Section 1512 (b) (3) (C) (i) HSA Governing Body Composition

Section 1512 (b)(3)(C)(i) is amended by: (1) striking "(not within the twelve months preceeding appointment been)" and (2) inserting "including but not limited to unions and corporation" after "major purchasers of health care".

Section 1515 (b) (3) (C): HSA Governing Body Composition

Section 1515 (b) (3) (C) (iii) of the Public Health Service act is amended by

redesignating subclauses (II) and (III) as subclauses (III) and (IV), respectively, and by adding after subclause (I) the following:

"(II) include a significant proportion of individuals, through consumer and

provider members, who are knowledgeable in mental health planning and the

delivery of mental health services."

This written statement is being submitted for inclusion
in the record relative to the Committee hearings held on
S.2410, the "Health Planning Amendments of 1978."

This statement is being submitted on behalf of the Radiation Imaging Products Division of the National Electrical Manufacturers Association (NEMA).* This divisional trade group consists of 54 manufacturing companies of conventional medical and dental X-ray, diagnostic ultrasound, computed tomography, nuclear imaging and therapy medical technological equipment.

We support this Committee's efforts to insure that
national and local health planning is an effective approach to
achieving a much needed reduction in the health care costs of
this country. We would only ask that the role of medical
technology be considered a necessary component of all such
efforts to contain the rising costs of health care delivery,
rather than being too often denounced as a major contributor
to these increasing costs. Extreme indeed, when you consider
that the diagnostic imaging equipment industry represents only
about 0.6 percent of total health care expenditures.

I think there is widespread agreement that the twentieth century biomedical research and technological innovation have been responsible for profound improvements in human health. Some diseases have been eradicated; others can now be prevented; life itself has been extended; and much pain and suffering has been alleviated.

*NEMA is the principal national trade association of the electrical manufacturing industry. The Association has some 550 member manufacturing companies, which are affiliated with one or more of its 8 product Divisions, each representing in essence a separate and distinct industry. The electrical products within NEMA's scope are used either as components or as end-equipment in all major phases of the generation, transmission, distribution, control and utilization of electrical energy.

National Electrical Manufacturers Association

Further, I believe it fair to say that in a number of areas hospitals will have to look to greater utilization of medical technology to effect cost savings. It will be needed in more efficient and accessible emergency centers and outpatient clinics. It will be needed to replace older equipment with high operating and maintenance cost in order to reduce expenses. It is also possible that some hospitals will have to turn to medical technology under new cost reduction measures in order to maintain adequate and safe patient monitoring. Yet these same hospitals will be faced with artificial limitations on the use of new technology.

We would urge the Congress, and particularly this Committee, to be sensitive and alert to any health planning cost containment policies that could inhibit the growth of medical technology, thereby institutionalizing inferior procedures and inefficient practices.

We also believe that another serious question that should be addressed is, what will the impact be on the development of new technology to meet future needs? Obviously, such development is an expensive undertaking with considerable commercial risk. It will become even less attractive to an independent technology manufacturer if its fair market potential is to be arbitrarily reduced or indirectly capped. Health planning legislation could well carry a secondary effect as to whether new technology is to be limited and also how the development may need to be funded.

We would like to offer for your consideration several changes to S. 2410. We would suggest that under Sec. 141, the proposed definitions be revised as follows: the words "single purpose" be inserted before the phrase "diagnostic or therapeutic equipment," in both paragraphs 5 (A) and 5(B). We would also propose that the dollar value set forth in Sec. 141, paragraphs 5 (A) and 5(B), be changed from $150,000 to $200,000.

We believe that the inclusion of the phrase "single purpose" should be included due to our concern that in smaller hospitals, for example, construction of a new multiple patient service room would be requested under a normal certificate of need process. But the HSA could also ask for a listing of all the numerous but different types of medical equipments to be used in the patient medical room. If all the installed individual medical equipment were to be considered as an aggregate, it could result in a total dollar figure reaching or exceeding the certificate of need requirement for major medical equipment.

National Electrical Manufacturers Association

We have also suggested that the certificate of need dollar threshold for diagnostic and therapeutic equipment be only that equipment in excess of $200,000. We believe this should be considered to avoid the inclusion of lower cost basic medical equipment not envisioned to be covered under the certificate of need requirement. Such a dollar level would then allow the local HSA to deal with only major medical equipment of the high dollar-high technology type that is of

concern.

We also recommend that Sec. 1503 of P.L. 93-641, National Health Planning and Resources Development Act, be amended in order to increase the membership of the National Council on Health Planning and Development from fifteen to sixteen members. This would facilitate the addition of a qualified technology representative from the health care industry for purposes of bringing professional experience to the deliberations and recommendations of the National Council, particularly with reference to the National Council's responsibility for "(3) an evaluation of the implications of new medical technology for the organization, delivery, and equitable distribution of health care services."

We wish to express our appreciation for the opportunity to submit these comments for your consideration as part of the Committee's hearing record.

Sincerely,

Podent M M lune

Robert G. McCune
Division Manager

RGM: ev

Subcommittee on Health and Scientific Research
Committee on Human Resources

United States Senate

February 17, 1978

Chairman Kennedy:

I am Ruth E. Kobell, Legislative Assistant for the National Farmers Union, appearing on behalf of our farm family members.

We are pleased to have this opportunity to represent the views of the Farmers Union and we want to express our continued support for the health planning process established through the National Health Planning and Resources Development Act of 1974.

We believe the Act has already shown the importance of comprehensive health planning and we hope that changes made in the law this year will make it an even more effective instrument for providing quality health care service to all citizens at a reasonable

cost.

We want to commend the committee for its effort to make the health planning process more effective and more sensitive to the real needs of the American people. We also want to express our appreciation to Senators Clark and Leahy for their effort to represent rural interests in the amendments they have proposed. We were pleased to participate in preliminary meetings in planning those amendments.

As an organization representing farm people, we are concerned, about the imbalance between rural and urban people serving on the boards of Health Systems Agencies, the basic planning unit. Rural and farm people are simply not represented in proportion to their number within the Health Systems Areas. This imbalance cannot help but be reflected in the planning or lack of planning for health care services in rural areas.

Suite 600, 1012 14th Street, N.W., Washington, D.C. 20005

Phone (202) 628-9774

25-122 O 78 pt. 2 32