86

(6)

(7)

(8)

(9)

executive directors should recruit qualified blacks, women, Mexican-Americans, or other minority group members.

HSA BOARDS AND STAFFS LACK ACCOUNTABILITY TO THE PUBLIC.

Because the HSA board members are often self-appointed or
appointed by fellow members, there is little accountability
to the public at large. One possible solution is to have
board members chosen in elections to serve for specified
periods. The HSAs are as important to the well being of a
community as its school board, and it is not unreasonable to
have HSA boards chosen in a manner similar to that of the
school boards. Requirements for all members to attend meet-
ings regularly should be strictly enforced. Members who
miss three consecutive meetings should be replaced. Be-
cause consumers tend to be absent more often than pro-
viders, special emphasis should be placed on encouraging
regular attendance by and full participation of consumer
board members.

FEDERAL REGULATIONS DEALING WITH CERTIFICATE OF NEED PRO-
GRAMS SHOULD BE STRICTLY ENFORCED.

Many of the state CON programs fail to comply with federal
requirements. For example, the Texas CON program does not
require HSAs to review and comment on CON applications.
Other state CON laws have similar loopholes that impair
their effectiveness. HEW should strictly enforce the federal
CON requirements. HSA staffs and consumer board members
should make every effort to lobby for effective CON laws
in their respective states and otherwise counter the opposi-
tion of the medical associations to the CON program.

THE HEALTH PLANNING INFORMATION CENTERS PROVIDE LITTLE
USEFUL ASSISTANCE TO THE HSAs.

A surprising number of staff and board members are unaware that the Centers exist. Those who are aware of the Centers tend to regard them as of little practical value. The technical assistance the Centers provide should be geared more closely to the agency's particular needs. The information now provided is often too general to be of value. Access to information and technical assistance should be expanded.

THE HSAS LACK SUFFICIENT AUTHORITY TO GENERATE EFFECTIVE
HEALTH PLANNING.

The overall planning and regulatory authority of the HSAs should be increased. Their review authority for hospital

87

expenditures should be expanded to cover expenditures of at
least $100,000 and above. This authority should extend to
all health facilities, including offices and clinical labora-
tories owned by private physicians. State laws governing the
HSAS should be strengthened to give the agencies the extended
authority needed for effective health planning.

FOOTNOTES

1

1In some ways the program may have succeeded too well.

According to one study, the country has accumulated a surplus of 100,000 hospital beds. Excessive beds add significantly to the costs of health care. In 1976, for example underutilization of these beds cost some $2 billion in health dollars. See The $8 Billion Hospital Bed Overrun by Barry Ensminger, p. 1, Health Research Group, Washington, D. C. (1976).

2See Access by the Poor to Health Care in Southern Hill-Burton
Hospitals by Allen Crimm.
Georgia (1974).

3

The Southern Regional Council, Atlanta,

U.S. Congress House Committee on Interstate and Foreign Commerce. National Health Policy, Planning and Resources Development Act of 1974. Report to accompany H.R. 16294. Washington, U.S. Government Printing Office, 1974 (93rd Congress, 2nd session) Report No. 93-1382, P. 20; and

U.S. Congress Senate Committee on Labor and Public Welfare National Health Planning and Development and Health Facilities Act of 1974. Report to accompany S.2994. Washington, U.S. Government Printing Office, 1974 (93rd Congress, 2nd session) Report No. 93-1285, p. 41.

Op. cit., House Report 93-1382, p. 13; and Senate Report 93-1285,
P. 13.

5

An indirect provider is a person who has a fiduciary interest in the distribution of health care. This means that if a person receives more than 10% of their income from the distribution of health care, they are usually considered to be indirect providers.

A direct provider is a person who has a direct interest in either the practice or provision of health care. Direct providers are listed in PL 93-641 as: physicians, dentists, nurses, administrators of long term care facilities, health insurers, allied health professionals, administrators of health professional schools, and other health professions such as pharmacists, optometrists, etc.

6

Certificate of Need laws require a state agency to certify that expansion of health facilities and services is necessary before the proposed expansion can take place. CON laws vary but they generally insure that "public need" be demonstrated.

7

Health Systems Agency Survey Report by Southern Governmental Monitoring Project Researcher Marc Bryant, August, 1976.

8

Health Systems Agency Survey Report by Southern Governmental Monitoring Project Researcher Jeff Norrell, Montgomery, Alabama, 1976.

9

Health Systems Agency Survey Report by Southern Governmental Monitoring Project Researcher Alice Stewart, 1976.

10.

Health Systems Agency Survey Report by Southern Governmental Monitoring Project Researcher Nancy Gossell, August, 1976.

16.

Health Systems Agency Survey Report by Southern Governmental Monitoring Project Researcher Murray Fogler, 1976.

17.

Health Systems Agency Survey Report by Southern Governmental Monitoring Project Researcher Bruce Macmurdo, 1976.

18 Ibid.

19

A Council of Government is a unit of government which does planning. It is a public agency usually made up of mayors, city councilmen, and other public officials.

20.

Health Systems Agency Survey Report by Southern Governmental Monitoring Project Researcher Mary Kancewick, 1976.

21 Health Systems Agency Survey Report by Southern Governmental Moni

toring Project Researcher Sharon Cribbs, August, 1976.

ო

23Ibid.

24

Health Systems Agency Survey Report by Southern Governmental Monitoring Project Researcher Ran Coble, 1976.

25.

Health Systems Agency Survey Report of Southern Governmental Monitoring Project Researcher Mary Nell Morgan, August, 1976.

26.

Health Systems Agency Survey Report by Southern Governmental Monitoring Project Researcher Tim Johnson, October 28, 1976.

27 Ibid.

28,

Health Systems Agency Survey Report by Southern Governmental Monitoring Project Researcher Elizabeth Gardner, 1976.

29 Ibid.

30.

Health Systems Agency Survey Report by Southern Governmental Monitoring Project Researcher Elizabeth Gardner, 1976.

31Ibid.

32.

Health Systems Agency Survey Report by Southern Governmental Monitoring Project Researcher Joan Shaughnessy, 1976.

33.

Health Systems Agency Survey Report by Southern Governmental Monitoring Project Researcher Glenda Bunce, 1976.

36.

Letter from Dr. Richard Couto to Dr. George A. Reich. January 16, 1976. Southern Governmental Monitoring Project Files.

37, Letter from Robert E. Norris to Dr. Richard Couto. April 14, 1976. Southern Governmental Monitoring Project Files.

38.

39,

Telephone interview with author. January 12, 1977.

Health Systems Agency Survey Report by Southern Governmental Monitoring Project Researcher Stephen Lythcott, 1976.