lop *p REPORT ON REGIONAL MEDICAL PROGRAMS June, 1967 z@ -@ r,@, 1 @7 @ I t ... I ON REGIONAL MEDICAL PROGRAMS- TO THE PRESIDENT AND THE CONGRESS Subtizitted by Pvillt,alll H. stetva?,t, M.D. Sit?-geoti Getieral Piiblic I-leallh Se@-,)zce U.S. DEPARTML,'JVT 0 I,- I-JE@ A L TH, L,-DUCATION, AIVD P17L,:LFARE junc 1967 CONTENTS Page FORR,,NVORD SECTION ONE Sumi-nary..... I SI-"C'I'ION 'I'NVO The Essential Nattii,c ............... 5 I r[ON A tivities and Pi-ogress ............. 9 s I,, c,. c SECTION ]OUR Issues and Prol)lci-ns ................ 19 SECTION FIVI," Conclusions and IZecoiiii-neiidations.. 31 I'ilgc I'ag SUPPI,I,,Ml,"Nl.': Regional Medical Programs in Action.... 37 N7[[ C.oi,siit;ijlts to the Division of l@cgioiiil Medical 1rograiiis.. 7 EXHIBITS N'llt Program Coordinators for Regional Medical Programs ..... 8 I Steps in Preparation of the Surgeon Getieril's Rcl)ot-t on I\ Ili-oct-ciiir(-.g for R(,-viewiii(I Al-)proval orol)criti(iiiil Griiits.. f@ Regional Medical Progriiiis to the 1'r(!si(lent ;in(] the x l'i-iticipil Staff of the T)ivisic)ii of Itegioyiil Mcdicit 1'rogrlins. Congress ............................................. 60 xi Complementary Relationships between the Comprehensive 11 Surgeon General's Special Ad Hoc Advisory Committee to Health planning and Public Health Service Ai-nendTncnts of Develop the Report on Regional Medical Programs to the 1966 and the Fleart Disease, Cancer and Stroke Amendment-, President and the Congress ............................. 61 of 1965 .............................................. III Planning Grants for Regional Medical Programs ........... 62 XII Public Law 89-239 (Heart Disease, Cancer and Stroke IV Operational Grants for Regional Medical Programs ........ 74 At-nendments of 1965) ........................ I ......... c XTIT Regulations Governing Grants for Regional Medical V National Advisory Council on Regional Medical Programs. . 75 Programs ............................................ I( VI Regional Medical Programs Review Comi-nittce ........... 76 XIV Selected Bibliography .................................. I( CANCI,'Ilk AND S'I'ROKI-" ANII-"NDMENTS Ol.' 1965 Oil or before June 30, 1967, the Stir- geon General, after consultation with the. Council, sliall subiiiit to the Secretary foi- transmission to the l,rcsicierit and then to the Congress, a i-cl)ort of the activities under this title together Nvitli ( 1) a statement of the rclitionsliij) bctnvccn Federal fi- iiciiig and financing from other ]la sources of the activities undertaken ])Ursuatit to this title, (2) all al)prais- al of the activities assistcd under this title iii the light of their effectiveness iii (-,ii-ryiiig out the I)url)oses of this title, and (3) recommendations with respect to extension or modification of this title iii the light thereof. Pziblic Law 89-239 section 908 'I'Iiis l@cl)ort on ]Regional Medical the time-consuming process of itii- tiojial conference of sonic 650 pcr- commitment to this program must be Programs is j-(,(Iuirctl by Section 908 tiatitig organizations it both the, iia- sons, representing a broad spectrum clear. of I)til)lic. L-.t%v @39-239, the fleart ])is- tiotial and i-c,,-ioilal le%,cls, issciiil)liii.@ of licilLli itid i-cl@tted grOLIIJS through- If these conditions arc met and ("Ilse, Ciiicci- an(] Stroke Aiiien(l- key operating shift, iii(I (lc%,clol)iiig otit the Natioii, A,as held in January the potential of the program is 11)(Itits of 1965. 'I'lic significance of ])I.Ogl-iiiii guidelines. I!)67 to discuss and exchange views reali7cd, health resources of the Na- this i-e(.iuiremeiit was highlighted by 'I'liese tasks have. 1.)(!eti iccoiii- oii the development of this program. tioti will move forward, region by the Set;-.ite Cojiimittce oii Labot- and 1)listic(l %%,itli the 'I'Iiis conference provided the back- region, in building new patterns of I'Lil)lic Welfare in its ltcl)ort oti the 1)ci,io(I of ;i(-ttial aberrations has been ground for the initial di-aftiiig of the collaboration, and people suffering 11(@art I)iscase, Cancci-, and Stroke so limited that firm conclusions (.-.an- l@I)ort; the I)roccedings: Conference from these diseases will receive the Amendments of 1965: not ),et be drawn concerning some of on Re ioital Aledical Pro@ra?tzs have care they need, more promptly and 9 the issues emphasized in the Con- been published (PHS Publication No. more efficiently. The Co??z?)zittcc views this reqzitre- gl-(,.Ssiotial (Iii-ecti,,,(- 1682). William H. Stewart, M.D. ?11(,Ilt for acco?piplish?tir?tts aiz,,l C)li tll(! otlict. hand, the 'I'lie c,.sclice of this l@cl)ort, I am Surgeon General ri,cotpt?ptc?tdatioiz.f for fitrthrr (level- sli@ii)e. and direction of program (le- I)Icase(i to ?iote, is that Itegional Public Health Service optii(@ytt as an ittipo?-Ia?tt aiiii t?itcLyral , I V(-.iol)iiiciiL (!It,,tz-ly (iiii-- Nle(li(-.,tl Ili-ogt-.iiiis litvc made a sub- U.S. Departyiie?zt of I)ai-t of this Irgi.51titioti. 7'his prot!i,ai?l .1 provides the opportunities for itzajor itlg this (ILlick and sLaiitiiil ;iiid impressive beginning. Health, L,ducatio?t, and lYelfare innovations . . . The impressive c?z- enthusiastic response it has received 13tit it is only the beginning. The task (lorsciiie?it.v of the co7icept of the indicates that it call fill all iiiil)ot-- ali(-a(i is to bring to fruition a truly p?o.t!?-aiii gizit- (i basis for leiiiytchi?ig tatit national great ol)- iiiii(Itic iii(I promising venture de- the pi-ograipt as voo?t as pof.Tible, but I)ol.ttllliti(-S this illl)oV,'Iti%.(. signed to advance the effectiveness the final fort?t in all its particulars is presents, itici the criti(-;il issues Nvitjl and (juality of medical care available not, and cannot be clear at this ti.Inc. Nviiich it is coiifi-oiite(l, lia%,c been to those Nvlio suffer from cancer, heart 7'ht@refore, the need for careful and brought into Silai-l)ci- focus. 'disease, strokc and related diseases. continuous reevaluation assuptics a . To be (-.ci-tain that full coti-,idcra- Critical issues remain, and cffec- special i?iiporia?zc(! for this progra@ii. tioli Nvas given to all aspects of this live regional programs arc not yet 7'liiv Co??z?)ilttre urges that the f;ro- initial ltegioiial NIcdicil I)rogi-atns completely realized. But as we enter (!XI)Ci-ictict! arid to assist in foi-,giiig tli(- I)eriod Of full operation, the .@reit?t. be adiiiiyiivtcrctl at all t'??Irs the conclusions arid recotyiiiicii(la- 1)rosl)c(-,ts foi- success appeal- highly @(,ith a view tozvarel the i(ic?ttifictioll notes in this ]reports we sought views favoi-,il)](-. of productive ?tio(lificatioizs for .(Itb- arid :I(Ivi(@(@ of .1 %vi(l(! range of ill- I,Ook-iiig to the future, tile single t)tl'.isl'ott to the,- Co?tgy-(-.(s when the ex- (livi(ltt;ils in health, iiiost important condition for ftirtlici- :111(l I)III)li(: (I-'Ixliil)iL 1). ],east I)t-ogi-ess is to siistaiii the enthusiasm, I"ot- 'tile illo-,t ratio ltel)ol-t fall, I appointed t Special Ad lIo(: %pigoi- atiti (-ool)(,-rative spirit of the describes progress and experiences Sul)coiiiiiiittc(-, of tlit- Niti(mial Ad- iii@iiiy individuals who have volun- (hiring the 20 months that have visory Couii(-il Oil Regional Medical tai-ily undertaken this I)ionIcering ef- elapsed since the enactment of this Programs to licil) in the development forL in the Regions throughout the i(.Ilisk-itioii. 'ritis period (encompassed of tli(- It(-I)oi-t (I-'Ixiiil)it 11). A iia- (country. 'I'o (lo this tli(- national Summary Itcgioiial I\'Icclical 1'rogi-ains liavc made an iiiil)rcssivc beginning. But it is only -.t beginning. Mucli is yet to be (]one. Many I)robl(@ins and is- stics are ),et to be resolved. I-IoNv- ever, if the future is iiiarke(I by Llic sainc ctitliusiasiti iiii(I cooperation and our national cojiiiiiitiiicnt is sus- taiiicd, a major change relay Nvcll be ,%,rouglit in the Nvorkings of Amcri- can iilc(licitic. This change -,vill benefit the licaltli I)rofessiotis iiii(i I)i-ing great 1)(@iief-its to the Aiiiericaii I)COI)IC. SECTION ONESumi-nary tion, to meet tile special requirements the 47 fii-qt Y(!ar gr-,iiii, ,,,),)Oilltiiig ,itid convciii,ig thr oi-y Gi,oill), -111(.1 rc- of ]regional Mcdic@al Progrims and 11, October I()65 President .1011"sO" tNv;ti-(Is LoL;li ,I)Otit $20 illillioll, ;"'(I A(Ivi,,, Lo c witli related 89-2.39, tll('. S(,(.011(l .tl)ottL $ I)rograiiis. Ill(l @tl'oke Aiii(,,,(I- initial cxl)(!riciice described in lioll. (]"%Ilii)it eff ect've nzccliani-57n should be Sc,rvic(! t cicilioiistrates the I)ro- An I iiiciits to tile IleiltIl , csc -L@@,,trds iiiis l@(@I)OI, itd other l@ecrioiis enc()iiil)a,;Scd ill ing the found to assist interregional a Act, aLltliorizing grants to hcll) cs- contain ,ibotit !)O I)cr(,ciit of tli(- N,,i- I)otclitiil for iinl)rov cessary to the licalLI1 Of tile Aiiiet-icaii people. To ities ?te tili)lisli R gioll-,ti Medical Prograiii tioll'S i)Ol)iil,-Itioli. ',',IC 1)(,gilillilig supporting activ egional Medical to cotiil)at licart disease, cancer, II-,ivc be- fulfill this I)Otcntial, tile following develop?nc?tt of R stages of I)t,ograiii ol)ci-atiotl,; clearly indi- Proara?its. This assistance will facili- sti,oke, and related (.Iisc,,lscs. 4. l@egiol"; witil tile S'll)l)ort of recoiniiiendations are, rk and i,@Tlplcmcntation of 't'llis 1)rogr.-iiii li,-td it.-, origii, ill tile totaling $6.7 million'. (Exilil)it catcd: -tatc tile wO nal Medical Pro- i,ccolillt)Ctidations of tile tioti-,tl al)l)licatiolis foi- program should be estab individual Rcgio ioii on Ilcart Disease, Can- \7) A(.I(li llti?tiiiiz,, basis. There is gi-anis. coiiilliiss grants to 11111)1)01,t )Illlllillg (covering ii.5lied oil a co icing (-c,i- and I)tr(jkc,, I)rcsclitcd in Dcceill- of tile Country (@,vel,y indication tll,,It tile al)l)roacil n Patients referred by pract Its alternate goal, like that iw 119-239 is YC,Itists should be included in the re- if, is to liell) lill(i(ll, ,evic%v ol' (.Icvclol)lll(.Ilt. authorized by Public L, omisitig. Extensioil of tile earcli, traini?i,r and dcrtto?tstratiO?L Of tile Coillillissioll itsc oil this record, i)rogrc,;,; in the valid and I)r s iii,ike tile best ill iiio(lcllll lncdi(,@,al sci- It of ltegioll,,il Tvicdic-il I)t,ograiii, buil(.1iig upon the initial activities carried out as necessary COI)IC (I(@velol)in(-i pilot projects, will lead parts of Re,,ioiial Medical Programs. eticc readily available to Ill 1) substantial. It is I)art'c- planning and who ,u[Tcr or ,'cc threatened i)y these 1'rogr, -carnation' of its potential and will .cs- r7 Federal hospitals should be co?z tilarly iiiii), ,ive %when vienvcd in the to I c attack iii-,ijor diseases. (011text of. the initial task@-, that to contribute significantly to th Videred and assisted in the sa?nc way ,ro accolliplisil this I)url)ose, Public I)C I)CI-foriiic(l. iliclil(l(-(, tile oil these iiiajor diseases. as COT?z??IU?Lity hospitals in planning Law 119-239 proposes tile establish- within tile Health Adequate ntea?is should befou?td and carryin,, out Regional Medical iiient Of direct tiid colititil'Ot'-s liiik- (-rcitioll uctio?l Of Progra?ns. Servi(-e of , iienv a(linillist(!I-illg orga to 77icet the needs for co?tstr ,,sciiiblilig of ,talT. this program and the agcs between the patient, his PIIY' 'izatioti -tllci tile SUCIL facilities as are essential to the TJnderlying cvcl- iii,, community hospital, and the gui(Iclitl(.,,@; liid to be d primroses of Regional Medical Pro- recommendation for its extension is Natioil'.'; Cclltc@ of scientific and oi)cd and I)roiliulgated; criteria and gra?rts. A limited amount of new con- the broad national concern over the academic medicine. It seeks to unit,- mechanism,; for review of grint al)- strliction has been found to be es- of the Natioii, extent to which new medical knowl- the licaltl-i resources (-stablislied. Tile of the )Iic,,itions had to be scritial to achieve tile purpose, edge and technology is brought rap region by regalia in close working iiiaiiy issues -.iiid I)i,ol)lcrn-s )t-t-scritcd Programs; priority needs arc cduca- idly and effectively into use in health relationships wliiclk will speed the by this it, federal y in Corn- ughout title knowledge,, north facilities, particular] ' services and medical care tliro transmission of I;cic" I)IC NVIIOSC lives Health action :111(i iii- itilitlity Authority to assist the Nation. Tile lcgislatiot, proposes to the I)CO tile construction of new facilities, telisively (lis regional frameworks for accelerating depend upon tile'''- ctis,,ed ,vitil iiclividtials itial bill 'I'lic first stages in the development from all 1)arti of tile. Country. Ill each %viicli -a,; rcciticstcd in the ill this transfer. it envisions two-way s Ite,@1011, iiiitiil ta,;ks incurred %working in 1965, was set aside during the co''- flows of useful science and technology of the ]regional Medical Program :n f the bill in the Congress. r,,vay. As of June ollt tile base, foi- developing regional ,idct-.ition o between academic and scientific cp-n- arc now Nvcll uiide Illlollg iii,,ijor li(".iltll 'I'liis Tilodificatioii should be carefully gencics and individuals who 10, 1967, planning is moving fornvai-(l (I(,sigzictl, in iiiiotint and a(linini,,;tra- tars and a of 4.7 Itegions %vitil tile -,til)l)ort 3 ll\etriotial Medical Pro,@i'am-9 colyiple- litis that ciiir-,ictcrize ill(! Aiilc"icill e- local mcnt of a Regional Program. T me of tile, (Iti(lstiolls iiielit Other 17e(lcral lic',tltll program,;, iver medical care in tb the character of the individual pro- health seen(,. So partictilai, terms the Cornl)rchcn-,i%,c,, nmunities of the country. t tile are generated by ill I iliiti',Itccf ,Is they rcflcc the graTns will vary NN'llicil ill(.. ll(-altli I'laniling ro ,Iccompli-,h these purposes) (lifTcring iiccd,,, rc,;olircc,;, and I)at- of ill(. ic-gislatioil iiii(l(!r labile l,a%v Sf)-749? w authorizes tire awtrd of grants in ol)ei,at(,s. Still others (!merger I)rogi-,, the planning and then for the terns of relationships. from certain I)roid changes %viiicii ai7c E] I-loxv call local programs over- ,il arrangements, The experience gained in tile year illel- (I(!vclol)mcnt (@ollic l,"Cl, of Space to carry out cer- oration of region, cc the first grant was made has inherent ill the flIr and functions signed to stimulate new pattern,.; sin that of these progrlms. tain of tile activities rovidcd considerable evidence ngen(lerc(l by Rei,ional M(!rl- cooperative action among PhYsi-p Tlt 'll,lollt! till.,s(, (,,,(.stion% being c nivcmity medical new cooper.,ttivc ,trr,-tngcmelits cin 1)(, Significi i(.;ll 111-of si):'C,(! fol 'ttiOll? ins, hospitals) health (lev(.Iope(I among institutions '111(l ill- ill,'. follon@'ifill inLr liters, public and voltint,' (tivi(Itials involved in Health tn(I Claii tilt-! cotitinit , ccitic- ,encies, racii regional arrangement s of health in(i medical In a(-ldition, it has been difficult medical afTairs. Regional group reP- ivailai)ilit' cl ttc a coordinated y tould h p to cre, IC area of heart thus far to obtain more than ,t tcnta- resenting a wide variety of interests ti rogram encompassing research care sel-@,ic(,s in t I @l I (,(I t'Vt, ('0111111itT]it-nt front ,,Italy insti ,,(I functions ]live colll(', tOgc ll(" 'I' Stl'Ol@(! :111(i I'('l I - -aining and continuing education, .1 111(lits- is because of 11 'I- s and rc- Ilii iiiii)recc(l(-.nte(I fashion to 1)1,"" (tisc;lscs 1)(! "igilifi(-,Illtly ;Ill(, ttitioiis and indivi(itia ,tticnt care demonstration and work coopcrttively oil (common Illy (Certainties over the ii,,itional intention i,ted activities. Its goal is to advance needs and goals. Over 1,600 iii(livi(l- lira he accessibility and the quality of iedic-,il Are ill(' I-egiollii i(iiiiinistriti%,(! and tile limitetl duration of.,,,ttlioriza- tial,,, including physicians, n is fol- it(-gional r\,I(@(lical tiiroiig litities (I(. for tli(!s(! J)rof I",Illls tiol, foi, gr'.ITI icaltli service,.; available , holit educators, hospital administrator,,,c .\,Clol)(-(l - he region for heart disease, cancer, viai)l(- an(I o%,(@r:t long period llrogi,aitis. Assurances of longer Sill) ;troke and related diseases. public health officials tnd members of time? port are essential to maintaining it'(' The emphasis in this program, rc- of the general public are serving on Can voluntary ),.Ofession,,il and vigor and achieving ill(- objectives of a,ckground Regional Advisory Groups. They are El Iccting the legislative b performing ,tn important role ill the institutional compliance be obtained this i-)rogram. prob- from whicli it emerged,, is on local and use of planning. This planning and development of tile in- in tile efficient disposition Many of these i,-;ucs and initiative and local ividtial Regional Medical Program. critical iii@inpo,,%,(,r, facilities ,ind lcms will be resolved in the future approach is intcndml to sustain thed . . atc that other resources oil a i,(-gion,,ii basis? conduct of the program. Others will essentially private and voluntary it seems reasonable to anticip tivc or legislative (-Ilaracter of American medicine. At workable mechanism,; for accomplish- Ej tlit! activities gcn(,,rat(!cl require either cxecu it permits the use of ing the goals of the Heart Diseasei under itegion,,il 'Nlcdical Programs af - action. the same time, -Cancer anci Stroke Amendments Oft care costs incl influence ]Zcgion,,il Medical Programs have federal funds to stimulate and sup 1965 wiI11 progressively emerge based [cc can made an impressive beginning. But port innovative appro',tc'ncs to Corn- on these initial cooperative efforts. the (-xt(',Ilt to Nvllicll -"tell costs )tily a beginning. N'turil is Yet to rnon problems under local leadership. be met I)y normal financing rn(!thocls it is An advisory group, representing 'I'licrc are., J,oNvc!v(,r, uncertainties'; stli)l)o"t still to be ,e., ,Olv(.,(l in the regional ]learn' interests in cacli in(I problems gioiial -se of the con- the further evolution of this program. il)S Region, including tho ise out of service, is require(] by law In part these questions ar stimers of slioill(i I)(. t-still)lisll(.(l I() ,,is ,in essential step in tile develop- ill(- diversity ,in(i complexity Of "'I'Iie ol)jectivt- ol' tills legislttioli is to I)IIii(I fl-()Ill sit.(.Il!!.Ill .111(l to I)t@0- N,I(I(. tIlosi! Illc(.11:11lisnIs (."ill ill(! ,otir(7(t of streii il,tli ill(, (if ill(,. coiiiintirlity . . . NV(' NV(@ill(I llol)C tli;lt III('. . . . iis t ;ifriliflc,,iiit ol, ill(.. of to oil I)ati(,tit ol, "(.i- I,iitili(7 fit,,,, (;Ottllllittl,,. oil, ],(zboi- o7 SEC'T'IUN The Essciitial Nature ;It( ) I INI) of to .111 tll(@, grotil)s and areas not sharing fully in aratc and independent components of l@(!I)(Art of tii(- Goiii- the overall progress. Efforts to iiicct the health enterprise, and 'the lack of illissioll ()II 11(@.ti-t I)is(.;Is(., Along %viiii gi-(-;it tli(,s(@ tli(-s(@ (leiiiaiicls for set-vices have been financial resources in sufficient N%,,ts tli(- I)I.ol)- by iiiiiil)onver and ft- tiiiotints and duration to assurc con- (1i;Lt(.. stiliiiilti,, fol- tll(.. I(.gisiitioll tli;it I(.Ills. I (@ility shortages an(] increases in costs tiriuiiig stability. I)e(-aiiie l'ul)lic I.a%v II!)-23!). 'I'liat foi- of i-al)i(II), of medical care. 'I'lle present (lay Circumstances of I-CI)ol-t, isstt(,(l ill of 19(i,l, ktiox%,I(-(Ig(@ ;laid moi-c efficient and efrcctiv(! use of the I)i-.icticc of medicine and the de- ;t of ogy. NVIIII(- Sl)(.(.i;tliz@itioll ]),'IS Ill% been sought livery of health services inay provide ;Iiiijt!d at the (lev(!Iol)iii(,iit ;t(,i-oss tll(! lt'V(-IS of it li,,isil.@o tlii-otigii i-(@gioiiilizitiori for itiaiiy itiorc suitable conditions for the nation of regional cojiii)lexcs of iiic(l- tli(- frigiii(,iiiitioti of set-vi(@cs, )-ctis. It has also I)ccii viewed as t growth of the regional approach. The ic.il facilities and resources. 'I'I)csc the I)t-o(,css of (lelivet@iii means to I)i-oadcii the availability of physician is the part of a coni- 9 ivoill(i function as coordinated sys- iii(-(Iical (-are. At the siiii(@ tljii(, the high quality health services. In 1932, 1)lcx system involving closely related tents to provide specialized st,-rvic(-s I(Ivallcc of scicllc(,. tlil,("Itclls the tile Committee oil the Costs of Mccii- facilities and ancillary services. The for the benefits of physicians and 1),t- heavily burdened ])Iiysi(:iaii with (-al Care focused attention oil this hospital has become the central in- ticiits in the several geographic -treas. I-;Il)i(I ol)soles(-.cii(.-e, of ktioxvlcdge. tl)l)roacii. In the same year, tile slitutioii in the community medical In tile longct- perspective, liow(,-%7e I., tlii,(,,tt in ttit,i) i,,iis(l@s I)C%V ))I.ob- ]3iiigliatTi Associates Program of the scene. Prepayment plans and group the ]@cgioiial Mcdi(,,;il l'i-ograiii (-oil- I(-iiis ill (-i)iiiiiiiiiii(-atioii all(] (,-citica- 'I'lifts Uriivei-sity-Nc%v England Mcdi- health programs contribute to coordi- ccl)t is the result of many ideas and tioii. Ne%v patterns of relationships;, cal Gentct- initiated the first coiiipre- nation and common action. Federal trends that have evolved over a I)(-- s)-stciiis of service, and mechanism.-, liciisive regional medical effort in the programs committed to social prog- '11'(! Cl'i 1-iocl of years. These include some of I nearly needed in iii(.(Iicitic, as United States. About 15 years later, i-css provide a pervasive force for the so(-ial, ccotioiiii(-, ttid sciciitiri(: in otlier fields, to co[)c %vitli and ex- similar ideas %vcre included in the action. change% -.Iffcctillq -.111 of ,;oc@i- 1)loit advances of science fc)t- the Report of tile Commission on I-lospi- Tlius tile regional concept emerged (.t%-, ;Is %vt.ll ;Is (I(!V(-Iol)lll(-Ilts ill tll(- (I(.- of tli(- 1)c!oj)lc of the Natioii. til Care and kv(!rc, in turn, reflected again in a nc%v form, in the major livery of iii(-(Iical and health services. ()tli(-i- important forces II-,Lvc also in he(-. I losl)iL2tl Stit-v(!v and COIISLI-Ll('- recommendations of the Prcsidcnt's The progress of science has exerted contributed to tile (-auditions and tioii Act of 1946 (Ilill-liurton Pro- Commission on Heart Disease, Can- ;I J)Owcrftil force foi- change. Since needs xviiicii set tli(,-.stage for ]@egional graiii) - Wliil.c other regioriali7atioii ccr and Stroke which proposed the "'oi-l(l War II great stricies lia%,c I)CCII JNIC(]iCll I'l-ogi-,iliis. factors plans have been advocated and at- development and support of "region- ill extending tilt! fi-olitict- of lia%-(, tli(-. 1)ul)lic's (,%I)ectatioil t(!iril)tc(l from time to time, these ef- al medical complexes". This proposal ii.icclic,il ktio%vlcdge arid capability fol. Heart]): the rising (.(.oiioinic c-,il)a- forts Nv(@t-(! largely isolated and called for substantial and sustained 'I'Iiis t(lvaiic(! ]],-is I)ilit), of tli(@ N;itioii, the liiglici- geii- Irritated. Federal support as an essential con- Of ('(IlIC.ItiOll Of tile I)Ltbli(-, I-'Ifl'oi-ts to achieve regional organi- ditioil Of Success. tly tai,ittlii of medicine to (@Oll- tlii- 1.(,(@ol.(l of sti(.(.(.Ss ill tile (.olltl.ol of zillion of I)i-ivat(-, and voluntary health t(@ll(I with the problems of licaltli aiic) tll(! iiiijoi- Colilliltlliical.)I(- diseases, sci-vic(-s liav(,, not been notably suc- I."SSI-"N'I'IAI, disease. It is providing a ftiii(laiiicti- otlict- ocial I)i-ogi-ess. ]it ad(li- cessriii. 'riie. reasons vary, but in N A'I'U R I:, t-ii illiberal% for progress in health, tioll, iittioll.11 has focused oil general they reflect the difficulties of President Johnson, at the signing of .,tilIlLilat'ii,g intensified cfrorts to bring the si)(!(:iil 1)i-ol)l(@iiis of disadvantaged Inducing common action among scl)- Public La@v 89-239 on October 26, 1965, saici, "Otir goal is simple.: to operation ivitli, 1)r.,i(-.ticiiig The, program design inherent ill is (Icfiiie(i in tli(-, Congressional in id -i-i%,(,s fi-otit :t of ])III-[)OS(.: speed iracies of medical research medical center oflicials, hospital . - iltil)lic 1,;t%v ll!)-2'@!@ (](. from the laboratory to the bedside." iyiinistritors -,in(I other health xvoi-l@- series of 1),Isic concepts: traizts, to 4!itcoit?'a,,t' e7?1(1 The bill lie signed into Law on that crs, representatives from appropriate 7'he boost itt (lia,,?iostic assist lyz the rstablish??ti-?it of i-(,,,io?ze7l occasion, the T-Teart Disease, Cancer voluntary health agencies and i-n(,ni- ?it(-tliotlv iv ?iot and Stroke Amendments of 1965, I)cn of the public. 'I'lic law specifies ?tz,,,(Iical school.v, r(.-,@(.,arch in.@tilittioll.v, stated the same goal iTi slightly differ- that there sliall be no interference i?lg fp.otli or b lica?-t (lis- a@i(I hospitals for research a?id tr(7i?i- cnt terms: to afford to the with patterns or the methods of fi- I:i7.@(', c(itict,r, .@t)-ok(@, nit(I itt(, (I?ictridi?ig co?iti?ziiing (,ditca- medical profession and the medical nancing of patient care, oi- profvs- tio?z) aizd for related dc"toyzstratio?i.@ institutions of the Nation . . . the sional practice, or with the of p(iti(!?it car(., i?t the,- )f heart opportunity of making -tvailablc to tratioii of hospitals. capic(,r, stroke, e7?z(l a,7tio?i tht- their patients the latest advances in 13ecatis(- this broad i-itilg(- of (-o- the diagnosis and treatment of [heart operation is the (-(,iiti-al of tllt,?-e7petitic capabilit'1, i?z tlt(., ??zajor (-i.,?ite@'s, r(,ht,re aii (,ffrctiv,., 'I'litts, I)ttl)lic Law 89-239 i-epre- disease, cancer, stroke and related Itcgional Medical Programs, (@,icli Piterplal, bcfzc,t,(,?i rt,.v(,arcli, lenClli?l(r, investment in i-egionii diseases] program is required to -iii ?id pat .'(,?it care ca?i bi-ip?,, rapid a?id initittivc. Tt invites and suliports the l'o ,iccomplisli these goals, P.L. advisory groul) representing the x,ari- a I I (,i-catiori of new patterns of (,oc)pcra- 89-239 authorized t 3-ycar, $340 inil- effectit,(, application of earn ttzcdical lion program of grants for the plan- otis health resources of tli(- region and a@id ili(@ ?ti(-dical capabil- tiv(,- :ictioti itnong physicians, allic(l incltitling constinict- participation. workers, liosi-)it-.tls, medical nin,g and cst-,Yl)lislimcnt of Regionil 'I'Iiis group has the important fiii-ir.- (@(-ntei-s, universities incl research in- Medical Progrims. 'I'liese grants pro- E] 7'ltt@ it,ill co?'- tion of aSSLiring f till collaboration an(] to th(, co?iipl(..Vit), of stittitions, in(I voluntary health vidc support for cooperative ar- I . . . r.ingcments which would link major advising ill the participating insti- Pnnki7ig (available to (711 ill,, potential Urgencies, and the. constii-ner- of health ttitions in planning iTicl cii-r),ini!, otit Services. medical centcrs-tistially consisting b(:?zefits of t)io(l(,i-it of a me(licil school in(] tfliliate(I tli(-, program. F-I of reaching liospitals-Nvitli clinical i-(-- '['lie Ultimate (-,I)je(-tiv(- of lzcgiori,.if search centers, local community lios- Medical Progriiiis is (-Icir in(i i,ii- of thf, Iiill pitals, an(] practicing physicians of equivocal. 'I'lic focits is on the rate(,(, of ?-e,gioii's ?tie-dice7l find It(-,gioiiii Medical Programs put into the Nation. Grants arc atitliorizc(i for The object is to infitien(,c the present @(lintt,(/ I I planning and feasibility studies, -,is arrangements for health services in i practice tli(@ tliit (@ssent'.-it 0 'I'he- iliz,i-t,sit of local II,-nltll responsibility in(i 1)o%v(@i- foi- tli(! iiii- @vcll as pilot projects, to demonstrate manncr that will permit the best in atill resources i'altv for th(.- eiv- 1)i,ov(!Tii(@tit of health services slioti](I the value of these coopcr,-ttivc rc- modern medical (-at-(- foi- licirt (lis- viii).tl)tl'ott of bli (,(I('h (@x(-t@cis(-(] In(-ally. 1).isi(, I)olicv .gion-,tl -irrangcments and to provide i else, t'..Incer, stroke in(i related (]is- fee tht, of (I of Ill(' is (I('SigT)('(l to ('tl' base of experienc(-, for further dcvcl- cases to be available to ill. 'I'lic scol)(@, coll(71)o@(itti,i, actio?t bi-@t te) I't@ (-Oiti-.i -titiov, ,qe I ttiori, t(lzti)tatio?i -iii(i opment of the program. of the program is n-,itiori%vi(Ic, cilcoin- tcti( ii ;it ill(- regional level. The objectives of the legislation passing tlieqrcat cities, suburbia, and The role of tli(@ Ptil)li(-, 11(@altli Ser@-- Ft-c(@(loryi incl flexibility to (lo those 'ire to be carried out by, and in co- rural areas. ic,(,. ill (](!V(@lol)illg this ))I-ol(l things tie(-.(.ssiry to a(-Iiieve ill(, of (,'.ICII J)I-ogl..till liis ])I-ovi(](@(l. soti,,Iit arrii(I Wli(,n tli(! l@cgional Medical Pro- ofiiiy oil(' @ll)(I So(@i:il gi-;iiii-, filliv (](,-V(@iol)('(l across tll(- of ;I I",(.gioll early to tIle), N%'ill to (@vel-y tioii of activiti(@s, sticii ,is i-escai-cli, III ill(! 1)(-ol)l(- S(@f.",i(.(.s fol' iii(livi(Iti;tl, lit-. lives, tliat: '.,I)ecialize(I training of tllicd li(@,ii-L iii(i "'(1 El Ili, 1)liysiciiii lias i,ca(lil), avail- ])Crsoiiiiel, (Containing (-(Itic-itioii of (]Is(.;I%(.s tli;it ;11.(, tiie ktioN%-](-(Ige, si@ills and t(.-ciiiii- I)Iiysiciatis, cxl)criiticiitatioii to find (Illilit%. Ifl(l ]it (limit tv, C.11 SLII)I)Ol't that I)eriiiit early diag- tll(, I)CST iiictllo(l-, to I(:Ilicv(. (Icsil.e(l X%-Ililg- til(@ (li%'(@i-sity : 11(i iiosis of tlicse diseases and I)i-oinl)t ]'(,.stilts, and (I(,Illolisti,.ttiori of the itio.-,L of otil- ille.(]- initiation aii(i itpproi)z-i-,ttc follow (,.frc(@tive, I),Itielit 'I'lic I.,aw (loes i(!,Il I-f-sl)ollsli)ility tllrotigii foi- tli(,@ iiio-,t (-fl'cctive ]@tio\vti not allow support of isolitcd I)i-ojects,, of 1(71lic\.illg tli(-SC does ot- dilative action. lio%\,evei- iiici-itorioiis, wlictlict- tIle), not (IC\-ol%,c tli)oll l@(@gioll.11 Nlcclic,-Il [)c iii continuing cciti(-@itioti, Ili-t).gr;titis ilozie. iiitist ol)ci-ate F] Ilis coiiiiiiiiiiity Hospital is equip- I)atictit care dci)iojisti'atioiis, COOI)Ctl-- iii (-oiijtiyictiori ivitit otli(@i- I)rogi-,,itii% I)ecl and to 1)rovide the full att%,e or ]living I(,];Itcd 0I)j(,Ctiv("S. I@Lit range of sci-vic(-.s Ili-, condition rc- oft IZC'giollll I'l-Ogl-,-Illl %\'ill glotial Ili-ogt-.iiiis, I)i-ol)ez-ly (iiiires, or is I)-,irt of a system which i)o%v (.fr(.ctiv(.iy tji(. it(.- s(,i,v(, ,is ;I k(.@ystoii(, of iii;ik(,s this i-@iiig(, of sci-%,ices avtilal)le gioit I)riiiqs to I)eat- its iiiii(iti(-. (-oiiii)i- sti,ti(@tiit,(! %vlii(-It will the de- to Iiiiii. iiation of institutions, -iii(i li%,(.I.y of tllf! t)?[)C of -,Iior-t (-v(!i-y I)ci-@ori %vliosc life and ol-,g.inizaLioiis to (](-fine tti(I iiit,v.L its i(-(,s I)Y ;Ill. iii;iy I)c in icol)ar(ly from fit i(-(--oiiil)lisliitig thin; goil, iL I.,; t, ol%.]l I)(.(!(Is Ill(l ol)l)of.tulliti('S. to fill(] %vi),s to liii-iiioniz(@ oii(@ of tli(-s(@ (liscases sl)otil(I have the Critical to ftittit-(- ])I.ogl.e"s is tll(' fitll sti-eii.L,,tli of itio(l(-i-ii medical of members of tli(, in(,(Ii- tile of and scicti- sci(!ricc available to Iiiiii through the tifi(., ft-(,(-(Iotti \%-Itli then. for cooperative efforts of the medical and I)I'Oft-,-,.sioil to I(-.C(@I)t til(l@il- fill] (efficient Its(. of .111(l ilitioll- sliai-(! of I(!a(let-sliii) ii'i this t-froi-t. ;lviilil)ilitN, of sel-vi(.(,S. ]Zc- related resources of the region in L(Itially important is the giotial I\,I(,(Ii(-al ofTcr tile which he lives. These are the goals to which Regional Medical Programs of iii-iiversity schools of to I)t-i\-at(, ,ttid I)ttl)lic institutions and -ii-c dedicated. I)ecoiiie involved in cool)erttivc ef- the li(-.iltli I)i-of(@--ioiis of the cotintr), fol-ts to tll(- fl.(Iit,.; of to that, oil (.froi-(s. (.11@tlivii,@es itl(l lic%V ;I Vollitlt;ll.y I i-t@sl)oiisibilities are I)i-esetitecl to lios- -Itl(l flexibility to I)it;il Idlllillistl,.Itol.%, Health ofli(@ei-s, iise tli(,iii, it is to work out Voltint-,iiy liciltli ag(@ticies, schools of .111(i lo(..,II S)'Stell)S to 'Ill(l tll(! Illie(l ll(!"Iltll I)I.illg tll(. of I)I-og- ))I.ofcssiol]S. Activitics aiicl Pi-oo,rcss t 11(@ ti t roil slil)lllit . t ?'('I)Ol't of tll(@ :I(.tivill(IS tofy(,Illf,f, ivilli ( I ) I st:lt(@lfl(-Ilt of I.(.],Itiolisilil) fi- iiaiiciyif,, tn(i Iiii;tiiciri,, fi-oyii (-)tliet- (2) tii of tili- of I,(zttl .@t,ctio?l !)OR -u @ JL JL '@'-L 'I JL Activitics and Progrcss ltl:llolt'l' 01: ol)jii(-iit li;is taken I)Iacc iii ,t tiiiie of for tli(! I)ivisioii for fiscal year 1966. resenting areas that included some 60 the 21 months from the tiziie widespread iti@iiil)ower shortages and 'I'lic 1)el)artiiierit of Health, Educa- percent of the population of the I,,txv l@o,-23!) (-aiii(-, into in (-oii.iiiii(-tioti %vitli I)ay-.ill(-] (I(!iiiaii(is tioti, and Welfare Appropriation Act country. ']'he first applications for until June 30, 1967, 47 Regions i-c- fi-olli illil)Y otll(![. lic@iltil I)I-Ogl-;Iiils, of 1967 provided $43 million for operational grants had also been c(-ivc(i funds to aid their plan- sticli as NI(@(licitre azici Nlc(licai(l. In grants and $2 million for tile I)ivisiori submitted. lung ;I(.tiviti(.s ;Iil(l I. of tll(..Se (Ili.,; (,otlt(!Xt tile, I)I.ogl.(.Ss reflected by for fiscal year 1967. Subsequently, in February 1967, also initiated tile ol)(..I.;Itioll;tl I)II.Its(I tilf- st;lt(' ofi(@tivity I 'I'lic National Advisory Council on the first four operational and 10 ad- of tlieil- ltegioilii Nlc(lit-..Il I)I.ogl.;Illls. l@(-giotiil M(-(Ilcii Programs, estab- (litioiial planning applications were (Lxliit)iLs III, IV) 'I'lies(t programs ti%!CIY slioi-t tilil(-. ]low this xvzls ;IC- lislied by the La%v, was named from recommended for approval by the re(-@ive(i ;twar(is of tl)otiL $24 million I)t-ovi(les t gaii.Lc of the outstanding experts in heart disease, National Advisory Council. At the for planning iii(I $6.7 million for ciii-(-,(-.tioti tii(t I)otetiti@il for the future. caticcr;tnd stroke, plus top lcader.-,Iiii) Council meeting in May, five addi- ol)cj-atiotis. 1) t-(.-gioiial in medical practice, hospital and tional planning applications were areas to which tile awards for I)Iiii- 'I'he Health (-.arc i(Iniinistratioji and I)Lib- recommended for approval. In June, iiing i-clate contain tljout 90 percent Actto?l.@ li(-. afrairs. (exhibits V, VI) It met continuation grants were awarded to of tli(! Nitioil'-, population. foi- the first tiTij(! in I)eccttib(!r 1965 to 10 Itegioiis for the second year of Additional for grant.- Slioi-tly tft(-t- tli(- 1,@t%v Nv,-is sigii(,@d idvise oil and policies. In early planning. to slil)l)oi,t tli(.! planning of l@c!lioii.,tl by I)r(-sideiit Joliiisoii oil October 6, February 1966, the Council met again Ilt-o to review arid approve tile 1)rclimi- Broad Participation I gi-.tiiis covering tli(-- i-e- I!)(')5, tli(! I)ivisloii of ltegioiial Mc(li- iii.tiiitlet- of the country are uii(](!r (-.tl I)i-(@gi-aiiis %v;is at the ii,.try issue of the Progra?iz Guidelines. in Plannitz,, revic%v or development. Overall, i Nitioii@il Institutes of II(-altli. ']'o Quickly printed, this publication was total of about 5,1. ltegiotial Mccli(7a] direct its t(-tiviti(-s, I)j-. l@ol)crt Q. given its initial distribution in March. 'I'lic promptness and manncr with Programs are anticipated. It is likely N,Iii-.qoii iccel)tc(l tile invitation to During the spring of 1966, about which I)rograiii proposals were de- that I)y tli(@- Iitt! stiiiiiiiei, oi- (-,trly fill I(-.IV(- his post @is ])call of xfc(iicille 20 applications for planning grants veloped reflect the interest this new of I!)(;7 It(- ioit-,tl l'i-ol,t-.tiiis ;iti(I Vi(-(- Ciiztii(-(!Ilot- of tli(- Univei-- were received and reviewed by the I)rograiii has generated in tile nation- 9 I al health scene arid give heartening ('OVCI'itlg tile entire country N%'ill I)(,' sity of Nlississil)l)i ,iiici Asso- initial rcvi(-w groups and the Na- (!Videzice of the willingness of diverse either in the initial I)].-tiinitig or initial (-i;tte I)ir(@ctot- of the National Itisti- tioiial Advisory Council. l@y July 1, interests in the health field to coop- 0I)el-,Itioti@ll st@iges. ttit(,s of Ilcaltli. I)i-ior to the arrival 10 grants were recommended for ap- crate in this new framework. The in- Ilrogr(,-ss in the development of of I)r. Iviarstoii, I)r. Stuart Scss(mris, I)r-oval arid awarded. Between July t(,rest arid enthusiasm generated Itegiorial Mcdi(,-al Programs thus ftr I)cl)uty ].)ire(-.tot- of the National In- arid December 1966, approxiinatel y throughout the country is the result iiiiist 1)(! measured tgainst tii(- tasks stittites of I Iciltli, wis responsible for 40 applications were reviewed. Many of a number of factors, not the least of illvolv(.,(l ill lttilicliiiig .1. new Ill(l (hit d(-vclt)l)iiieiit of plans and I)oli(-,ics were returned foi- revision or a(ldi- which was widespread participation iiiiiov@itive venture dependent to t foi- iiii- new I)i-ograiii. tiotial information. Tweiity-four were of many individuals and groups, both very high degree upon local 'I'lic Stil)l)l(-tiierital Appropriation approved arid funded. As a result, in the formulation of policies at the I)i-ise. 'I'lic establishment of many Act of 1966 provide(] initial funding 1966 ended with a total of 34 l@c- national level and in setting up and ii(!%v relationships iii(i activities has for the 1)i-ogi-.itzi, making available gional Medical Programs receiving planning their own Itcgional Medical rvlol.(.ov(.I-, this $2,1 million foi- iii(I $1 ;twii-(Is for- planning I)rofrraiiis, rel)- Programs. I I tli(@. ('('.VelOI)Tn(,iit of these Regional TABLE I TABLE 2 All of the Na- itiefli(-al s(-Ilools "'(I AWARDS FOR I'l.ANNTNC', ANT) OprRATIONS OF RrcIONAT, Ml--Ir)TCAI, Ai)vis(-)ItY Gitotil's ill('S(. of .IUNR@ 30, 1967 I.-Oft l@l'(;TONAT, Ml,"I)T(',Al, I)Ito- % (ICV('IOI)TTI('Ilt lltVc Ntttnl)cr Aniotillt I)articil)ate(l. In virtually every pro- ',10, 1967 grain, representatives of State incdi-: TOTAL ...................................... 61 $30,946,907 Ntim- Ilcr- cal societies, health department,,, can- C.,itegory 1)(!r celit- cer societies, heart associations, hos- Planning Awards ............................... 57 $24,277,174 ;age I)ital associations or hospital planning 47 19,822,153 agencies have taken part. For I st Year Activities ....................... 4,455,021 1634 100 -t(l(litioli, iniTiy programs have For 2(t Year Activities ........................ 10 TO'I'A I,, - . - - - - - . . III . ------- - ali,(@.icly (lev(-Iol)ecl links Nvitit iiiiiver- operational Awards ............................ 4 $6,669,733 - Practicing I'lly-si- sity resources outside tile medical For I st Year Activities ........................ 4 6,669,733 ciai)s ............. 356 22 schools and with otlier,itate and local I)rivtt(! an(] public agencies having Mc(licil Centel- interests. i,,,xiiiil)ies or ti,es(! About one hundred consultants Onicials .......... 281 17 Actit@ities iii Schools of I)eiitisti-v, Nursing, aided the nc%v Di%,isioti I-)v providing tlte Re,,io?z Mellll)cl-s of Pill)lic. . 2Cio I C) So(-ial Work, Business A(itilinistra- advice and counsel on various as- (location tii(i Public I-Tealtli Voltiiitat-y Health tioli, I-, pects of the Program during the ini- Similarly, in the I'legioris, tile -tTi(i I)PI)artrncnts of Vocational Re- tial period. These advisors reprc- spread participation of concerned in- Agency l@cpi-esciit- habilitation, Welfare, Education, and sent@cl a broad cross-scction of the (-Iivi(Itials as members of Regional Ad- ftospitals. C,oiniiiiinitv Councils, atives ............ 19c) 12 leaders in American medicine and visory Groups all(] as C,ooi-dinators )I,-iTiniTIg ('OtlllCilS, Blue Cross and I-lospit,il Actriiin- 1. health fields. They devoted intensive and staff is infusing the Programs istI."Itol,.s .......... 170 to SIT]Iillll' groups are also being involve(] efTorts to the rcvicn%, of Program Pro- -,vitli vitality and ciiiira(-,tcz-. Over in Tiny instances. TZel)res(@iitativcs of 1600 individuals are participating as Otlict- I lctltli A(lTyiinistritioil and Public posais and grant applications. Some of these people sat on technical rc- members of l@egional Advisory Workers .......... 14.2 If(,,tltli Service hospitals ire also view grotips.-Others contribute(] Groups. Mcinbei-silil) in these groups Piil)lic Flealtli fre(IticTit their thinking to the development of ranges from 12 to 1 1 1, averaging '12. 'I'lic int@nll)crs inciiiclct v,,iri(-tv of 1)t-o- Oflici;lls .......... 122 7 Reqio?ial such sl)ecializeci activities as continu- fcssional backgrounds and rcl)rcsent-,i- Or,,aitizatio?zs ing education, community health Otlici .............. 107 7 tion of a broad cross-section of insti- planning, svstems analysis, data col- Several kinds of institutions have tittions and organizations. 2.) lectioii, communications, evaluation, II fillfilim(@lit @f tll(. intent of tll(. Ittclii(le,.@ 51 R@gl'on.v, of it)hich 17 assiiin(-(] responsibilities ',-ts coor(ii- ,in(] the preparation of this I'lel)ort. Program, the major health -,igcn(,.i(!s ha(l released I)Iaiinti@g gra?zt.@ an(I I lend ii,,xtitig for ]Zcgion,-tI (Exhibit VII) of tile regions have been involved ill al)plicatio?i,v tender revieiv. N4c(li(-;tl I)rogr-,iTiis. Since the I(!gisla- have not materialized in the 'ri,csc coordinators are building ccrn, TABLE 3 @tafTs Nvitli a N@,idc range Of Corn- initial planning proposals. t,oll does . lot designate ttic,,c agencies of June 30, 1967, there They must be dec-dcd iil)on by the 1)ctcncies. As people working TABLE 4 11-@,AD@)t3AIt'I'l-.RS ANO ,vcl,c Sol,,, 600 staff various institutions itid interests I)ai (,Ooltl)INA -,DICA 1, S. 'riiesc include over S IN PRELIMINARY 9 ir, tll(" (ICVCIOI)Illcllt of tile, GitAN'L'EE., I.'OR L@EGIONAI, Mr III these I)rograin 13FR OF PERSON ticil)atin I)Ito(-,RA?,IS, JUNE 30, 1967 joilat workers ,vitli train- Num I 'I'lic agency.,o selected act,; . 00 profess PLANNING REGIONS FOR REGIONAL Progriiiis. SC cool)critive iilg in medicine, hospital administra- MEDICAL PROGRAMS for all involved ill the tion, and Other licaltli disciplines as late(I fields such as sta- Rcgions I)rogroLiiis. tngc 9 vell as in re Poptilatioti r. Aiiiollg tire @7 Itegiol", rvc("lvlllg Gr,,int- tis lics, sociology, syslcnll 51 ,)I,Itillilig t,,raiits, 2@@ University itle,(Ii- I,ype of Agcl,cY ces tics, CCOIIOII unications TOTAL ................- -ilools leave assumed 47 cdt,catioll, cOnIm 4 ....... 47 and I)tiblic relations. Special coordi Less than I,OOOIOOO ......... c,oordiii,,itilig 33 liators Or consultants for heart dis- (.cti,irc I)rivat(! lioiiprofit',Igell- 28 rnonly 1,000,000-2,000,000 ........ 10 SCVCllt re newly orga- Universities .... case, cancer and stroke arc corn 14 cics, 10 of wliicll WC -- 21000)ooo-3,000,000 ........ 5 25 included. iii7,c(l for this I)lll,,)ose, 5 are ille(li(!al 3,000,000-4,000,000 ........ State ....... 23 s ulti-institutioiial Ill-iv;ltc ..... 5 00-5,000,000 ........ 8 ocieties, and 2 ,tnd oll(' illt('.r- -- -- Nature Of Prelir?zi?zary 4,000,0 10 One State ....... ISO undertaken Planning Regio?ls N4orc than 5tOOOtOOO state tgcll(,,y have Noill)rolit 17 12 olial Medi- of which 47 had this task. ('I".Iblc 1) Agencies. 'File application'; for l@cgi , ,,cludes 51 I?egiotts, ad al)Pli- (.1,11 J)i-ogriiiis planning 91",Itlts ""lvc received planning grants and .4 h Pro(,ratit Coordinators M(.(Iictl cogral)liic areas ill .ons under revicu). 5 6 (refined the 9 g c[T,rts will cati area Staff Nvilicli the initial I)Iaiinir 1 recognized -y plan- i(I Newl@' 13c focused. it has I)CC, in 30 cases, the I)rcliminar ool,(Iill,ltoi,,, ai Ol'i tiiiz(-.d 'rile I)roc,rain G y )CI(lcl.sllil) 1)0- Agcllcle';. 10 3 that these definitions arc preliminary ning regions approximate State lines, I-)irectors holding k c refined during the plan- to the existing respon- 3 and will b operating due principally sition., ill the administration Of other 2 ,ind by Medical I)i-ogriiiis cOlilL; Agcilcic'; - - ,illg process sibilities of inany of the key group, fro,in a variety of back,,roLili(-Is. AI)oul exl)ciicn,,c. giolis have participating in the preparation of TI(i 'rile individual Re placation. I)-,Ilf I)rcviot'%IY held important I)OII- State ' rom less than the initial planning grant ap lions it, ,Acdic,.il education, sucil a-., interstate 2 2 ranged ill population f Inasmuch as none of the Regions is vice-I)i,esid(,nts) iiiedi(:.il Agencies.... I million to over t8 i-nillion. (Table bound by State lines, 1-nany of these Llilivel-SiLy I)rofessol@. Otilcl@ 4) 'I'lic incdian is 2.6 illillioll persons- preliminary definitions arc likely to s "'(I inary plan- ,ciloot dezitis private practice of lie coordinat- collectively, the prclim in Pro- be modified on the basis of critclia II- I -I-Ie graiiiee. differs all, sed ,Ive, c .0i,ic froiii fT earth needs. icille itid fro,,, positions of I.719 headquarters zvheit the I?egioit re- nizig regions cncompas more specific to h at Region filed s low in being or proposed cover administrative leadcrsliii) in hospitals. this arrangement or the latter gram country. Gaps in gcograplii- In I I Rcgions, the initi re States . . (7uested The rest previously held key rolcs ill I I fine the entire s an early con- includes parts or 2 or MO agency did not have the caliabil'ly to assi rich wa voluntary lic',Iltll and governmental formalfiscal evlonsz'bi'lity. (-at coverage, w -,Igclicics. ,in(i in 10 it is part of a single State. tiniiing education 1)i-ogriins and ii?i- (litiolls. Nl(,@tilo(]" of olit Some regions primarily cover iirl)-,in Tiiet educational needs are also t,(-- (I(@itiniisti-@itiolis of 1)@iti(-Ilt lilt(] metropolitan areas. Others follow iciviiig .vi(lesl)rca(l .Itteiltioll. .11)1)lyillg (-V.Illl;lt,toll MA.I()It I'f.ANNIN(: lines previously established for plan- 'I'lic patterns of o(-(-.tirreti(-(-, of .11',o 1)(@lilg tested. %VAN' ()It ning health facilities. heart disease, (:anc(!r, sti-ok(- and t-(!- III t(l(litloll to .111;tlyti(.,Il ;I(.tlvl,ty, Al, Ml-'I)T(:Al. l'ItO(:ItAlt@, NlAl@(:Il late(] diseases arc also I)eitig stti(lic(i planning for R(-gloii@it Ili-o- 1, 1967 Plannine, fly many regions. Most ;ire ti)alyzitig griiiis iiivolv(@s iiii.joi- t-fl'ot-(s (]it-ect(-(] Activities patient referral patterns and existing to%vzil.(l Ili(., stl-eligtllciiitig of tll(! I-el;l- Stil)iect 1,Jiicl(!r Stti(ly The planning activities of each Rc- methods of providing diagnostic, tiolisliil)s Ill(l (.oll)zlllllli(.,Itiolis ,IlI 19 P(itie?it c(ire .1 I 1:01 treatment and laboratory services. heart) -.111(i I I Nvitl i t gional Medical Program arc directed Present and I)ossil)l(@ cortitni.ini(,-atioii V;it.iolis .11(@ at the design of operating programs and transportation patterns relatiiig I)c-iiig itse(i to ftii-tli(@r (,ool)et-;t- and the steps for their establishment. to these services are ilso receiving tiv(" I.(.IItiorlsllil)s. 'I'll(! (!St,'Il)lisllTlletlt I i(.s ..................... 30 Initial planning activities have gcn- wi(l(!sl)rci(i tttentioii. 'I'lies(- I)Iitinitig of @vorl@iiig t;isk for-(,(-s ;iti(i (-oiiiiriit- [)is(.;Is(- ............ 213 crally been of four major types: studies have, in most itistan(-cs, 1)(!(-ii te(,S, ('oll(lll(.t (if Ill(l 2@l [] Organization and staffing for based on previous data collection cf- %Vot.l@Sllol)S, @it)(I tile (@illl)loyll.lellt of 1);l tt(-i-ns of Set-vices ...... 25 planni?ig and coordination forts and have, in turn, contributed liaison it-(! (-otiiiiion. Nii- I,;Il)ol-;Itol-Y Sei-vic(,s ........ 25 to the development of cooperative ailerons I)i-ogy-,iitis ii-c s(,,Ii(!(Iiiiii g (.()II- Stren,,thening relationships and arrangements among tit(,- 1)arti(,i- f(@reti(-(-s it (-oiiiiiiiiiiity liosl)iti I iti(l I'l@,ilisl)ol-titioll 1',itt(-riis. 21 : s liaison amon-, institutions and indi- elating o@gtnizations. %vitli otll(.I. lo(,;II 1-olil)s to (.Xl)l;lifl I .9 viduals throughout the Region About one-half of tit(! planning all- aii(I (]is(-iiss tit(! I)iii-I)os(-s ;tii(i A,I(itil)ott)er D(,r)elop?pie!ytt t)f planting data 1)lic-.itions 1)rol)os(,-(] tit(! tirt(l(@t-t@ikitig or ill(! I'livsi(.I;lll of specific feasibility studies IiTtied -.it Ivol-l@iiii, toI,'t-tll(-I- ill 1)1;11)llillg @ll (I Preparation of designs for pilot Niii-siiig N,I;itil)ow(7i .......... 2() ,assessing the workability and utility of maturing ;ill(l f(.;Isil)ility operational progrartis I [\,I;ll)l)oW(-l ........... 25 I)I.ogl.,Illl Many stti(li(-s lias foiiii(I to I)t-, oii(@ of A principal effort in the planning are (!xploritig I)ctt(.,t, ,viys of a(lviii(-- Ili(.. illost lll(!tli(@(Is of (.S(.1i)- fair (,Olllllloll of Regional Medical Programs is tile ing educational and training activi- l'Isliiilg Ill(] I)OW@-I .............. 2(i careful study and analysis of many ties. 11'artictilar attention is I)cing objectives. relevant factors: (]'(!tnograpliie and given to improvements in continuing Alilioiigii It(-,gioii:il 'I rairil'?@ry (end eeltireitioli I)iostatistical characteristics of tile education 1)t-ogritris foi- I)otli l'i-ill,f-:iiii is ill ili:illnl %v;i@'S tit I([ ing physicians and allied health I)ct-- Itegion, the manpower ancl facilities gi.@ltils. .I....... ......... 211 resources, the adequacy of an(] sonncl. The effectiveness of tele- 2'i@) iii(-;tiis in ;t(,tioii is I I y needs for specialized clinical facilities phone, radio and television nctworl@s r(-I)oi-is of that i:(@ ......... 2f@ and problems of manpower supply in ranking comintinity'liospit-,ils to tini- l@(-'.,ollt-c(.S. 2 and distribution. Surveys of training versity medical centers is being in- reliort,-tl /I, iii,lit,i(hiil Re,@it)n(il ifedi- ,in(] lil)rary resources, on-going coii- v(@stigate(i iiii(ler dancing local (.Oii- clit .............. 2 lit oll,iiieti(tatioii; tilese col,iiiiittecs driw JOZ?Illlll ??Iedical ci,?t- I c(Itio7t. Upon I)Otll colllliiutiily in(i acadctnic I)[ -iiLt-tl Is -.1 to til's I Ills. t(,,?,s (irid co?)I??IllylitY hospitals- III resources. in line wid, tile spccifica- I)OI't. 'It is )II SIN [,/.Vf- .of I?lo(li'lll ']'he dcvrlop?l?eitt a@id de?tioilstra- t tile l@egioiial Ad- is :1 1),"( jolis of the L tioll of lillp?,Ovcll tiel.llio(Is a?id ar- vi@sol-y (;,.Olll) itself iiitist approve all II,(, /III o to:,, s for Iii-