Director of the Southern Regional Council, provided a useful critique of this report. Kerry Tassopoulos, who provided extensive research assistance, made an invaluable contribution to the study. Carole Riley, Susan Reid, and Kathleen Keegan also provided research assistance. Elaine Kporha-Brown drew the charts. Marge Manderson designed the cover. Betty Washington, Eugenia Surrey, and Janet Carlson provided production assistance. study. Robert E. Anderson, Jr. and Anne Marie Bradford edited the Page Crosland, Director of Communications for the Southern Regional Council, released it. SGMP STAFF FOR THIS REPORT: Wayne A. Clark, Director Elaine Kporha-Brown, Senior Program Officer Earl Picard, Program Officer Tim Johnson, Research Assistant Kerry Tassopoulos, Research Assistant Nevin Brown, Research Assistant Jesus Garza, Research Assistant Carole Riley, Research Assistant Susan Reid, Research Assistant Kathleen Keegan, Research Assistant Jackie Styles, Research Assistant Corliss Oliver, Administrative Assistant FOREWORD I first became aware of the American Health Care Crisis about ten years ago, while I was still in medical school. It seemed to me then that, since we were in the midst of a health care crisis, a major change must be about to take place in the health care system. A crisis was, after all, an acute phenomenon, a collision of opposing forces that must lead to a rapid resolution in one direction or the other. Today, I know better. The American health care system, like "the gift that keeps on giving," is "the crisis that keeps getting more critical." Ten years ago, we were concerned with a two-class system that delivered second-rate care, or no care, to the poor and to minorities. Today, we are still faced with that problem; but we are now beginning to recognize that our health care system also inadequately serves the middle class and affluent. For those of moderate means, adequate care is rapidly being priced out of reach. For those who can easily purchase care, the road to good health is still fraught with fragmented services provided by an array of subspecialists, with unnecessary surgery performed to keep the subspecialists busy and well-fed, with unnecessary hospitalizations required to fill unneeded hospital beds, and with the constant threat of a medical catastrophe that could bankrupt any but the richest members of society. Rather than resolving itself, the crisis in the health care system has thrown other institutions into crisis. We are now faced with a 14% rate of inflation in the health care industry, a rate twice that which exists in the remainder of the economy. State treasuries are ravaged by ever-increasing Medicaid disbursements. Insurance companies find themselves unable to provide malpractice insurance to doctors. And General Motors now spends more on health care for its employees than it does on steel for its automobiles. In the South, the situation is even worse than in the rest of the country, largely because the South is poorer and resources scarcer. While the nation as a whole has 133 patient care physicians for every 100,000 people, the South has but 103 per 100,000, and the rural South, only 69 per 100,000. Infant mortality rates in the rural South are 23% higher than the national average. With 45% of the nation's poor, the South receives only 16% of all Medicaid expenditures. When faced with a crisis--whether it be the result of war, natural disaster, or the health care system--we turn to the federal government for help. The government has in this case responded by declaring that the crisis can be resolved by making the health care system rational through planning. During the past few years, it has established agencies to carry out this planning--Comprehensive Health Planning Agencies and Regional Medical Programs--but these have proven to be inadequate. Thus, in 1974, the National Health Resources Planning and Development Act (PL 93-641) was passed by Congress and signed into law by the President. This Act established a new health planning process and a set of new, more powerful agencies to carry out the process. The most important of these new agencies is the Health Systems Agency (HSA). It is probably safe to say that the vast majority of Americans have never heard of a Health Systems Agency. Yet, during the next few years, these agencies will play a key role in determining whether or not we will have access to a convenient source of primary medical care, whether or not we will be able to afford services, whether or not the poor will continue to receive second-class care-in short, whether or not the health-care crisis will continue. If the HSAs will have this kind of power, one must then ask: who will control the HSAs? Will it be the consumers who have long been suffering from the crisis? Or will it be the doctors, the hospitals, the insurance companies, and the others who have gotten us where we are today? The Southern Governmental Monitoring Project has undertaken to study this question in the South, and it is a study that comes none too soon. The study's methods are meticulous: It examines in detail twenty-seven HSAs, then puts its findings in perspective by considering the legislation surrounding and establishing the HSAs and by considering the other agencies to which the HSAs must relate and from which they evolved. The answers it provides are not heartening. And yet, the hour is still young as far as the HSAs are concerned. They have not yet had time to achieve the status of "members only" clubs. Consumers, if they organize and act now, can still have an impact on health planning. I hope this document will bring an awareness of what is taking place, not just to health planners, but to health care consumers throughout the South. It is not simply a document to be read, filed, and quoted, but one which should inspire, on the part of the reader, some action directed at his or her own HSA. We cannot afford to sit and watch the health care crisis go on being critical for another ten years. 25-122 - 78 - pt. 1 14 Dan Blumenthal, M.D. |