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Senior Vice President, First National Bank of Cincinnati.

He is also Chairman of the Health Care Committee of the Greater Cincinnati Chamber

of Commerce.

CORVA was one of the first designated health systems agency under the existing health planning law (P.L. 93-641). The Cincinnati Chamber played a major role in helping CORVA become so designated and involving business people in the health planning process, even as early as the mid-1960's.

Ohio is not alone in having responsible input and leadership in health planning from the business community. The Middle Tennessee Health Systems Agency (serving Nashville and environs) has also been responsible for a number of astute planning decisions saving the community millions of dollars in questionable health projects. John L. Brown, Corporate Director of Employee Benefits for Genesco, Inc., serves as Vice Chairman of the Project Review Committee for the Middle Tennessee Health Systems Agency.

In addition, Lachlan L. Lyatt, Executive Vice President of Butte Knitting Mills, serves as a member of the County Health Planning Commission in Spartanburg, South Carolina. And, Richard G. Wardrop, Manager, Employee Benefits Program, Aluminum Company of America, is a member of the Legislative Issues Committee for the health systems agency of Southwest Pennsylvania.

Finally, it must be mentioned that the current president of the American Health Planning Association, which represents most of the 200-plus health systems agencies, is Bernardo Benes, a prominent banker in the Miami, Florida area. There are, of course, hundreds of other example of business participation in health care. It appears that where business is represented on health planning boards there is more stringent review of health projects and generally the health care system is improved as a result.

The CORVA experience has been documented in an article which appeared in the October 31, 1977 issue of Business Week. CORVA and other agencies and business people mentioned above also are described in "Health and Industry," proceedings from a recent conference on business and health planning, sponsored partly by Genesco. The specific role that the Cincinnati Chamber of Commerce played in the development and implementation of CORVA is highlighted in this publication.

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CHAMBER POSITION ON S. 2410

We will address several major provisions of S. 2410:

Governing Board Members

The National Chamber supports S. 2410's provision to require that the selection process for membership on health planning boards should be made public. Also, at least one person representing business should be on all health planning boards. We also support the continuing education of these board members. To the extent possible, existing resources, such as the National Health Planning Information Center and Regional Health Planning Centers, should be used for this purpose.

State Planning Authorities

The National Chamber opposes S. 2410's provision to increase state authority in the planning process. State planning bodies, bowing to organized pressure, have in several instances reversed decisions by local planning groups, which would have saved the community unnecessary capital investment. There should be local solutions to local problems. Moreover, these decisions should come from private sources; thus, we favor limiting the number of public officials on planning boards.

Date Collection and Coordination

The National Chamber supports S. 2410's provision to improve the linkage between local and state health planning in so far as it will improve local health planning. Data gathered and analyzed by the Department of Health, Education and Welfare from these sources should avert the problems associated with the National Health Planning Guidelines issued in September 1977. Hospital bed-to-population ratios in these controversial proposed rules were intended to be a guide. However, because of their perceived rigidity, it appeared that their effect would be to close many hospitals located in rural areas. We hope, also, that the amendments to S. 2410 will avoid this confusion in the future. Also, data collection should be coordinated with Professional Standard Review Organizations and other programs with similar activities.

Capital Investment

All health care institutions in any area have a responsibility to help meet that community's health care needs without wasteful duplication of facilities and needless expenditure of funds. They should be required to make available their budgets, financial statements and scale of rates to private and public payers. All hospitals, extended care and nursing home facilities should accept overall decisions by area-wide planning councils, or be subject to penalties.

We also favor a project review process which recognizes the cost-effectiveness of health maintenance organizations (HMOs) and other alternative forms of health care delivery. Further, the planning process should address all health facilities, public and private.

However, the National Chamber opposes attempts to place an arbitrary national limit on capital investment and require health systems agencies to enforce these limits. Such national limits do not take into account those communities which might require more or less investment to accommodate local needs.

We support S. 2410's providing incentives to hospitals to modify their operation to reflect the changing health needs of their communities. For example, the closing or converting of unused beds for other uses should be encouraged, so that there is appropriate use of health facilities.

Health Planning Efficiency

Health care planning councils should be adequately staffed with competent personnel so they can operate efficiently. We support S. 2410's section allowing the funding formula for local health planning bodies to be based on the needs of the area and the financial needs of the local health systems agency.

SUMMARY

The National Chamber has long supported the concept of local health planning especially as it incorporates input from business people. Indeed, our advocacy for a "Council on Health Advisors" precedes by several years the actual formation of the National Health Planning Council, created by P.L. 93-641.

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Because of this relatively long-standing support for health planning especially at the local level the National Chamber supports the passage of

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S. 2410, with these reservations: state health planning authorities should not overrule decisions made at the local level; the number of public officials serving on health planning boards should be limited; and, the level of capital investment should be determined locally.

Under the present law, health planning is a relatively new process. Business has played an active part in health planning but recognizes that changes are needed to improve the process. S. 2410 should help in this regard, and the National Chamber supports its passage.

RE:

Written Testimony of the City of Philadelphia concerning
the Reauthorization of the National Health Planning and
Resources Development Act of 1974

Dear Senators Kennedy and Schweiker:

On behalf of the City of Philadelphia, I am submitting the following written testimony in connection with your Subcommittee's hearings on the reauthorization of the National Health Planning and Resources Development Act of 1974 ("the Act"). We believe that the experience of Philadelphia provides a graphic example of the need for revisions in the Act, and particularly the concept and structure of health systems agencies, to deal more effectively with the problem of the cities.

The National Health Planning and Resources Development Act has been law for more than three years. The City of Philadelphia continues to support the basic principles of the statute and particularly the concept of a rational and cost-effective health care system with meaningful and representative local planning and development agencies.