20. 21. 22. Lack of a hospital within community of practice Prospects of too large a work load Insufficient number of physicians for adequate relief Lack of Continuing Medical Education prograns Inability to use time of paraprofessionals (e.g. R.N., pharmacist, lab, X-ray techs) more productively with patients Professional status of rural-based physicians anong medical peers Other specialists moving into a heavily dominated General Practice (or Family Practice) community A General Practitioner or Family Practitioner moving into an area heavily dominated by other specialists Lack of adequate clinical and technological support Absence of Group or Clinic Association Practice Opportunity Dissatisfaction with public schools How would you rank the following incentives" that might be used (Rank 1, 2, 3, or 4: 1- most important, 4- least important) A graduate minimum salary quarantee Tax or other financial incentives for building and equipment Row would you rank the following recruitment techniques in their effectiveness for attracting health professionals to locate in small communities? (Rank 1, 2, 3, 4, 5, 6, 71 1 post effective, 7 least effective) Newspaper ads Recruitment visits with potential candidates Professional journal ads Word-of-mouth advertising National Health Service Corps assignments Other Federal or State Programs You may sign here if desired, however, no signature is necessary. Statement of the Texas Hospital Association Subcommittee on Health and Scientific Research Committee on Human Resources, United States Senate Re Amendments to Public Law 93-641 by 0. Ray Hurst, CAE Statement of the Texas Hospital Association Before the Subcommittee on Health and Scientific Research Re Amendments to Public Law 93-641 Mr. Chairman, I am O. Ray Hurst, President of the Texas Hospital Association, which includes both rural and metropolitan hospitals. Our organization has in the past supported comprehensive health care planning and was active both at the state and national level in this support. As you are aware, there was not in the past, and is not now, wholehearted support for this activity but I am here to speak in the support of the renewal of P.L. 93-641 and am most appreciative of your courtesy in allowing us to be heard. Our support in the past has been based on the theory of local determination as expressed in locally developed plans. Currently the debate centers around whether the planning process will remain an essentially local and state mechanism of resource allocation or become a federally controlled regulatory system. We oppose the changing of the basic concept of the program to one of federally imposed regulations at the expense of local planning. Although many points could be covered, local resource allocation is the major point of my testimony. Originally it was thought that planning would be of assistance to resolving the problem of an almost endless demand for health care with hospitals bearing the brunt of the increased demand. Increased types of patients such as short term psychiatric, patients suffering from drug abuse, alcohol abuse and patients requiring treatment heretofore unknown were admitted to hospitals in larger numbers. In this activity the hospital acted as the consumer advocate in attempting to meet this demand. net results were two: The 1. Hospital costs rose in direct response to the recognized public need for access and quality of care causing questions concerning how much should be spent on health care. 2. Hospitals were accused of empire building and their medical staffs pictured as groups demanding the very latest equipment for the purpose of selfaggrandizement. We viewed planning as a means of expanding the base of local input in assisting with these medical requirements which had assumed major social and economic significance requiring carefully thought out solutions with due care for local requirements and, above all, avoiding formulas that had limited or fallacious bases. This general concept was the basis for P.L. 93-641. However, in the implementation of P.L. 93-641 local and state plans must conform closely, if not absolutely, to national planning guidelines which, in turn, already have been issued as rigid formulas--formulas that if allowed to prevail will ration health care to the extent of refusing admission, in some states, to every fourth prospective patient. Authority for enforcement of these guidelines, although not specifically given by Congress, can easily be accomplished by denial of funds to Health Services Agencies who do not conform--as well as other sanctions. These desperation attempts to force local compliance to rigid guidelines stem from either a desire for power or a more generalized and understandable reason--the 25-122 O 78 pt. 2 55 |