REPORT ON REGIONAL MEDICAL PROGRAMS TO THE PRESIDENT AND THE CONGRESS i June 1967 CONTENTS FOREWORD SECTION ONE SECTION TWO SECTION THREE SECTION FOUR SECTION FIVE BZTHESD,l 14 MD -- 9 , SUPPLEMENT: Regional Medical Programs in Action. . , . EXHIBITS Page Summary. . . . . . . . . . . . . . I The Essential Nature. . . . . . . . . . , . 5 Activities and Progress. . . . . . . . . . 9 Issues and Problems. . . . . . . . 19 Conclusions and Recommendations. . 31 I II III IV V VI Steps in Preparation of the Surgeon General's Report on Regional Medical Programs to the President and the Congress. . . . . , . . . . . . . . . . . , . . . . . . . . . . . . . . . . . Surgeon General's Special Ad Hoc Advisory Committee to Develop the Report on Regional Medical Programs to the President and the Congress. . . . . . . . . . . . . . . . . . . . . . Planning Grants for Regional Medical Programs.. . . . . . . . Operational Grants for Regional Medical Programs. . . . . . . National Advisory Council on Regional Medical Programs. Regional Medical Programs Review Committee. . . . . . . , Page 37 VII VIII IX X 60 XI 61 62 XII 74 XIII 75 76 XIV Consultants to the Division of Regional Medical Programs. Program Coordinators for Regional Medical Programs. . . . Procedures for Review and Approval of Operational Grants. . Principal Staff of the Division of Regional Medical Programs. Complementary Relationships between the Comprehensive Health Planning and Public Health Service Amendments of 1966 and the Heart Disease, Cancer and Stroke Amendments of1965.............................................. Public Law 89-239 (Heart Disease, Cancer and Stroke Amendments of 1965). . . . . . . . . . . . . . . . . . . Regulations Governing Grants for Regional Medical Programs............................................ Selected Bibliography.. . . . . . . . . . . . . . . Page 77 81 87 93 94 98 1001 103 HEART DISEASE, CANCER AN'D ' STROKE AMENDMENTS OF 1965 On or before June 30, 1967, the Sur- geon General, after consultation with the Council, shall submit to the Secretary for transmission to the President and then to the Congress, a report of the activities under this title together with (1) a statement of the relationship between Federal fi- nancing and financing from other sources of the activities .undert&en pursuant to this title, (2) an apprais- al of the activities assisted under this, title in the light of their effectiveness in carrying out the purposes of this title, and (3) recommendations with respect to extension or modification . of this title in the light thereof. I `. ,. , Public Law 89-239 FOREWORD This Report on Regional Medical Programs is required by Section 908 of Public Law 89-239, the Heart Dis ease, Cancer and Stroke Amend- ments of 1965. The significance of this requirement was highlighted by the Senate Committee on Labor and Public Welfare in its Report on the Heart Disease, Cancer, and Stroke Amendments of 1965 : The Committee views this require- ment for accomplishments and recommendations for further devel- opment as an important and integral part of this legislation. This program provides the opportunities for major innovations . . . The impressive en- dorsements of the concept of the program give a basis for launching the program as soon as possible, but the final form in all its particulars is not, and cannot be clear at this time. Therefore, the need for careful and continuous reevaluation assumes a special importance for this program. This Committee urges that the pro- gram be administered at all times with a view toward the identification of productive modifications for sub- mission to the Congress when the ex- tension is considered in the future. For the most part, this Report describes progress and experiences during the 20 months that have elapsed since the enactment of this legislation. This period encompassed the time-consuming process of ini- tiating organizations at both the na- tional and regional levels, assembling key operating staff, and developing program guidelines. These tasks have been accom- plished with dispatch. However, the period of actual operations has been so limited that firm conclusions can- not yet be drawn concerning some of the issues emphasized in the Con- gressional directive. On the other hand, the general shape and direction of program de- velopment has clearly emerged dur- ing this period. The quick and enthusiastic response it has received indicates that it can fill an impor- tant national need. The great op- portunities this innovative program presents, and the critical issues with which it is confronted, have been brought into sharper focus. To be certain that full considera- tion was given to all aspects of this initial Regional Medical Programs experience and to assist in forging the conclusions and recommenda- tions in this Report, we sought views and advice of a wide range of in- dividuals expert in medicine, health, and public affairs (Exhibit I) . Last fall, I appointed a Special Ad Hoc Subcommittee of the National Ad- visory Council on Regional Medical Programs to help in the development of the Report (Exhibit II) . A na- tional conference of some 650 per- sons, representing a broad spectrum of health and related groups through- out the Nation, was held in January 1967 to discuss and exchange views on the development of this program. This conference provided the back- ground for the initial drafting of the Report; the Proceedings: Conference on Regional Medical Programs have been published (PHS Publication NO. 1682). The essence of this Report, I am pleased to note, is that Regional Medical Programs have made a sub- stantial and impressive beginning. But it is only the beginning. The task ahead is to bring to fruition a truly unique and promising venture de- signed to advance the effectiveness and quality of medical care available to those who suffer from cancer, heart disease, stroke and related diseases. Critical issues remain, and effec- tive regional programs are not yet completely realized. But as we enter the period of full operation, the prospects for success appear highly favorable. Looking to the future, the single most important condition for further progress is to sustain the enthusiasm, vigor and cooperative spirit of the many individuals who have volun- tarily undertaken this pioneering ef- fort in the Regions throughout the country. To do this the national commitment to this program must be clear. If these conditions are met and the potential of the program is realized, health resources of the Na- tion will move forward, region by region, in building new patterns of collaboration, and people suffering from these diseases will receive the care they need, more promptly and more efficiently. William H. Stewart, M.D, Surgeon Genera Public Health Service U.S. Department 01 Health, Education, and Welfart