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The Regional Medical Programs Collection

Brief History

[Dr. Ralph Q. Marston at a Regional Medical Programs meeting]. [1968-1973].
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In February 1964, President Lyndon B. Johnson delivered his health message to Congress in which he announced the establishment of a Commission on Heart Disease, Cancer and Stroke. Chaired by the eminent heart surgeon, Dr. Michael E. DeBakey, the Commission prepared a report, "A National Program to Conquer Heart Disease, Cancer and Stroke." Published in December 1964, the report recommended instituting cooperative arrangements at the regional level, to make the latest advances from biomedical research available to benefit the health of the American people.

Ten months later, in October 1965, from legislation introduced by Senator Lister Hill of Alabama and Representative Oren Harris of Arkansas, the Heart Disease, Cancer and Stroke Amendments became law (Public Law 89-239). The act authorized the establishment and maintenance of Regional Medical Programs. Its purpose was " to encourage and assist in the establishment of regional cooperative arrangements among medical schools, research institutions, and hospitals for research and training, including continuing education, and for related demonstration of patient care . . . . " (Sec. 900, Public Law 89-239). Fifty-six regions were established, covering the nation, including Puerto Rico. In December 1965, the National Advisory Council on Regional Medical Programs met to initiate the program, and in February, Dr. Robert Q. Marston was appointed first Director of the Division of RMP, an NIH office. Dr. Marston served as Associate Director of NIH, under Director James A. Shannon. The National Advisory Council awarded the first planning grants in April 1966, followed by the first operational grants ten months later, in February 1967. By the end of that year, sixty-one Regional Medical Programs had been designated and four of these were operational. Most programs were located at or near university medical schools.

In 1968, the Regional Medical Programs office was transferred to a newly created Health Services and Mental Health Administration (HSMHA), and Dr. Marston became the first HSMHA Administrator. The original RMP was expanded with additions from the National Center for Chronic Disease Control to form a Regional Medical Program Service (RMPS) within HSMHA, with Stanley W. Olson as Service Director.

Later that year, the RMP was extended for two more years and the program expanded. By 1969, forty-four Regional Medical Programs were operational, as Joseph T. English took office as new Administrator of HSMHA, when Dr. Marston became Director of NIH.

In 1970, the RMP was re-authorized for two more years and again expanded. New provisions reflected an emphasis on primary care and regionalization of health care resources; added prevention and rehabilitation services; added kidney disease treatment programs; added authority for new construction; required review of RMP applications by Area-wide Comprehensive Planning agencies; and emphasized health services delivery and human resource utilization. New modes of this utilization included "physician extenders," such as nurse practitioners. Fifty-four Regional Medical Programs were operational by the end of the year.

However, in that same year, the RMPS was reduced by the phase-out of many of the original chronic disease programs, leaving in place only RMP, the Kidney Disease Program, and the National Clearinghouse for Smoking and Health.

In 1973 the RMPS enjoyed its peak year of funding, with $140 million appropriated. Emergency medical services were playing an increasing role and receiving a larger share of funding. However, in the Nixon administration's proposed health budget, the RMPS was allotted no funds for FY 1974. Bureaucratic and local support gained it a one-year extension. The National Health Planning and Resource Development Act of 1974, Public Law 93-641, consolidated RMPS with the federal Hill-Burton and Comprehensive Health Planning programs. In 1976, after a transitional period, independent RMP operations ceased.

One side effect from the Regional Medical Programs was the creation of the National Network of Libraries of Medicine, which was recommended by the DeBakey commission and authorized by the Medical Library Assistance Act. It is in operation to this day.

Brief Chronology