1.

2.

3.

4.

5.

STATE HEALTH PLANNING AND DEVELOPMENT AGENCY (SHPDA)
Conducts health planning activities of state; implements
state and local health plans related to state government
Prepares preliminary state health plan

Assists SHCC in review of state medical facilities plan
Serves as planning agency of the state; administers

state CON program

Makes findings on need for proposed new institutional
health services

6. Reviews all institutional health services offered in state

SHPDA

1.

2.

3.

4.

HEALTH SYSTEMS AGENCIES (HSA)

Assemble and analyze data on health of area residents, health care delivery system, health resources, patterns of utilization Develop and implement HSP and AIP**

Conduct public hearing on HSP*

Review and make recommendations to SHPDA

HSA

*Health Services Plan

**Annual Implementation Plan

***1
2

Community Mental Health Centers Act

3 - Comprehensive Alcohol Abuse and Alcoholism Prevention,

Treatment and Rehabilitation Act of 1970

*According to authorizing legislation (State Act 558): "SHPDA shall be located in the Department of Health for administrative purposes, but shall be an independent agency under the supervision and control of the Governor."

**Will Consist of thirty-three

***Thirty-two appointed--increase of one proposed for next year.

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CONCLUSIONS & RECOMMENDATIONS

SGMP interviewers and researchers talked to consumer and provider board members and planners of twenty-eight HSAs throughout the eleven-state South. A common theme running through these discussions was that at this point the HSAs are simply not effective health planning agents. A major problem is that board members have differing views about the HSAs' role in health planning. Those consumers who are not deferential to providers or sympathetic to the providers' views regard the agencies as unresponsive entities dominated by medical interests. The providers, with a few exceptions, are suspicious of the agencies because of their centralized planning authority and span of control. Health planners generally believe that the HSAs lack sufficient authority to counter the power of the state agencies or the influence of the vested state and local medical, hospital, and insurance interests.

Nonetheless, there is little doubt that the HSAs will be more effective in providing regional health planning than the CHP agencies that preceded them. The HSAS generally adhere more closely to the federal requirements for a consumer majority on their boards, since HEW can now reject board members who do not qualify as consumers. Thus, HSA boards are more representative of the community as a whole than were the CHP boards, which were overtly controlled by medical and hospital interests. Although the HSAS have less federal funds than anticipated, they are stronger financially than the previous agencies and will be able to provide more thorough review and planning. Most important, the Certificate of Need requirement gives the HSAS authority to review hospital expenditures of $150,000 or more. When considered collectively, the advantages the HSAS enjoy over the CHP agencies are significant. The HSAs clearly have the potential to promote comprehensive health planning and to help stabilize the costs of health care.

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Despite their greater potential to plan effectively, SGMP findings indicate that the emerging HSAs are more similar to the CHP agencies than they are different from them. Moreover, the planning activities of the new agencies give few indications that they will soon realize their full potential. Operating under conditional designation, the HSAS have been concentrating largely on organizational matters. Yet it is not too early to conclude that they suffer from debilitating limitations that must be eliminated before the agencies can provide truly effective health planning. SGMP findings indicate that the agencies are characterized by common problems. Those problems, accompanied by recommendations for alleviating them, are as follows:

(1)

(2)

THERE IS A SERIOUS LACK OF PUBLIC INVOLVEMENT IN AND
KNOWLEDGE OF HSA ACTIVITIES.

Each HSA should undertake an extensive public education project. Agency directors and staffs must make a concerted effort to explain the HSA's purposes and work and to demonstrate to the general public how health planning affects their lives. Meetings should be publicized by the local media, and each agency should widely distribute a newsletter covering such topics as meeting agendas, board vacancies, status of health plans, review activities, and other relevant items. HEW should make special funds available to support local public education projects for each HSA. These funds should be in addition to the financial support currently granted to the agencies.

CONSUMER BOARD MEMBERS PLAY ONLY A MARGINAL ROLE IN PLANNING
AND REVIEW.

HSA directors and staffs have a special responsibility to
provide training in health planning for consumers and to
encourage them to act independently of the medical interests.
Training should not simply be pro forma but should routinely
consist of workshops, educational films, and periodic re-
treats. Too often the assumption is made that only the
consumer board members need training in the intricacies of
health planning. SGMP findings indicate that the need is
just as great among providers. In those agencies where
the directors and staff themselves are dominated by the
medical and hospital interests, it is essential for consumer
and public interest groups to monitor their HSA and bring
pressure to bear on it to balance the combined influence of
staff and providers.

85

(3)

(4)

(5)

MEDICAL AND HOSPITAL INTERESTS DETERMINE POLICY DECISIONS
AND OTHERWISE DEFINE THE ROLE OF THE HSA.

Provider membership should be decreased and more equitably
distributed. Hospital administrators and medical doctors
are over-represented on most HSA boards. Greater emphasis
should be given to recruiting providers who are more
sympathetic to the consumer viewpoint. Recruitment of nurses,
representatives of mental health groups, public health
officials, social service representatives, and other pro-
viders who are not medical doctors or hospital administra-
tors would help redress the imbalance that now exists on
many boards.
It would also increase the overall compre-
hension of the health systems area's needs and demands.
HSA by-laws should be amended to include a requirement that
a designated percentage of consumer board members be present
at board meetings before a quorum can be declared.

LOW INCOME INDIVIDUALS ARE RARELY INCLUDED ON HSA GOVERNING
BOARDS.

The HSAs have a moral and legal responsibility to include low
income individuals on the governing boards. Each HSA should
devise a means of recruiting, training, and otherwise en-
couraging the full participation of the poor. Their trans-
portation costs and other related expenses should be borne
by the agencies. HEW should not allow HSAs to substitute
individuals who work with the poor for low income people
themselves. Individuals who represent the poor should be
on the boards; but they should serve with the poor, not as a
substitute for them.

WOMEN, BLACKS, AND OTHER MINORITY GROUPS ARE INADEQUATELY
REPRESENTED ON HSA STAFFS AND GOVERNING BOARDS.

The HSAS must move beyond the stage of having only "token"
representatives of women and minority groups on their staffs
and boards. Existing HSA staffs and board members should
take the initiative to insure that women and members of mi-
nority groups are recruited for board membership. Such ac-
tion conceivably would jeopardize their own positions.
Therefore, HEW should strictly enforce the regulations re-
quiring equitable representation. HEW should insure that
the public education projects include specific programs to
inform women and minority groups of opportunities for both
volunteer and paid participation in the agencies' efforts.
HSA staffs are less representative of women and minority
groups than are the boards. As staff vacancies occur,