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        QUFTION I WW @d ve giv* @rity &ttfAution to @,, Cancer and Stroke?
        U;,>Vat: 1. Theo* are tbo klUor disem".-71% of @that
                      R@ DU@         44%
                                     16%

                                     U%
                        that is      In theme fields is nA @g applied today.
                    T" bM does pmvido outeority for ina=ion., at the *ption of
                      the aPP3.i@t,, of @ other disease fomd by the 5'wgeoa Decal
                      to be of major sipuioozco to the holth of the NatILons
                    The      sue @ed iu *ravishing @o complexes wi3.1 be
                      invaluamo an ve @o" usys sad       of or@@g our
                                          'blow
                      ap      to aWiou pft     of othw typ"#,


            Does not the emphasis on the categories of heart diseases cancers and
            stroke as individual areas of action under the program run counter to

            the long term effort?
                1.  To develop the concept of and means for comprehensive care

                    for the whole patient?
                2.  To avoid fragmentation of medical education and the teaching

                     rocess?
                    p

        As  The importance and magnitude of the health problems in the area of heart
            disease, cancer and stroke demand special emphasis in arrangements to
            bring these diseases under control and to assure that the advances of
            research in these areas milk are broadly available.  Thus these diseases
            can serve as the initiating point of a program whose.eventual culmination
            will be a general enhancement of health services and the quality of medical
            care on a broad basis.  Thus, although the categorical identification pro-
            vides an appropriate beginning point,.the eventual objective is the kind
            of comprehensive care which is considered to be the best framework for the
            delivery of health-services.  There is little danger that this approach
            will.contribute.to any fragmentation of the teaching process.


           Question.  What major diseases other than heart diseaset cancer and stroke

           does the Department plan to include?  On what basis would the Surgeon

           General and-the Medical Complex Advisory Council select other diseases as

           proposed in the bill?

           Answer.  When, in the judgmentof experts in a field, it is determined that
           advances are be ilmade more rapidly than they are being applied (as is the
           case for heart disease, cancer and stroke) attacks upon these new diseases
           could well be launched through the organizational structure of medical
           complexes.  In institutions having unique activities relating to other
           major triseases, the Surgeon General could designate other categories for
           specific support,  To do so, under regulations, evidence that a major
           national purpose would be served would be required,


         r@,LT  flON3  12at other diseases mieht be :Cound to be o:r wmjor ai,@iwmee
                     to the hoalth of the iiatioe so as to be included i,,a the
                     complexes established uader this bin.
                  1, following the precodeat of hoartm "near.. and stroke diso"e
                        we wild onvions asaiotb-Lg the establishment of coi-aolexes
                        for dis@" invol*Ug highly specialized aad elaborate*
                        treatmmt, (sk4llaj, equipment fa4ilitios and predates),

                      This might inaludi @oy disease.
                  21  it might c@  @ oover  disease  entities  clo@  related  to
                        the @l Is, equipment @, necon,su7 for the treatzm-it  of
                        h@ dioo"o,, canaer,, and stroke.  For @les.

                             Bmip tvmors

                             Lung disease
                                            invol     to o@er      stroce


                                                                  ishad, U,,-dcx this bill?
                     @d     postal. retardation qom@)le.,,c be establ
                      9 is v,,athority ja the bi3l for @clu-.3ioav &:t tlio optioA of t.,"o
                  Thor
                     gLp@li=at, any disease fouad by the @rcooa Goaarcl to bO Of
                     41major siL@i@ce to the health of the Natioii.11
                  There is no doubt Ua-t ==tal ret-ar,@tion is such a cUscazo.'
                  Hot-iover, und             I enacted in 1963 there is
                               er ?.L. as-i64
                     for the est&blis@@t of =Uvers:lty affiliated miii@tta x,@@v,@
                     facilities and :Cor construction of mental rotardatio@"i co   ity
                     facilities. kloo,, states have mo,@icys =der P.L. 88-156 I/ for
                     Planaing comrohonsivis actioa to combat mental retrLrdatioa. I'ho
                     -zato@ =d child h@th ame-ad-raent;s Proposed by tl7,o i-,    str
                     this y@ would authorize $2.,750,000          v for 2 @ra @L-4
                     to follow up this pl@g.

         I/ The l@t@ and =d Realth "d X=t&l R@@tioa aa=iac,                    @,.dmc4lt@ of


                                           iio

                                    ZL


            Question.  What would enactment of this bill accomplish which does not
                                                               ts of organization,
            occur at the present time?  What are the new elemen
            treatment, research, or train nsz?

            Answer.  At the present time  no adequate organizational mechanism exists
            whereby the highest quality medical care available in university medical
            centers can be brought to bear widely in a community.  Community hospitals
            are eager for assistance from medical schools, but this usually cannot be
            provided by existing arrangements.  Comnunity-wide planning, whereby
            expensive duplication of services and equipment is avoided, is rudimentary
            at best.  The provisions of the bill would bring about:
                 (a) Stimulation of appropriate health planning among medical centers,
                     community hospitals, and other health agencies*
                 (b) Organizational frameworks whereby medical schools would provide
                     services and personnel not otherwise available in community hospita So
                 (c) Diagnosis and treatment, now obtainable at only a few locations,
                     in more places and supervised by adequately trained doctors not
                     otherwise available to the community hospitals.
                 (d) An improved selection of research patients, who could be selected
                     from the total number in the community rather than from the smaller
                     group now available through a university hospital.
                  (e) Training more extensive and varied than that now provided, since
                     both a larger number of patient s and a more varied set of-circumstances
                     would be available  to the trainee.


               lots  14hy is now Fedoral laZi:Aatioa necessaxY?
          ANSTd,mt  The legislative authorities pres=tl7 available are directed tovard
                     the SU.0@  separately of ease,-itial basic resources For health
                     facilities.. @power, and kno,,iledZo.  They do not lead the=olves
                     to the spo@io @ gigantic task of interfratiag res@ch..
                     clinical care, and con@uirAg proteszioaal education tor a
                     coo@-ated aituk on the three "Killer diaeaseall (heart, career,
                     and stroke).


                      Q.  How much of the proposed program of complexes could
                      be carried out under present authorities?

                      A.  The authority provided in S. 596 would allow the
                      creation and support'of new mechanisms of relating research,
                      professional education, and high-quality medical care.
                      While all of these activities can be supported to some
                      extent under existing authorities of the Public Health
                      Service, no authority exists to provide for the planning
                      of the complex organizational framework, and the effective
                      linking of research and teaching-to diagnosis and treatment
                      of heart disease, cancer, and stroke.


                             What is the proposed use of the construction
                         authority contained in S- 596 which pemits up to 90%
                         matching by the Federal Government?
                         How would this authority relate to the present proposal
                         for extension and expansion of the Health Research
                         Facilities program and the proposed new authority for
                         nonmatching construction of research facilities for
                         regional and national purposes?

                         A.  The construction authority contained in S- 596 -would
                         be used to pay up to 90% of the costs of those additive
                         facilities which are essential to the operation of the
                         complex.  We would not anticipate a large amount of new
                         construction under this program, since in most cases the
                         complex would link existing institutions and existing
                         facilities.  We would expect a larger number of applications
                         to propose some modification of existing facilities,
                         We would not intend to use the construction authority in
                         S6 596 to provide construction funds which could be
                         supplied under other grant mechanisms of the PHS.


                       Should aproject receive help under this legislation if it
            QUESTION$
                       could be helped through normal               uill.Durton
                       p:rogr@ forhbogPit4l COIIIB@t'Lc*?

                               O&O hove is to provide for the linkages and mechanisms
                       Our purp
                                                    through support to staff,,
                       to assure the overall Program
                       services and dewnxtration pratr@-  THOD* specific 'tem
                       @ch require ad4itiowl fund,* would bereforred to "i@atins

                       mchanigms,


             ,QUUTION: What facilities and equ'Pmeat could be Provided under this
                         legislation that could not be provided uAdOr Rill-BurtOn
                         and U"ltb R"OOVCB Facilities legislation?

                         This program is to establish a rlotwovk--thc PurPose of Program
                         is not r-ougtw=tion alone.  Construction would be secondary
                         to the control @osso pywilaing UrAque, specialized or
                                        job,* fociliti" n@      for the purpos4 of
                         otherwise    Si

                         this "usll Programs


                       QUESTIONS AND ANSWERS CONCERNING REGIONAL COMPLMM
                            FOR       DISEASES) CANCER A.ND STROKE
                                    AS PROPOSED IN S. 596.

                           What vould be the relationship of the heart disease,
                       cancer, and stroke complexes to the present NIH program
                       for the support of research and research training in the
                       fields of heart disease, cancer, and stroke and other

                       major diseases?

                       A.   The proposed program of medical complexes vould not
                       displace present programs of research and research training
                       supported by NIH.  The complexes vould provide a means for
                       more effectively relating the research and research training
                       activities to clinical training and patient care activities.
                       As the President's Co@ssion on Heart Disease, Cancer., and
                       Stroke made clear., the extensive medical research programs
                       vhich have resulted from the generous support provided by
                       the Congress to the National Institutes of Health have
                       helped cre@e numerous centers of medical excellence vhich
                       can be the foundation stones of the proposed comp exes.


            Question.  In whit ways would a regional categorical center (for example,
            a regional cancer center) differ from a clinical research center now spon-
            sored by the National Cancer Institute?
            Answer.  Although cancer clinical research centers now supported by NCI
            exhibit a range of characteriptics--including many or most of the elements
            that one would expect to find in a regional cancer center--there are clear

            differences in concept and purpose.
                     A regional Cancer Center would involve responsibility for improv  g
                     the quality and availability of cancer research, training, diagnosis,
                     and treatment throughout a specified region.  A dancer clinical
                                           supported does not have regional respo'n-
                     research center as now
                     sibilitie6 and is limited in function to clinical research and

                     research training only.
                     The designation "cancer clinical research centers" refers to a
                     specific limited clinical research component of an existing'iiisti-
                     tution.  (Perhaps ten beds with staff and supporting facilities
                     in a cancer research institute, university hospital or similar
                     medical institution.)  However, the designation "Regional cancer
                     centerit would apply to a broad'clinical facility involving an
                     institution as a whole; or a major organizational segment of such

                     an institution.


                tion.  would the research and training functions of the complex
                                                               financed through other
            (including construction of research facilities) be
                                                    t and operation of a medical
            sources than the grants for establishmen

            complex?
            Answer.  Research and research training projects carried out by investi-
            gators within the complex could be supported under individual research
            project grants from appropriate PHS or other granting sources.  Similarly,
            support for a categorical clinical research center approved for incor-
            poration within a complex might be supported directly by a categorical
            Institute.  The pattern in this respect is apt to vary depen ing upon a
            variety of institutional funding and cooperative arrangements*


                     Q.  What would be the role of the categorical institutes
                     and the categorical advisory councils?

                     A.  The categorical institutes would continue to provide
                     support for research and research training in their respective
                     fields with the 'advice of their Advisory Councils.  It is
                     anticipated that this support would continue to go to the
                     component institutions of the proposed complexes.
                     Individual investigators within these institutions would
                     still apply for research support th rough present mechanisms
                     and their proposals would be reviewed for scientific merit
                     and for relevance to missions of the institutes.  The
                     proposed program of support for medical complexes would
                     not supplant the categorical institutes as the primary
                     providers of research and research training support in the
                     fields of heart'disease, cancer, stroke, and other major

                     diseases.


                      Q.  Would present categorical or general clinical research
                      centers be absorbed into these complexes? If so,  would
                      they continue to be financed through the categorical

                      institutes or DRFR? i

                      A.  NIH would continue to support general categorical or
                      clinical research centers through present mechanisms.
                      It is likely that many applications for gkants under the
                      proposed program of medical complexes would be received
                      from institutions which currently receive NIH support for
                      a general categorical or clinical research  center.  It
                      would be appropriate for such applications to  indicate
                      how present research centers would be related to  other
                      parts of the proposed complex.  If the present center were
                      included in a complex, support might still be  provided
                      through the categorical institute or DRFR; however, the
                      further development of the complex might include financing
                      of the basic core support of the research center through

                      the grant for the complex


                     CL"lt                                                  cl     10 fo_

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                           or oth@ .,io @.cXit aLc.-i,llly -,,.To uj- d1   'bi  t      L       a       t
                           to aasis@
                         Ziere i-iould )rob@.bly ba cea,,ral             thmtieh t7.ke @iYL@Lcaa"4j,
                            u  t    ed oA bazis o:C       -a@,da of the


                          Could a local healt4-                             re

                                                                                      C.L 0

                          prov:Lcle the l@,                                      'ZLember.-, O:f !L,-.e

                                                                                             etc.


                                                                                                     t

                                           a4,d treat                                                  U0   -aa
                              a iLiit o-6' a                           hQ          o::- o-'@         ity
                              k,.?iiieh co-a:Ld i@@clwie a -IC,             Z,,
                                                   hos.-jital                      -zot b@ @l


                                   oesalt have a medical zchool, bu                health
            iQUrz$TIOI.i:  fly state d                                t we have a
                         departme@,., a good ;@,emeriol          ard a few nu-@rin- 'tip@s.
                         a.  EDw &to the folL@s i,.% vj             to be benefited

                         by this bill?

                         b.       ep.3 wa do t
                                              o becoza l@z:        IC

            A lq,"X                      an,-'        t           could be itt rc,c@:.
                         I,.ospitals.  @.is irt tL"Z-a Can be      to the mr-@,diczl
                         in an odlo,@tti,-,S or nearby stnte t,-,crcby ir,,nroviaz the cuality

                         of care.
                         b.  T.%e mediV-.-I pro;E@.-,ion and the health
                         take the    itiative 4.a c i@orias possible relatioazlli Z lAt,71

                         c@=t@- iu offer states.


               1.  What qualitative consideration will be involved in the review and
               approval of applications for grants for the establishment and operation
               of regional medical complexes?
               2.  Will not such centers inevitably mean that these grants will -o to
               the institution and location already capable and well-serviced in
               respect to research, training, and demonstration capabilities
               3.  How will this program help the institutions and areas of the country

               that do not now have such capabilities?

           AO  1.  The major qualitative considerations bearing upon the review and
               approval of applications for grants under this program will be the
               potential of the proposed program for accomplishing the purposes being
               sought through the concept of regional medical complexes.  Many communi-
               ties throughout the country have diverse capabilities for improving
               the quality of services in these critical areas and for establishing
               relationships between existing research and teaching institutions.
               What is needed is the plan and the funds to support the cooperative and
               coordinate relationships which comprise a regional medical complex.
               2.  While it is probable that the initial awards will involve institutions
               and proorams based upon existing capabilities, a major objective of the
               program will be to encourage and assist the development of such capa-
               bilities on a widely distributed geographical basis.
               3.  An important part of the concept of the program of the President's
               Commission is effort directed towards enlarging the number of centers of
               medical excellence and capability throughout the country.  Coordinate use


                                                                        h as the
              of other support progra= of tne Public Health Service suc
              General Research Support Grant, the Health Professions Educational
              Assistance Act and the research and training grant progra@ will be
              utilized to advance'and geographically equalize capabilities requisite
              for the development of effective regional medical complexes.


                                                                         d  recognized
               Question.  If regional medical complexes must be built aroun
               centers of research, training and care competence in the three disease
               ar                    ram help to bring quality care to persons  living
               eas, how will the prog
               in regions where this competence isn't now found?

               Answer.  It is probably trud,that the first regional complexes will be
               set up where the largest population concentrations and the required insti-
               tutional competence coincide geographically.  But the program is a national
               one; and its benefits will not be reserved for heavily urbanized or other-
               wise favored regions.  The Public Health Service, as program administrator,
               will constantly seek the broadest national access to program benefits.
               How many regional networks will be required for full national coverage
               is not clear now; and one can only guess at how long full program implemen-
               tation will require.  (Perhaps ten to twenty years.)  But throughout this
               period--and for most if not for all parts of the country--there should be
               reasonably steady gains in the quality and accessibility of medical,care.
                   The program will promote these gains in several ways.  For example,
               program.implementation requires systematic and continuing assessment  of
               institutional competence (both research and care) in relation to local or
               regional population needs.  The resulting profile of national categorical
               competence becomes a most useful planning document: categorical strong
               points become possible components for new or extended regional complexes.
               Potential strong points logically become the focus of joint local and PHS
               efforts to raise institutional competence the needed fraction more.   ap
               areas--if sufficiently serious--can pin point the need for concerted local
               and national action, possibly including the establishment of new develop-

               mental programs.


               Q,@4 TIOil:  !low is the term "re-ion!' used Lit @.his logislatio-,i"

                           I-,'a e,,ivizion that such raZioiis            Ily

                           a population of Lvo to 3 million persons. located in a

                           conti-@as                 a-za4, @,kich mi,,,,ht be Lntez- or

                           intrastate or ot-*%er subdiv4-.64-on.


           QIJESTXO,N: Ilauld 'you describe the rea4 on to be served by ou,-h a comploul

           ANST=:    Tne a,@,,31icarLt must describe the goo,,-vaphlc region Pl@ -
                     population base.  la any cns^- t@iiz uould have to bO a
                     BP-Oaraphic area of sufficient size a,.v4 population to hold
                     resources necessary and as3,,r,-- their effective utilization.
                     Thus, a region might be part of Greater Ilf-v York, t",,,e ent re
                     metropolitan Washington, D. C. area, or a
                     portion of ZeatueL-y extending from ti%e univeroirj ical

                     school.


             Question.  Will there be a single medical complex for a specific region*
             with component institutions responsible for categorical specialization? or
             will there be separate complexes, at least for each of the three major

             disease categories?

             Answer.  Each regional medical complex is expected to have (or to develop)
             component institutions with the necessary competence in the three major
             disease areas.  Separate networks for each disease category would raise
             administrative costs; might lead to unnecessary duplication of facilities;
             would increase competition for trained manpower; and tend to unnecessarily
             fragment provision of quality care for sick persons.
                  It should be recognized, however, that these regional complexes must
             build on existing categorical competence; and few regions initially will
             be equally well served in the three disease areas.  Therefore, it  s POs7
             sible that some networks may at first cover just one disease category*
                  For largest metropolitan areas, with several medical schools and
             associated hospitals and a number of institutions with required categorical
             competence, more than one complex may be set up if the need for this is

             shown.


               Question.  What are the criteria for evaluating institutions to go

               into regional complexes?

               Answer. There are two over-riding criteria for  inclusion  of  institu-

               tions in medical complexes       recognized competence in one  or  more
               of the three major disease areas'; and (2) willingness to cooperate  in
               a regional framework to make high quality care regionally available.
               Typically, the regional categorical centers will be drawn  from those
               institutions that are heavily involved in relevant clinical and pre-

               clinical research and r"V      training, as well as'patient care.
               Such institutions generally will be found in-major  university  medical
               centers or associated with them.  On the other hand, the prime  location
               for diagnostic and treatment stations is:in community hospitals to
               which the largest number of patients.and local physicians have access.


          Q.  would the regions to be served by these medical complexes and regional
               medical centers.be.,determined solely by the inclinations and desires
               of the applying institutions or would some specification. or plan be
               worked out nationally for this purpose?

          A.,  At t'ne beginning of the program the original definitions would reflect
               the initial plans and capabilities of these institutions ready to
               propose the establishment.of medical complexes.  As this program develops
               very positive   effort would be made to assure equitable geographic
               distribution of'medical complexes.- The eventual objective would be
               the evolution of a national network of medical complexes to assure the
               availability of the-benefits of scientific medicine to all population
               groups and areas of the nation.


            Question.  To what ext4@@,;a would these me(,.--al complexes be locally controlled

            and locally run?

            Answer,  Regional r,  .cal complexes woul@- 'or the most part encompass
            non-Federal instit-  .ons, whose participi-,-;@,n in the complex would be
            supported by grAn@.  Thus, independent responsibility and local initiative
            would not be diminished by that relationship.  Specific arrangements for
            local control--including the distribution of responsibility among component
            institutions--will tend to vary among regions.  They will also tend to
            change through time, as one 'or another administrative problem develops,
            or more effective forms of cooperation are found.  Initial arrangements
            for local coordination and control must be spelled out in the grant appli-
            cation for the complex.  Prerequisites for grant approval probably would
            include: assurances that a properly constituted local advisory group-has'
            been set up and is functioning, that key local agencies, professional groups
            and institutions have been consulted in setting up the complex, and-that
            cooperating institutions understand and agree to local arrangements*,


            ,QMTION: Will Ovs'rY P*rtiOD Of the United States be covered?

                       The ultimate objective is to assure that every person have
                       Person have -access to the best in @ical services-  This
                       does not mean gaturati= the country worth complexes--
                       for we have neitTaor the manpower nor resources to do to.
                                                    f developing techniques" stim-
                       We view this program as One 0
                       lating'broader coverage in all related services and facilities--
                       vith the complexes wwrZLzU4 like demonstrations in a

                       vider co@ty.


                       How long      It take to develop a national network?

                       Decades


              @UL@TIONT  where would responsibility for this program'* administration

                         lie within the Public Health Service?

              ANSWIM:    tn developmnt of our plan for administering this program

                         it is our intent to utilize c@. otenetes found,,'Ln various

                         coMancate of the Public Ite4lth Service.  Assig     t to an

                         organizational unit will be made after the plan has been

                         move fully developed.  During the developmental phase the

                         Office of the Surgeon General will *$sum* the responsibility.


              QUESTXOII:  Could not provision for continuing education in heart disease,
                           cancer oW stroke be made under the educational iMr                 t

                           &rents proposed In the Ilealth Professions BducatLonal

                           Assistance  @ments of 1965?

              ANS14ZRs     The 'Realth Professions Educational Asolistance Act and the
                           proposed amendments eve des @ ed to give primary emphasis
                           to the education    of students.  This proposal would aghasixo
                           the continuing education of the practicing professiomt,


              Question.  What effect will the proposed categorical approach have on the
              curricula of medical schools and on undergraduate medical education?

              Answer.  The complexes will have relatively little effect upon undergraduate

              medical education.  Greater availability of excellent teaching cases, the

              increased volume of research,and the greater rigor of diagnostic and thera-

              peutic methods all will improve medical education, but only secondarily.
              The great educational impact of the complexes will be on graduate specialty

              training and upon the continuing education of community physicians.


      qwstion.- You are propos@ to i;upport staff. UUt proportion of the

             staff of a reSaar teaching tiocp@l or medical school are

             y,ou go@ to @port umler this biU

               If they have specialists in cardiology 4nd canc6r ym

               golM to pick up their saJ-arles? Aren't you w*i us

               somewhere else to give basic support @ts to radical

              .,Oehwla? and luproved grants too?

      @ers   Only those additional pto-ferolonal wA technical vernotmel

             necessary to operate the components of the "mftoal @lse

                be @rted order this bill.

             The mjor aWbasio be on contimiation education for
             for Coastline @iei= other proiessiomi Peraonuel.,


          QUR,STION: What will be the impact on manpower--now available or being

                  developed? WILL this further dissipate our resources?

          ANSMT   The complex to a scheme designed to got service* to

                  people effectively and efficiently. Thus, altliouah new

                  kW* of medical spetiolist--teathers will be developed,

                  this will be balanced b7 personnel econom"o in Improved

                  Vey* of mobilizing service resourc"6
                  The cwplex arrangement will co@inly accelerate the coordination
                  .&ad effective use of existing Manpower and improve Its quality.
                  Alsog the rate of developwnt of Manpower will influence rate

                  of 4*velopmat of three progrea.


              The program would seem to greatly increase the requirement for medical
              and paramedical personnel. How will these needs be met and  where  is

              the manpower coming from?

         A.  This program will indeed increase the  demands for medical and other
              health personnel.  This increase, of course, is reflective of the level of
              health manpower that this Nation requires to provide high quality and
              truly effective health services. Present shortages of  manpower  will

              obviously affect the pace and magnitude of the initial efforts  under
              this program.  However, the plan of the President a Commission  calls
              for specific efforts to enlarge health manpower by continued  support

              and increase in level of training programs, initiation of new training

              programs at both professional and subprofessional levels, and the
              expansion and support of health educational institutions and programs.
              Specific effort to support and enlarge the medical and dental educatiorkl
                          as a part of this program is encompassed in legislation now

              before the Congress.


             qUESTZON*o  What will be tho relation of the complex to aroo-wide hospital

                        planning under the Rill-Burton program?

             ANSW]MT    The applicant will be required to thov the relationship

                        to local plannitia activities; further, these sr* anticipated
                        to be silvatk consideration throu Sh the ma@tomw ai the

                        ,applicants *dviisory committ".


          @tiont  Is the pro6rma, then, another aul)ect of reaioud or comiunity

                    plwmin,z for health? Now -wcaibl it dA@ffor fmn areavide hospital

                    pl        p@rsg commity wa@'L Health centers, :ror

                    e,xauple vUeh a" p",oentlv authorized?

          @e.ri   @uis on contin@ eduaatiori--rapl4ly @oang specific

                    knovUUe In treatiaent.

                  Not mq on* of those Zr as 1:inits researchp training# wA

                    latient "",nu does require reu ionship vith ww

                                     wtivities


             QUESTION:  Aren't you really talking about developing cm=nity plans
                        for service here? Isn't that the big void to fill?  Vo sees

                        to be doing a lot of this constructing, restarch, and training

                        vith other support.

             AN$ M i    Community planning for service can subsequently be related.

                        This program is concerned vith the quality of health service

                        In c      ties--by bringing to bear the advances within

                        teechLog and research centers to the commnity services,,

                        through the c       ty hospital end the practicing professional.


           omtiorit  Aren't you really t4alking about   I   money @ effort

                     here? I)on't you bave      Pede@ ai4L for 4LU theme things

                     If you could =4 join them toaother by pl=ane:l

                     No,, ve don't bave an the pieces--we are avare of gaps,, of

                             deC,mes,p in mww amvs,, Tl)ls progrw p3mvides $or
                     p       @s the orgmizatioral linl,.ages @ elwento of
                     the netvozka that @ in@inatitutioml) ete-p and that

                     lint the @essima Practitioners to the research mA

                     tJA admatioma system$


                QU@TIONI  HOW is dt 90i@;) l,'Gdr@@rtil share jus-tifi.,)d In this pro&,,Tan an
                             cOntrastod to other i'll,j Urs.@@4t prog@?
               Atl,j'WL,Ut  The hieher Federal share is Juatified by the urgency of the
                           nood to lau.,ich a coiicortsd attack on those
                           And the necessity, of rapid develop*@ica-b of oyatems for provision
                           of high qwaity patient care so that resoar@ kaowlodf,,* can
                           be applied as rapid4 am possible to @ple.


          Coleatioft: Mat share of the funds would be used for construction?

          Here      A @r poft:Loa mu In the earliest phase of the pro

                            I:t VW   Om*     @ex        becom established.


            Question.  What will the   t nonies be used for, e.g., Professional
                                   gran
            staff, ancillary staff, equipment, renovation, new construction, patient
            care?  In what proportion? Who will decide?

            Answer. Grant  f.unds will be used for professional staff, ancillary staff,
            equipment, renovation, construction and patient care, but the latter only
            for care, allocable to training, research or demonstration.  The proportions
            would be as set forth in proposed budgets by the applicant institutions.
            Such budgets would be reviewed, both by medical scientists'and by administra-
            tive specialists, and would be subject to regulations similar to those
            promulgated fo r the clinical research units now operated through the NIH.


            r,u  Tiatit  nou do you contaVlate usiug 450 millioa in thi;s first year?
           A14.@@fate  We en@ioii the astablishTiaent ofbur such complexes in the
                      first year of operation ranrSing in cost from @10-15 million
                      wwh,  RougUy,, us believe this rmy be distributed as fol2ovot

                    12,1 mMioza per complex., generally as followas
                         42.5 aMion - for the ad.-,.Tii@.itrative aetuork anti
                                        com=icatiori liaos of the modical coate'r,

                         $5.0 a M ion - for basic support of ape @ ic activities
                                        in heart disease, cancer and stroke.
                         45.0 million   to establish 20 diagnostic and tre4t,-moat
                                        stations in local and commity, heath
                                        f&OUities.  ($250,,OOO @er station)

                              aMian


            QUESTIOIls  Km would the coWlex" help the practicing phyeiclim who

                       to not otherwim* associated vith a medical school, teaching

                       hospital. or other sponsoring institutions

            A@#        Three ways are @sionedi  (1) he has access. through his

                       local affiliations to the program of continuing education

                       carried out by the complex. and (2) he had recourse to
                       consultation *v4 assistance (3) he way tsfor his patient

                       to the sector,


          Q. The bill provides for the payment by the patient  or  a  responsible  third
              party, for the services rendered under this program except when such

              services are incident to research teaching or demonstration.

                      Who will be the recipient of and what will be the disposition of

                      such collected fees?.

                  2.  Should they not.be used to offset, reduce or,otherwise reimburse
                      the Federal expenditure?  What arrangements will be made for this?

         A.   Fees received by institutions comprising a medical   complex for  services

              rendered under this program will be received by the   normal collection

              framework of such institutions and will be used to reduce or reimbur  se

              for the Federal expenditures made in support of the program of the
              medical  complex.  Accounting  arrIangements will be worked out  which  will
              provide for appropriate allocation of costs under this program between   the
              Federally supported activities and those constituting the normal operating
              costs  of the.participating'institutions. and these' pattewswill be used

              to allocate income received for  services.rendere4,to provide  for  proper

              reimbursement for Federal  expenditures.


            @stions  ViU the costs of transporting patients to regional centers

                       be p"d for under +,his prof,@?

            AAsvert    In specific situation where essential to the pu*oaes of the

                                TOO    its* for "search,, train@p or demonstration

                       purposes


         @est:Lont How =ad o "demonstratioe patient be differentiated from

                 one @ fte an ordi@ pationti

         Aw"ri   A 'domonstratlojo patient Is a variation ou a teaebina

                 I*tionto also a Motion of a research @-ject. .@ vou]A

                 be booplUUzed vnder @ements clearly ident:lWng his

                 status.    @t to "Uaal caVlazo RegUar-patient
                 co" costs WV to@bom b7 @er afthanime volunt"7


       Q"Gtims Ym eV Ym an wt p@ to m patient care costs excel
              those incident to trainim, reaftmhp or d @stration

              activities. ilw do you jWge whether a patient is being
              used for tra,i,nin Fiscal

       @er:   If hospitUt@ oay for teaching @ses yes.

              txtra costs Om It hospital stay veft ad for

              0 rw Ur$ to i*@Utato ""Una


           O*ationt You b"e stated yetiont care will be provided =4 for

                     dew=tmtion@ trairAng) or ronearch., Won't thin mean flooding

                     elemnts of the ompl" vith persons o@ing Vaity service?

                ri   ftft of the @leant's @tted program will include

                     ptwedures to I* established to meet tlda problem.. Nuch

                     as At our Noti@ CliMcal Cmterp aLUgibi.Uty vtU be

                     t@@ed for either resea=h., training or 0,    trati one,,

                     it vM not bd a *on       or cozw@ operation. @h

                     *@ex vM d"ondne :Lts om "fe*r4 o"tft. O* ke7 to

                     tma         astm 10 tbo @ticing @CIOA*


         QUISTIONs At* you going to sor" more patients (if to--how? and  ow MNLI)

                  or just r&SA* the quality of tare of patients tow being s@t

         IANOMS   both. This.pmgrm will be providing samthing that is not

                  attainable am except In so= arose. The patients who he"

                  those diseases will have access to better #M wro Intent"

                  .ear*. More o@to will be available to then with their

                  p@LeLons @n$ available to them better Womms mA

                  @oultttioa.