In  the  case  of   the   MMP   the   tragedy
                                                                                                                               is  double.   The   technology   for   health
                          Federal funds cutoff                                                                                     xists, the  spirit  and  the  person
                                                                                                                               care e                                 nel
                                                                                                                               who  can  deliver  are   willing,   and   the
                                                                                                                               mechanisms  of delivery  are  off      the
                                                                                                                               drawing  boards.  Cooperation   long   sought
                                                                                                                               but  rarely  achieved  had   built   up   me.
                          llow, feel" .1 AC                                                                 a.,,i
                                                                                                                               mentum.
                                                                                                                               But   the   momentum   is   now   lost.   The
                                                                                      0                                        the  carrot  of  revenue  sharing   is   held
                                                                                     'r.@ p                                    out  for  almost  all   the   HEW-   programs
                                 as                                                            p                               tnat   are   being    phasedout,    prospects
                                                                                                                               @or  a  quick  regeneration  are  dim.   Some
                                                                                                                                                                          up
                                                                             In seven years,   comprehensive       health      -rr,@ams  eventually   may   be   picked
                          By Richard Brooks                                  care  had  moved  from   barocr2tic   ]Orion      in  piecemeal  faslr-'on,  but  the   interim
                                                                                                               exp             iletween  June   30   and   whenever   states
                                                                             i.0 a practical concept. 1,Vhere        erts
                         SEVERAL    WEEKS    ago@    on    a    Alonday.     from    the    federal    government'    Had      are  motivated  to  move  with  their  antic-
                        Dr.   Dexter   Nelson   kissed   his    children     failed,  people  like  Nelson  and  Creditor      ;,,aated  financial  shares   will   mark   a
                                                   100-M'.                   de  the  leap  from  theory   to   practice.                        in    human    and    mana-
                        9004                              le  drive   to     ma                                                substantial waste
                        Chicago    Emm    Princeton,    M.    He     had     With $2.3  million,  a  pittance  by  feder-      *-,e@-ial terms.
                        made   the   trip   many   times   before,   aid     il  standards,  the  IRMP  funded   projects      What    disturbs    observers    away    from
                        he  was  used  to  driving.  jus   rural   prac-     for   health   screening    in    industrial      Washington  is  the  cold  shift   of   power
                        tice  takes  tdm  from   one   distant   hOsi2l-     piaiits,   community   health    information      with few, if  any,  provisions  for  the  in-
                        tal to the next.                                     and  referral  services,  more   centralized      terim  period  until  state   resumIption    of
                          But   this   day   the   drive   was    longer     and  accessible  kidney  disease   and   hY-      funding.
                        than  usuaL  It  would  be  the  last  trip   to     pei7tension  control   pro-iraris,   prepaid      For  those   Progressives   who   were   set-
                                                                             comprehensive    health    care    prograris      tiny ui)  Health  A-fainte.-iance,  Organiza-
                        fulfill  what  Dr  Nelse"   had   known   as   a                                                t
                                                                             health  systems  for  doctorless   commtlni-      tions  the  cutoff   means   a   postponement
                        real  comroAtment   to   an   idea   that   coal
                        work-the    Illinois     Regional     ',Nlediczi     ties,  the  Metropolitan   Blood   .CoLmcil,      of  a   healthy   idea.   For   the   company
                        Program.                                             and other projects.                               health  centers  supported  by  the   IR.MP,.
                           he    proWam    was    designed    to    ut@7                                     ts r
                                                                                                                    .@lud @  @  the  cutoff  means  a  lessening  of   their
                                                                                        'PPORTED projec
                                                        medicai      ex-     STAFF SL                                          ability to serve their clients.
                        a reservoir of professional                          ed  work  with  the  Brown   County   Health
                        pertise,  nd  ruled  by   iiat   frOm   Washing,     Center  a  clinic   for   senior   citizens,      FOR    PATIENTS     everywhere     In     Mi.
                        ton,  but  by   advisory   councils   of   prac-     s@udies'.in physican  distribution  in  @Lhe      ties,  the  cutoff  probablv  means  a  post-
                        titioners    Eke    Nelson    who    volunteered
                                                                             gcago  metropolitan   area,   and   a   push      -,ionement  in   the   establishment   of   a
                        their time-
                                                                             for  use   of   pro'olem-oriented.   medical      medical   record    keeping    system    that
                        THE    IRM-P    WAS     perhaps     the     best     records.                                          mic,rht  speed  diagnosis   and   cure.   For
                        plan  of  its  kind  in  tJe  country.  Itwas  a     The   IRMP   also   worked    for    asgeqs.      rise  Metropolitan  Blood  Councfl  and   its
                        bhteprint    for    m@,    medicine     accessi-     ment  and   evaluation   of   medical   pro.      't.@ousands of clients,'the  cutoff  means  a
                                                                   giong     grams,  training  of  more  health   rersnn-      @4erious blow to expansion
                        ble, a mo&l for local and  r?                        riel, and pressed for developr.,ie'nt  of  a      I  For  the  more  than  250'health   profes-
                        health  sys@.   In   the   last   seven   years,     liealth-education consortium.                     siorals  who  volunteered   their   time   to
                        apparently    the    Department    of    Health,
                                                                             Health  care,  IP.,VIP  officials   believe,      serve  on   the   regional   advisory   group
                        Education,  and  Welfare  agreed  w,.'   h   iL3                                                       and   other   IRMP   committees,,the   cutoff
                                                                             should begin as early  as  an  indi,@,d,.zal
                        potentW;    more    than     $500     @n     was     recognizes  what  -health   is.   Preventive      means   a   swift   devaluation   of    their
                        @led      @      Regional      Medical      Pro-     medicine  is  the  key.  Rather  ',ban  pro-      thousands of hours of effort.
                        gram coffers nationwide.                             mote  insurance  that  pavs  only.  when   a      Finally,  for  Dr.  Nelson  the  cutoff  sig-
                        But    like    RMP     officials     everywhere,     cure is  needed,  the  IR.NIP  eidorsei  the      rals a  few  hundred  fewer  miles  of  driv-
                                                                                                                                              n   a   disappoint3nent   that
                        Illinois  planners  received  an   abrupt   tel-     concept  of   Health   Maintenance   Organi-      ing per week a d
                        egram  in  February  telling   them   to   phase     zauons-to   make    good    heaAth    rather      will be hard to conceai.-
                                                           Dr.      Nel-     than poor health the primary concern.                                                         di-
                        ,out all operations by June.                                                                           Richard Brooks is the education 9
                        wa had the unpleasant task                           BY  supporting  the  use   of   problem-ort-
                                                        of      chairing                                                             the pioneer Press.
                                                                             ntedmedical records, t'A-Ae  IR?ilP  wa-.It-      to" to"
                        his   last   meonal   advisory    group    meet-     c
                                                                             ed to  help  health  personnel  easily  ar'-
                        ing.  He  confirmed  the  fate  of   the   IRNIP     rlve  at  an  accurate'appraisal  of  a  pa-
                        with   @   director,   Dr.   Morton    Creditor,     iient's condition.
                        wh  -0  was  @ed  with   the   task   of   wind-     As   Dr.   Nelson   ironically   noted,    a
                        Ing down the program.                                -week before  the  final  regional  advisory
                        The    tragMy    that    day    several    weeks     group  meeting   5,000   orientation   books
                                                                             on  the  use  of  problem-oriented   records
                        ago  was   nrt   just   anGther.   casualty   of
                        the    commmkations    gap     between     Wash-     arrived at  the  IRMP  office  for  distrib-
                        Wwn   and   the   bustings.   The    IRMP    was
                        more    than    "@    another    program."    It     That    untimely    arrival    characterized
                        was a            y   organized    effort,    the     ',he  dilemma  of  many   HEIV-funded   pro.
                        excited  response  of   practitioners   to   the     g-rams,  from   OEO   agencies   to   educa-
                        simplest      @al      de@      of      all-that     tional projects  authorized  under  the  El-
                        the   worklls    best    health    tMmloZy    be     ementary   and   Secondary   Education   Act
                                                                             of 1965. Via the HEW  shift  in  priorities,
                        @ble to aU citizeuL
                                                                             millions  of  dollars   are   being   "recy-
                                                                             cled"- slowly. if at all.