p-

                                                                            lulllliii      -i@
                                                                                    * E 0 3 II @ll         iiii I


                                                              c-f

                                                                                                    s       0, v,@ d

                                      Stc;,ce uni,t-                                       p@
                 Dr. 4'iar-,L'Tic's:                ti-lct Vt@1-Y -'I@ficult @c,                    As    itt

                        -c                    -y groups
                 cure i              adviFc,,.                                                     -1

                                                                                                     gny-,qi-.ere

                        3      3 c-r 10 or 15 E!ays -i ,<;z2r
                  @ld dcn't pay cor@sull@eit .4ces for away c!f tlie,-;e                                 V"-Icy give
                 'heir tiL.@.  'Itiest @-@e 'oull@-reds C,--5                    Cif 742r@-IIC--UrC-. Of professional

                             h are c,-,titr3,.ljutee.
                 tape vhic

                                                                                tiv--t,-cs   iii   a    coord      el
                 '@sT^, very '-reqee-@itly involve. r.-.,iior healtl-i i,-                                  i its te
                       ic;l,!,             fro,:.                         r,-fr--qr@ri tc- i          co-inty
                 healt,-. departr-,eiit to             ,.ure  tlie4.r irivest-.-ei@@t i-r, I)cttcr designed

                  nd   better airace".
                 "I t  -@l(,uld   be   posrible   fer   us   to        a cilcul.-,tioii of i.;Ii@-t this
                 but   it i-iot@-ld be r.,,iG'Le e. d i rl.!    ..... I @.rz confident, however,  that every
                 d o I 1 a r IL note s ten        r e   o ni   r,@   c P. 1 p r c fri w, s li s a ii r, f I u e a-- e c n
                 L-;2fty re-ore dollars -.nd has 2 vevorable inf lueA--e by havinfr, tlie@n mnaged

                 more 6ffectivelY."


                                Al@-il
                                                                                      Li  o r,.,.-itc e

                                                                            was      pilcviee .1
              ,,icli'cle by        scicnt,,.f-'@c                    be r.-.c;re         trai-.s'Lerred
              to lz'tic            of he2lth cervicc-a     and, by z;o           ii.@pro-ve the
              quali4L-y Of ('he health care I)-"(7vlcr@d.    Ws-                        th-.s to Le
              litit t@e bc          of @@lie                                              r@f tht-!

                "'Vi,e @,-2Lse it-,,;n x,?hic'Li the                                Sf@rvi-ce is
              bpscd is thpt the providers of --zre iii the Private                      fi-ven t@ie
              opporti,t.,-Iities, have both the iriiikle ce.!),icj'.,@y ir@.d the!        provide
              qL,@,.Iity c-v-re to all t-,mericc.-ts.              this                 t@ie i--suc
              has bccozqe c-,.re of 'LiGi-i best -;--o                       'Lhc-ze orpo-@tunities.


                         1r  u               4.'i 2 L
                 c,f  t'tie  C. tic, v       ttce- c@:% @,r,

                            y  c,, f e    r  b i. n,    e        c  t   c  r     ci      y@.. c- c;,    c,   t. rs i i p r@

                                                                        i@  @o   r, ,-.i te    t: t"'-@ !.s @@c--pr a xn

                    time,: tc-d 30, tf,'OD 1--@"Ys ic !-a P, 5 ,  cr  10 nerceytt -)f

                                          x7ill  I),r;  ir.,v.@l-@ed   in

                                                                                I   @-ffect@6d by
                               acl,ivitzes.  Iri tcrr.-.@  cf hrL-I)-i.t
                                 it i-3  e-E!,      f--@d      t I   '@70                                 p,:rticip2te ip.

                 er bcn@-fit from                                                   This
                 ok gll &hort  terr@,  non-Feder@.1 hospitals-.  Of  the  1,470
                                  860 ire  the  prlt-@3.-ry c,,po;-,sors or sites of  the re,?icnol

                 rtc@dical  prc---r;ra,-- activity."


                                r                                                                     I)ef ore        subcc-t i itte
                                  u
                    of the      Ef@.u@-,t                                             r.

                                  rrc;ct,,F"", X.!C  @i:e  ij@  ing

                    1q,@     lock on  it as  t'-- Fe  tral                                                                offitctivc..
                    @-ccc.,-s  to  th--  privz@te                                  E@   7@.  ti  c@  t  i r@, 3. r- c7 f   -t  i n  t h ct s c-
                    ter@,,s,  @."c            the                                                   tc3   fti-:@cti-c,)t iiithILn  their

                           I-;a  l@p-vc-                                                                 th(t                   to     do

                    tticir  c;-v,,n  project r--vic-w            pric'.        t:!,c           i-,,irt r,,@ike  t'Llc      o vn
                    e@ecisic          @bc,@tit 'cw  troy  irve@@t                     fu,-es.       We  czrry  ti,rcj,,tfh  a
                    review  process  as we h-@ve  in  t'le                              but wt!                 lor-kino E., t  t'Li e ri
                    (tlie rcj,,LorLS) %;Icr(-, as COL--;)etc-itt                                  rather  tl-icn       as         project
                    r.-;Chanics  aa  they were  looked on  tc-,@ t@-,uch  irL e,-rl'Ler  ri..iyc..it


                                                                 'i 23, 1971, <!urfy,,, hez
                                                              i t t
                          c     t 1 c  1  C. t:, r;

                                                                                                 cu.r@-nf,:                                           F-,-(--jcctP,,   cover

                                                                                                                                           t r v.   L,)                  t s

                                                                                                               live  core  ect'L-,7it-Lts,
                                              wit't,

                                                                                           core  iTi

                                                                                                                 the  e@                                  f r, r C.,@  r.,.- e ii t
                          clinics              and outp@-,ticyt  eePgvt,"'i

                           r,  c        i,-, d   d                     cz:ire  -,Ct@,,@
                                                                                                                                  2!iD,C@'u'O  p.-,t-icnts.  An
                                                 l@5  pc,,rceNt  is  user-'   to                                                                  the        brc...Pd        zrea

                                                                                                                                  I,,cd  tc-                           c       re

                          and  expa:,,tj'ed  sc,-@-vicL-s.                    Vle                         p        CC4-S   ir,.clueie           the
                          n-url-es  end  otiLer                                                   pers@t-.nel,   i.-icluei:,,-                               physicians,  in
                          new  cl@ilis  as  @,icli  vg  upgrading                                                  skills.            OLr      r-1.,qnp@@4er  training
                                                                                                 t,.!-l  c-;f  tle  v.@rious  l@in,@is  of  l-,c-@ilth
                          rescturces  I;it'l@Lli  CO.-;Mur,ities                             hospital,-,,   clinics,   r;.c-if,,hbrr'-Ioc-.d  he@-Ith
                          cc,r@ters,          spec-'@2lized          fzcilitic-s,           and           r..-.e(lical           school           healt'ft           co@-,plcxes,
                          but  i-.ie@cktd  are  net  I,-taited  iri  any  @.,@iy  to  ti-ic   lattcr.                                           Fir-ally$   Oppro;r.-
                                           17  percer..t  of  our  furi.is  support  projects  cci-,ceried
                          coordinating,         tile         activities         of         com--@ur&ity         i.i-istituti.ciis          in          order          to
                          develop        means        of        ir-,%provilig        access        to        aitd        tire        quality        cf         2vailable  health


                                                                                  ill.-."" S        11  C;Ltbcc-@ru@Aitte
                Dr.                                    1971,

                                                                                                                 bP-

                                      c? s t@ b       car     L,                              to

                                                                                          Prc@-rvrs IL:o Corvcne tile

                key prcv4-d,@@- and consun@-@,r groups                         fc.)r


                                                    19  I
                                     @f@rL!. 2P,
                                          t t e C, n

                                                             ic - 1    ci Ftrr            t                          L' r

                                          by  Stvte

                                                                                    rcrv-"-ccs.     Tri tt,-rn,

                                         p--c,@r@zris z:re             to cci.--pr(-hcr,,@-ive
                             to                                                                        fr,@,izl the

                                                    an--' to set                               rej;i-cr@al


                                 t tle 11 i_-611 cc, St o                ri---e ic.n 1 CZ:                         c.,i n

                                                      being     frcz-!
                                                                                                                                    to I(.@

                                 one o4 the t I s @i r,,,  i@,7                   s bc, f  cr@-  1975  i.@-                        to          c to  (-To  I.;       t'i
                         tl-L@  quality   cf   iTed@cpi   (.@.re   Zurich                                                                by                      Died

                                                                                                       prc-,cluce        sorLe         pro       11-1            5 I r,@
                         n,l                                                                                                             fOL-,ri     Cl-Len-

                         "'lu'D'ic h,,i'@pitals w4ic"-, currently ,@roviee
                         pccplc! because  ti,,c!y                          ir.      icr@.--ts      P---e             tr@     li,-,v@-     to      face      the      fact
                         tlz;:-,t this cz:re is                                                              systni,.s    -re    &oing    to     identify
                         the   difference   b   twcen   good   a-,ii   bp,.d   c@ire   @,.t   lcvels    of    sophistication

                         N,illiich .ione of t-,s feels reac',y to                                      c@i,,.

                         "I-i @;iyth @@e e-iei riot                          about   is   test   b@-c,,Ic,Ei-cil    researc'i,,    tieces--crily
                         r-jp-2ns  bottom  he,-.14:h  c,@.rL-.   ii@  jlc,,-,.-d  t".zt                              rc-,t true.  Tli(i secc)rd

                                                                              t,        bility to 1)urceaT@e care,  the                              system      is
                         x@.,,as      that      if      you       ircrclas,2   LLe
                                               exp.-3j,.@,ible  did  -2n                resp!Dti-,.    1,@le    'Lcut-.d    -L'L-.at     is     nr,@t     tr,,.te.     Ane,
                         the   third  one-,  i-i',".ich i..,c  arc                                   into        i        better        uvtdcrstar@diii-        on,        is
                         ti                       In(,       the       nui-I)c-r       of       people                      to           provide           iedical
                           iat

                         E-C)-v-'@ces  is   ti,@          whey  to  cvercor-.c  tile  ro:@Irpo-,?er                                         Th@.t       is       pi-e-
                         er@irt,-@ntly               false.                tire  faci-t,,         an       Ln       teresting       dilermR       as       we       go
                         into  tile                                                           if     -,Oe      i-,-e      tc-      i-@Lrtein      e:zn,-,rtise      ii

                         the  q'@ality  of  Liedical  care                                             sure   tii@t   it    is
                                           le  Of  -the  Pi-ly@@'iC!.Pr.  Prd  15'llgt  is  tlle  role  of  tl-ie  people?  I
                         La  the  ro

                         b c. I  r_ v e  tl--, a    c, 1 1 ow i ng  c      6 n t  w       I  o,--    u r  b y      h c  ct S.   h t   e s
                               TIS-ecia,li,-@ts       will       ccretir,.u,-       to       be       trair,       (1;       they wi'i-l'bc-           co-rfined           for

                         ti-
                                       t  p@i  r  IC  t:t@,                                   N@     1 be              cv,:-.rr@d    by  LI-c

                         r                       ijy  c                                                        c   rL,:,        t                    c           r   c    E,


                                                                                         t 1,          p@yr,   c icirt.
                                             Cl
                                                            pt)-!.c tire

                                     we   -a,'        c O-Ve-r                                     to cce a

                                fo,,--  a  ver      -e                      L
                                             y l@r                        ;4:         C.'Lllv.,@i-@t:r,     a   c
                                                    CY

                                           tte
                  I)rcur: t to the- iL       iiticri   ef   i   PhyLicia.-,.   Aiet    @.4c Ico'L-, P, little further.

                     t c@ t-2 r. e %le l@, tC.,       @-K -v@ 0cre           @-o
                  pGrtioi.t o'L  t'l)-e  time spent@- by professional P'3@-pl@ i,,,                             otter-
                                                                                                      L;

                  tic.n tc., iridivid@ual-- @,ii,@c, d,, list need to be-                                    syster-

                  at
                      "A mijer input is                  to be the use of nutonated techniques arid
                     bel-,'c-qe  t!-z'is fill i-@c'@uee sc-:ecr@iu-, r,;etl-icc:s ii,iich fill late their
                  cc.ncentra,6-1.0n on healt'ri                       riti-,L-r tt'lan or. the identification

                  of a,--ute           e-f illnesses.

                      "As a cor                                   bt a %'-'Li  --rart    us
                                  .sequence,  t'.ic@-e    wi                              e of allied health
                  L-@.zrpower. And Rlt$iou-h this         va   startle   you   a   little,   I   tliir;k    our
                                                             y
                  currc,-@t efforts  to (1)  ircreise            the (,-,ill-p-lit r@.4 medical schools, vrsaciated
                  with  our  ef@Lcrlt-.s  to   (2)   reorganize   the   wky   ir   x@hich   healt',,.   care   is
                                                                            y s or.         -I lotit)
                  bei-ng   pro@ridf--d,   -.,ill   lead   to   a    discover      @-,ewhere          the     lire th2t
                  WC -Sr3                tc-o  teary  pi-iyc-'Lci@-?ris.  If  the   letter  is       successful,  the
                  forr,-c-r  is   ur,@wise.   II   the   former   is   Pursued   and   the  i.-t@c-r   is   rot,  i-) e
                  Rare         to  have  to  c,-.6t  aroup-d  to  it   a   t      l@,ter date.  So all these
                  ef -@orts to vastly irzcrclnse tl.@-dic.?@l                     %..Intel  t-e illusion            tli i

                            provide      iacdi
                                             tal cgre, gr   goin-           to  be                   and,  in the

                  course of tirio, 1 t'@-irl, are          -oii-- to be etrepr,(,,,d.
                      tt                     'Les, rLot                     ti-                but    in    acting
                        The     solution     I             rL              to  e riu    ers,

                     re                      c-f t";:
                                                         y

                                                                         C.-,, c- s  t

                                                               c     I,;:n  cl.,-


                  thcre                                                             @i y                        'is
                                     rg te b--

                  u  e

     ,17


                                                                                 :-nbii-ied?
                                        "Should P,[\/iP and Cl-iP be co
                                                             t  question   is   LJIICCILIIV-
                                        Ti-ie answer to tha
                                        ocably ,no.'  Ti-iey  serve  a  d;-Ir-,Fei,ent  kind
                                                                               -efer-
                                        of a purpose and if I have my
                                        ences,  I  would  say   that   Cl-,,p   and   RI@fPs
                                        should  operate  in  such  a  viay  IL-i-iat  @L-hoy
                                        have a  productive  tension  be'Lw  e  c,-  n
                                        them,  one  forcing   dp-nicincis   on   -@he
                                        other.   the   other   dealin-   with   those    de-
                                        mand  .s. 1-tiey Si-IOL,!d have z) basis be-
                                        tween  ti-ier-n  for  an  effective  i-ie@,o-tiation
                                                  what the corni-nu ril-L\/ needs
                                        between
                                               resolution   in   capacity,   the   idet-iti-
                                                                         L
                                        with  a
                                        fication of reasoi,,able priorities, and
                                        the   reaching   toward    those    priorities    by
                                        a comi-non understanding ...

                                        "If  we  are  to  be   effective.iri   R,""",P   and
                                        CHP,  @he  problem   is   a   double   oi-ie.   r4ot
                                        only must we be responsive to con-
                                        sumers, but we must be abie to interpret
                                        to     consumers     the     difference      between
                                        an  it-rational   and   the   rational   effort   to
                                        meet    their    basic    needs.     And     because
                                        it   is   a   sophisticated   issue   and    because
                                        the  health   care   system   is   co,   npiex,   it
                                        means that the professional effort of an
                                        RI@PIP   or    any    other    organization    needs
                                        the.full  understanding,   the   f   ull   e,-,oloi-
                                                         -ie most minute interpi,eta-
                                        tation, and tl
                                                               unity so they can
                                        tion to the comrn
                                        appreciate   the   difference   bet@,v--,--n   ti-ie
                                                                               Clamorous
                                        visible., the glittering and th-
                                                                                    ezilth
                                            -id               is e senti,@l i  or  li
                                        ar   what really          s
                                        maintenance    for    control     of     co,-;@Latid
                                        for   the   basic   health   of    the    community.
                                                               -Dr.              Margulies


                                                                                          6 IL 3

                                                                                            ii,ii-C   to  I-()to
                           ti                                                                                                                                                             the
                                                                        il!Lc                                                !)Cut. q@ cut. I  -,III
                                       title             ]Lot.
                          sol@1-1. to @e", 1-t)ll                    fell 'II
                                                           (],(-iiig is
                                                                                              y,olir (roo(I                                                                                    AVe   e:t   II ;11-;)
                                                                                                                                                                                          feet,-, of        )i,,t retrililili@r N-,-
                                                                                       IIO'L to C@
                                                                                                         litii,iie    Fail'                                    ree
                                               You ii@,st, -,41,,Id. T'l@c,                                                                                                                                                        F.,.
                          the                                                                                                                 of fw]C@s
                          iii '@)72 ,iiid        the                               tli'ey               ()II'- 'I,-i ,])e tc,,til                  of   i-)ro-                                  011L, Of II",
                                                                                                             L
                                        il!l(l  I   N@-oiilci   tii'ticip@.te   rii(-v   Nvoiild   (lo   -,-e@-   Nveill,   tlicy    Nyotilct    be                                        this I(Illlilli@t
                                      tliit level.                                                                                                                                                          I.;,I(
                                            -@o-ti](I !i-,t%-c@ to          :is i-oi,, iii(lic.--te(]. @-it fi@e e-N,                                  -I III s                                    Iiti(..:; ill :I
                              !3i,t  it.  v                                                                                  )Liise    of    I)rc)
                                                                                               L
                          wli;,-Ii  ,ii-e  le@s  I)roditeti-%-e  zii,,(l  less   iii-i4   t@rL.                                                                                                 As       (Ic

                                                                       TIOLE ]@ DFVELOIIING 11310
                                                                                                                        s
                                                                                                                                                                                            till)e,of      i
                                                                      1-o,,it-   assessi-@).eiit.   of    PL"    "!s    ill    tlie-    @Vdiiii,,iistr
                                     1)]@ill to                      ef'foi,@Lz3  iii  the  li-A@f  0   ii)d   iii2iij)(-,wei-   i       .i-Las     ?
                                                                                                                                                                                                                 Ilt
                                                                       I  to  tl,,e                                                                                                          ll;,itli  o!l(,           ik
                                                                                          ,c@@-c@l,)i iiieiit o@        lic@,lith

                             Ot'@e Of tll,@iii is to II(,]])                                          tiioqe                             iiid     iiist',Itti-
                                    wliieli                 to l'ol-i-ii @i@i' il@
                                                                                         10.  If  1-oli  look  @it   rie   ai-i-;ii-   of   i-,i-                                            tl)e,
                            IN-i(.Itiils qiid  I,,istitiifir)jis  I'cle,it'llie(I  :is                                               1)    ]I'-    ill    t.ll()                                              110   V t'
                         d
                                            e@,I(l  of  the  lie,,iltli                                                              tl,,ev    Hill,     tlio                                ;t. so'
                                                                                                                                                                                                       t
                         siiilio                 its those i-,i tle i-L,,-,'oiial iiiecli,,@zil                                    'tll,eatlv      ilic@Ett-

                                                               ]five, :I           role.                                                                                                                               li@
                                                              of file ir4kiO  wll;cll  %%-ill                                     -,Cl'lll)l,!Otls ,,tteii-
                        t i(j"l   is   tli@                     of tl)e                                                                                    tl)e                               fo' t

                            'V%'e Avill )(@td to                       v.,-,!@-s  oi@   iisiii   ,   iii-iil)o-@t-cr   iiioi,e.   ei,@ectiN-elN-,   of
                        ilioli@itor:ill@,, tlir-, qtialitv ol' e'o,l,(,. 111,-l of                                                                 quality                                                         to tii:ir
                        is il"fel@ior it i:-, i,c,c-:tore(l to ill                                                                                             y
                                                                                                                fill  of  N@-Iiiell  @ile   c
                        tlle                of tliill("s ill                                                                                                                                        nto tle Nvo"(1-@ -%'-"
                       Cfyective.                                                                                                                  call    I)-

                                            i                       is coiict-ri)c,(I, I sii .1) et t'                        po'(eiitiilit
                                  f                                                                               @'t
                               s            -s iiiiiil)owei                                           5             0                      v       ior      I,                                                             II (Io!'
                                                                                                                                                                                               qiiitl'      -1
                                                                                                                                                   niore
                                 PIIN- otlic'].
                                                                                                                   Of   @,ill    oT    our
                       Cit,s. I !I(!, l@9cl@ of
                           If N-ol,                  Oil it for :I                         I-oil            z-.@o @Lliit  if    t
                                                                                                                                                   liiorp,                                      to   tl):It
                                                                                                                                   :,,il(l   if    i%-(@ Iiii-e
                       ll("t    lo    jl:LN-C                                       -.Iliid ive %,:o;i't                   it            to     be      ('Ioie
                                               'fluids of other POI)I)le.                                                                ]miss          I)-icl                                      il.0
                        0 Oli.
                                                                                                                                                                                                doi     ill,
                                                                         t-Iii:- c:ili be floll(. N,.-itli                                 wit])                                                illol'O
                                                                                                                                         Or         for-ni,-tl
                      I)IIzzi@,                     j C)      C, I'@  of(,.@l.t?   -V.-]lo   ii,c,   Ii@                     t-lilic,
                      fo I. ti I o ::c,     t i    t i     tllc- s.--i ]lie               AN-]lo 111,11@e I'                         '10TIll


                                                                                                                                               1) of                            O,. L lioz;l-iital Nvslio,3 1-0
                                                                                                                                                                             o"11(@r                  of
                                                                                                                      of
                                        -t cut.       1
               go'll        )Out                           FIJI

                       fP'   -iiid         i, c      r,3 i i I
                                                                                                                                                                                              ilIN-01   eel ill  iii@@tit-,iti
        ;ii   the                                                                                                                                                I,,I)I:CA'1'10'@        C E -@'I "". n
                                                 of )'.o
                                                                                                 Oll(,     of                                                   A@-liicli    lii,,zli    oil     trick     life     of      ,cti'vitiec;      ill
        to I.(,rv v,-cll
                                  tlicy v@illi(I I)e                                                                                                                                                                    wliicli   is   ,I
                                                                                                                                       is    tile,
                                                                                                                                                                                       of tll(,                               trt;

        'it   the
                                                                                                                                                                 tll(,                  I I e ,, (I ,; of              colli@iiiil-iit-,-.
        (I
                                                                                                                                                                           lo,    Yei,N,                                                 tlio,
                                                                                                 A,;                                                 t@                         L
                                                                                            :,It         I-'                                                                      I ,-              to  tl,c                      of        t'lle
                                                                                                           )(Y
                                                                                                                                                        is t -               -ii)ilitv it                                 r the
                                                                                                                                                                                                                  3  O
                                                                                                 i'l@i     of closiil(,r             lo@)l)    1), t@vee,                     e@ s                                          fol,     those
                       ill
                                                                                                              'Lli(I ill(? ti                     (,f tlic,                    )N-110 iiiiist,                        the             sol-N-ices.
                                                                                                                           -oil                          ioll lici@,                                   o,- i,.ii-.ior                       o,,:
                                      Ctll lilalzp 'L
       -lit   of                    ill'tin'                                                iiiiivcis                                                                                out iliui,e,                  t;ic  tivo  1'elzite
                                               tej,.i,,aco
                                                                                                           cile :Iliotli,@r too                                         I)v
                              @ils iiid iiistit-,i-                                              Al']):it i,.,C iieclcl I,-) hiicl@,v i'S IV I I': I t                                          @@-li(,n   tlic,   training   is
                                                                                                                                                              ])]'OVI  @ci          ('oi- ]-lot.                                              is
                      ,It. I Ile
                                                  of  An-
                                                       tile                                                                                      tllk' tv;o,  111(,[                          (liF,:Coverel  tile,  lived  foi-
                                                                                                                                                                                                                     and
                                                       tj
                      11  s                                                                                                                                                                    ,iiicl NN'
                                                                                            it            ,o tllti.e                                                                                                is             ])I"Ict!C('Cll
                                                                                                                          @ill(I  o@  tliill
                                                                                                                                                                                                                                          leave

                                                                                                                                                                        of                    Iii@:iltll
                                                                                                                                    it                                  i          I
                                                         of-                                need-., of t'j)e                                     to ]@t ilic@ 1)(,ol)l(,                           i i-oie,(@ ill  NVlllt.  illev
                                                                                            ,,et. Ti-iis  i@  i  to;:,.!               iii@ti,,titioil:ll coiccl)t.  I  tliilll.c  -,%-e  call  coiiti@il)ute
                                                                                            sl)l(liidi(Ily to I  liiL
                     Of i@,I)icll ,,]-e
                                                                                                 @Afi-. Cc,@-iy. T]i@l,,L is                                       1. (,oiilctll't (,V(,]l                     to  start   I)Iltt;li@
                         I)IIO(-rr,"iiiis c@t           1)
                                                                                            it into ilie                        -\.oil (1@id I)iit -voii are .tbsc)'iiitelv I,i(,Ilt.

                                                                                                                                                                                   CEN'I'El'

                                              fol.    I'(,-
                                                                                                 In  iliv,  eli@trict,  tile                                            @fedicii    Cei)ter     liis     their     oN-cr
                                         led                                                               'I fe
                                                                                            (@,11 i I e           %V @tii('-               f-roiii the All):iiii-                                    Sellool. It li,,is
                                                                                                                                                                                                                                        -O'IC'
               of Ill       (If    0111'   (Jerlcic@-,                                      Nv(,l     1.   Tli(@-%-  ]into  i'oolli            foi-                     @',O  oi, lo there. It is q V(ll:\7                           il(IO(i
                                                                                                                                   -,It the                                of
              ti             t))  '                                                         1.                   -Ive       oilli              ii     (IOZ(@ii     sttl(lellt4z.      If      @.0ii are                    to   idcl   oii
                     t  i f                      itiore,
         11 oil(                'ill(i if II-(,                                             to'tliall                                                                        to lia@-c to liive iiioi-(@
                                Ls     to
                            .3,                                                             I)uild,.                                                                                                     Ill,.  :)Ck  there   I;.;   710
                                                   lot-ie
         s
                                 .  11  11          't I II                 I                                                                                                                    11 1)],Ic@ lil@(,         the   I-')erlz-
                                                                                            need           for tli:it it ,ill if               (,II  Iql@e      tire (;tll(l,ellts to
                                                                                                 I I I-(,, @feclic:ii  C(,],.t(,r.                         ollIN.           little  ilioil(,N-                              radio        for
                          )'i$iol!, Nvitll          -                                                                                                                        facilities,          )'O                         -it(@  I   lot.
                                                                                            dol-iiiitor;(-s
                                 'II or fo;-il-"!]                                          iiioi-e
                     II'(  nice       .(@F                                                                                         Yoit l@iioi@- tli(@                              :it lie,-I@sliii-o,                                 Coiter
                                                                                                                                                                                              pro(,rllll.


                                                                                                                                           (i2i

                                                                                        (A  I-;)-. T                                                                     II.      i-d iii tlit, q,,ie,,-
                                                                                                              IL                                                                       L
                                                                                                                                                                              ]i-,tcl lo
                                                                                                                                  .-tiii -c)i
                                                                                                     )Oil                         soil
                                                                                                                                        IC,                                  Oil A-%-]iy )-oil

                                                                                                                        ilifi,,ittoli                               Co"-., ji-ist, lil@e,
                                                                                                                    "IV
                                                                                                if                                                               of                   N-oii ii-c  iiot

                                                                                                                                                                                    stii-e. t]],it-.  N@-e
                                                                                      o""t,                                           iii@l   @jl,,Ll,pvll       iv)i,,,t.    (10   to I.
                                                                                                        ki-e,  I Oil     (,rolll(,, Io                                      to  (It-)   sollie   of   tile
                                                                                                         ])e.     i-li-Ititiite"l ill oi"@t'll               of      il)(@
                                                                                                                                           ii),,ii  '              .     il-'c-@ilit
                                                                                                                                               i@(,  a  i,c,,i,v   si@ii                               ,oil
                                                                              to             I (101i't                       that.                                                           to    filil(,-
                                                                              ti(,Il ,iloile.                                                                                           II,("   call   (to
                                                                              \Vlltt  iieeds  to  be  (',oiie,  iii  coi,,oi,'k  v,-iLli  (-)tllel.                                      "Iii(I      other

                                                                                                                                           of iliese
                                                                                   t t                                                                         r                       tll,,Lt
                                                                                         tight! too. 'rii                     i@,              ii@vfiii ti! iit. ;@t                          is
                                                                                             I  liit)l)ell to                                                 ill     iiiv               NN,Il,iclt     ]its
                                                                                      liell)ocl  I                             I)N-I         :@l"(l                      @iiistifilt(@    of
                                                                                                       0 j;cl.                              -N-  :LI]  @iii   to   1)(@,                   11)0111@     tile
                                                                                                  tll(.N-  c-,i"l  :it  :Ill(]   it i -:,I II
                                                                                 Ycili S..Iv the                      @ll)loll,,It of              is ]lot eiit., I)II'L. ),Oil                         tile
                                                                                                  ive.  [],e  lo@",IIL,                     ill ile@@ll.Cli ,Iil(l ill q@,i               IV  ri      this
                                                                                                                                                                                                          of
                                                                              ille(lic.11
                                                                                 D                :1,1111,@. A@        (10   f(,el   tl)(,

                                                                                                                                           3'@ll'.%I,'I'JI     3']'STI-@(,
                                                                                                                       voti                                                                  ititoii),Itic
                                                                                                                                  tlllt   is    ill(',Ilt,iolle(I    Oil                        of      tile
                                                                                 D                                                                Ill                    iii   cool)(,i-atioil    NN-itli

                                                                                                                                                                                         II-oiill(l      the
                                                                              coiiiitri-                     to      ])i-o\-i(](,
                                                                              for lieii,t. iii(I                       (li@c,:Ice.                               iiii(I  otli(,i-                      :iiid
                                                                                                                                                 services    ill\-Olle    Ill(,.    collclli(,t    (,)f
                                                                              i            of                                                                      oil sll(.Il it(",Ils

                                                                              iyt  )it aii(I                       the
                                                                                                                                                                  @is    iiite(,i-.tl    coiiil)oii(,@iis

                                                              t


                                                                            622
                                                                                                                                                                                                                    f  ]light
                     of                                                                                                                  (-,f
                     clo@(, ties                 lo.,-:il                                       lotii(i              for
                     I.ll(l    follo%@-iti)                          of tl)(@               Ictil-iti(,s ;i,-e tie(I 'lo
                                                            -.z-id iii(@iiile                   of                                 I.(,Sl-
                       lit   +,o  ,@-o  I-],  t ('(-III               t !IC 1)1-0@yllzt I lis.                                                                               @7
                                                                                                             o"-.t ill tlie,

                                                                                                                                                                                                                    IT
                                                I)rof,i-;iitis     to iiiijit, ,i           Foi- exiiiiillol- iii S,,tlt
                     Citv tlif-,                                                                              I)ro%-i(Iiii"
                     ill,,iie(i ilitilt:ll)lllsi(- liel@iltli               Seri-lc(..s ,is 1):Il.t oi@ tilc,                      of  ,I
                     lici@,-,Iil)ot-lioo(I Iiealtli c(,iiter                  is
                     sil)le,           ctreto  t   lo@v,   socio-uollollli(@   till-i@ct                             'I@I)e
                                          iiii-ol@-es
                                               lieziri.,ily   aii(I   C.N'e    tc,.,ts          s,7-,i-ei,:tl
                                                            ,-                       I                                                                                                                          @   (t   ]lot
                     as NN-ell  as  the  tr;iiiiiii,, of                             qiid   ],,il.)or.,itoi-i.   @ti(tc-s    iN-lio    ire
                     i-cei-iiite(I  frc)i)i  Iiijozig t'@ie coi-.,iiiiiiiit@,  ])ol)itlilttion.                        ;,.]I(l     otl,,er
                                                                                                     :iji(I I)i-oiiiote
                     tire ilicl(liclil @,ii-e  %vitli  tl-lc, expect:itioii  tlllt tilroll(-rll                              (I(,te(.tioii
                     efforts  tlie,  cost  :iiid  disabilities,  iziciii,j,e(1  froiii                                  sta(,es         of
                                                                                                                                                                                                                    C.t I'lls
                     dict@qse i%-ill I)c red-Liced.
                                                                                                                                                                                                                        till

                                               EFI-'F('T Of'  S,[OlilN-0  ON

                                                                                          I    ill(,.    cliiii(,(?s     of     siiiokiiig
                                            IN'!iit  ,il-e  tll(,  statistics  0)                                                                                                                                       ]lost
                                 i'l@IN,ij     I Si,rilifie;llltli-                  iiiiiiilell ol it'lisiic   s   I
                                                                                                                  ce       11       pi,et-
                                                    t-                                                                                                                              :I @i,il                  ; T-.
                               t 11,11 11 lloll-Siilol@i!) "f illof
                                                                                                                                                                                                                           it.
                                          Tlic,    )3t-itis@lt    Pei-tiiit:tl    Nloi-t,,ilitv    S,tii(li-    ii     oiie     of     the                                                                                Ill
                                                            %vitli  this   (111('@tioll.   I   N@ill   1)1;1"(,   ill   tl!e.   1,0(.Ol.(]
                                                                         tl)-.,,ii  17.0()o  bii,tlill  1'e,col.(Io(i   ill   1   N%-(..ck

                                                                                                                                                                                                                     to    s@

                                                                                                                                                                                                                        to
                                                                                                            du.th raises           r3tes
                                                                                                                                                                          'II I)L'(                                     ]lo
                     S@.okini filoth-,                      ...............   ------------------------            17.2             27.6
                                 rs      ---------------------
                     fi@ns@-r,c@.ing mc'@crs .......... ---------------
                                                                   ----------------------------------             13.1             19.3                                                                             )St  ill)

                                     of    tile-se    I-.Ites          tll-,it  siiiol@iii-  )]lot,ll(,I-s   11:1(1   31.,'i   I)el.cellt-                                                                          )I)Oz.t

                                                                                                                                                                                                 YOII
                     ]lo
                     1.11   @ijiotlict-   vt.ii(iv   of    i@toi-e    tli:tli                                                                                                              lit"-r:I(Allztl

                                                                                                                                    11011-                                               %@1IN- :il'il                  101
                                                 Ire    (@o                 ll,@t
                                                            liciii(It@(I    t                         of tii@
                                                                                          Nvolil(l II-                             fill                                              'Ills
                     if tlic,                 i,,ot beeii -t
                                                                                                                                                                        113,111.


                                                                                        624

                                                            0, tl)(-,

                                                                                                                                                                                                                    to
                                                                                                                                                                                                 l@(,i;l(r                   witit
                            @@s f-(@r wlii,
                                                                                                                                                                                                    li@it. tll(,
                                                                      that tells Is
                                                                                                                                       :@,(, -tioii
                                                                                                                                                                                                              Co. -i-P
                       so,          "IISP- O'
                       tlio.@c- iieivll- prol)ostyj.

                                                     l@,IP!ZOI-ED
                                                                                                                                                                                                                                     CLE.%   I   N,tL    c@
                                                   Oil               Oil(' of N.O"ll.
                                    fo,..                                                                fl.o,-,, (@iyol'is @111(ic-l'til-rs 1)1.0-                                              ('Ieii-iiigllolise
                                                          e, C"tr(t tij:tt- ]Its
                                   ll,j),It is tli-@

                                                to II),.
                                                                                                                                                                                                       er to I)e the
                                                    s               of                                                                                                                           flealtli ?
                      ill i@lic@ ilioi-c@                        iiiicler.;TOO(l :zel)Se of tli@,tt i@,-C)I.(l              t]],lL i.;@ 'Llic. 1)],   ',II-                                         Dr.                                                  TI
                                "til(I ],IA.o@it of ilitclisil-C or                                      (.,Oi.ojllllrN,                                                                         ifetltli
                                              it, i   t                                                                                          iiiore,                                                  Geiieritl's
                                                                                                                                                                                                    0]
                         Ilei-,ilizc(l
                                                          el. slieli  is fli@tt  fol-                             :iccicieiit  i-'Ict'jliis or t                                                 licaltli  li-,iz-,ir(I
                                                     oll(@, siiell ts til:it, i@,itelcle(I for                      i"ils of                "!f
                                                                                                                1-1 I                                                                            rilit .il)l)rol)i-i:I,Le
                                     'ill iiii-ell@-I't'C or                         Circle limit. or                  tlitit, i@.@ i)izt, ol,,e cle-                                                        llcl                 (1c,@itli    :    (jet
                    litelit, rlle, iiiiit itself is of little                             if    otli    r                ez: c@iitiil                                                            e
                                                                                                                                                                                                                   ati(I
                        IT z;  (.Irtctii-c filli,@tioliill!@
                                                                                                                                                                                                                         TI.TE    LIN'IZ     I':     LI-@li
                                        s%-st(@iii  foi-                        ti'ie  i-;ctijii  to  tlj('          liost)itil

                                                                                                                                                                                                                                L I'(' :1 ('C" I'('
                                           tli          i,.-c  a  coi                                                  I
                                                                                                                                                                                                    -Nrr.  TI
                                                                                                                                                                                                 tic,                              sell            seat
                                                                             I(,  ii                     ol.  t    II,-,  iiilo  t"."                                                                  ,iii (,iielo@ecl
                                                          to  SI--Lfetv  @ll)(I  '['I                                                                                                            .V(IElll Ci!-T:irette
                                                                                                                                                                                                 Diseilse.-, is '-\-Olv
                                                                            '-elic@
                   it  i     ]Acting    ti-i(@(i     ']I(l     te'ste(I.-                                                                                                                        tliillg is                                        belie',
                       It .11  o                                    iiiii-ses                                         to             stieli I',!Iits
                                                                                                                                                                                                       4L,Iie
                                                                                                                                                                                                                                                     stit(,
                   tic,, line to                                     lio@  it;il     :It.                                                                                                        lost     stispect     coinb-:iiit'lor"@     @itiol),s
                   l,oi- it  1)eriii                           niii.,@(?S ill tilit-. li                                                                                                                 filliic,-ql                                  11,(]
                                         i                                                               lio@-i);ttij  to Ill(.Jllito".
                   ill  t@-i("  -el-elit of I                         I)I-cs(            I)') -ci,
                                                                                                                                                                                                       to(i tlint, the                            '-cneles
                                                                                                                                                                                                 Mies
                   foi, tire liitielit                    cii.e(I foi- ill           (!('t  ]ill the                      ll(ys,l)itill.                                                                   obtaiii,@d           co-@@)y o'              ol
                   the i@)""Illllijlcr foi-                                   etill(I                    ol,
                               lll,,il@c                                                                                                                                                                            SI-itiites ol
                                                                                                  is  tez-ii-i   ]]:,tell:       ]ill  is.     (-]felt                                           0  siisl)eirts?
                                                                                                                                                                                                 Dr.                                 TTiitc"iir,,tcliiii
                                                                                                                                be
                                                                                                                                2- oi-
                                                                                                                                                                                                              Of
                                                                                                                                  "IS                                                                  si'llo,
                 to                                      foi-     ]It,-Ilsik-C                  Foi, llie             I,C!(Oio",Il  ll!e(lic';Il                                                       est'i't)lisllc                      St,. i.,3  -t  -


                                                                                                                                 625

                                                                                                                                                      c,, c c@ 3I
                                                                                                                              @"Olilllit   to   ]II,
                                                                                                                                          I  of
                                                                                       to                                                  @3
                                                                                                                                     oils,
                                                                                 Collt(!Ilt-, V@.i4L]i
                      Q                                                                                                              iiiii)- l@la)it
                                           Air-                        tl")@4'  flie  otil
                        zl(.tioll         iiit'.
                                                                           i@Ir. CO-.\Ti,

            A I? 1.                                                                                                                           01"@  I'-\ @k'-\ D I I I-;.%  1,Tl  I
                                                                                                foi,                   iii(IL Ifealtli is @i             of vc)lll. C)"(ritilizltic)ll
      f iiiit(le  r        @ilec@ to ],C,@                                                                                           @-oii   d(lzicl"ll,c.   for    Lis    iv]i.,it    I-ou CC)ll-
                                                                                                                                                                      for
                                                                       FiO@r to I)o        lie.
                                                                       Ileilt II ?
                                                                                                         T
                                                                                                                                                              for    @Siiiolciiiff        Iiid
                          iiiiik.@                                                                                                                      (illiollitioii o.,  tlie,       St,,r-
                                                                       Ifetl'Lli    -%v q                I                       Ilo@vilir_,       tll(@
                                                                                                                                         tll@lit,        "Ci,,7.trette,         s!nok-iii(7 is      a
                                      ol.    :c                        lielltll    11:17-111'(1 of                                         ill     tile                Stites       to  IN-,Lr-
                  0
            .])is  f                                                                                 I-oil
           (ti                                                                                                                       Its                  is    to    licl]-)    re(Iiic-@     ilic
              tlllt, ;14,;       O')(@   elt-@
                                                                                                                                 -i@tted                            siiiol@iig
                                                                       edii(-,,it-ioii  iiiet

                                                                                                                                 S'3101@lNG           A.ND     ILL,N-ESS
                                          I)o"                                                                 (,n,,)v   of    t          tli:it      :I               S.                     of
                                                                                                                                                        tlic-. co,,iiiti,v
                                                                                                       s.?iit      to I)li,-,rii
                  'I-,to   tlic,    Ai-iiiv'4:                                                                    -a'(1
                                                                                                                                 .   0 ,iiicl stati,-i@_r tli,,i                     iiil@  ]@e-
                                                                       that     tii      ciiclo,@d      1)o@'Lcr      1)                                          t '@T         I
                                                                       t.,,veen                                                                                                 iiid Otl,cr
            iii t] o@,                N@-lie,-o                        Diseases       is '-\-oiv                   l@'Itt@ilili@ll(,(I.@,     to    111(@,          ]falls          tile
                                                                                 a--,                                            late                        ol,   F    ,
                                                                       tli'                                                                                                          of     this
      Lil)(@(i to staff                 iiiiits                        yeir tli(3                     IllsiL:Jtllt(!s of 1-1(1@iltli                  I)IION,i(IiiiL,  @,I)C)t.  r,-z(lio  -Lil-
                         a                                             lioiiliceiiiclli.,3 wliicii                   tli@,it lvc@ ('toiit, I-,iiow the                 ol@' eii-ii-)Il-vpelll,,l
                is -ill  iltei,;i:itive-                               bijt sil,@,I)eet (.C)Illl,,i ii,,it ioii.@ of N-,Ll.iou.@                      -,iicli IC;                    -,'ntl ex-
      0.@I)it,il to liloilitc,.)-                                                                                                                                               si-)ots sii!-r-
                                                                                             tlje li@teiiei-s ivi,'Ite               tczlc    for     1)
                                                                                                                              .iyid    ,                                O.       114.    '    ,To@.
                                 ti-ei.tillie)lt                       giiect-ed tlitt                                                                                          -f
                                                                       I   liai-e   Ol)("Iillc(l   I   COI)V   of    i'lli@    I.)"Ill    I)IIIet,    -trid    it    stated    oil   six   tliit
                                                                       tlle CI',Iso of       one]             ;I,                                                      Ir        I
       is     itiost                      tl)at                                                    )11.v       -..I is                                         tIlf    t@.    i-.tl lierc,   ?    'Is
                                                                       tile                             sa-,-iii,_,  it,  klioNvs  tl-](,.   c:liisc   of                                  trip,
                                                                                                                        -I   sq
                                    iiiti.    I                                                                      Itl      y tlic,.- do iiot biit, r  t-I
                                                                       !,T,    loil,,Ll    lii,,tittit@z,     of     Ile@i                                          cr        list.  iiiinil)c-r
                                 is.     tii,,it                       of  itlsl-,ccts9,
         co.:;ts Call    I)e                                t              Dr.                '@Nfr.                      letter        qiiolecl        C.                   Olson. prcsidei)t
      ill l@,ltliiii  i  2-    or                                      of   tile, Aiii--ricaii                                                                                 of    ciieral
                                                                                                                                                                                -eCll
                                                                       Pract'  c of                             'fr.  O]Qoii   states   tll..Lt.                liii'.z
                                                                       )-cite, siliol@i"!!! illel iiil-!Cr                                            tiid    otli(,r     cl;zll@@.-.c;c@s it; iici@,v
                                                                       Nve-11                              T))i.;                                     1)(@, v,-ell                   1)1.  'tile


                                                                                                                                                   Tncrease  or

                                                                                                   1971  rstit-@@-te
                                                                                                     $70,298,oc..,)           $? 5, CC)D,  00      +$4,702,000
                                                                         Grants  .  .  .  .

                                                                                                                                              listinciit  and  ol,cr@itioti
                                                                         (,rants  are  at.,,a-ded  to  assist  In  the  pl,-tning,
                              +$                                                                                                   ,line,  alid (itr,,o-.tstrtitions  of
                                                                      of             @!C"Iical prc.-rars  for  resc,,rcil,  LT,"
                                                                      patient      care.
                                                                                                                              "'of!     Pro:z    to  i'nPrON'c
                                                                                                        the                               _ra
        ;7,27,',OC)o                                                     It'is  the  objective  of
                                                                      bil.J,,y  of  @@vid  Access  to hJzli  cuality  l,ealtit  care  Lc,  all  kiericaiis  tlii-,,u@li
                                                                                                                     c   C!    E' i,?,,t  utilization  o'  lierLItIi
                                                                      ir.-,)r3vei-.cnts  in  t',L,                  T,,,r     f"ic
                                                                                     ctl,.er  resc@rces.                                  iii.,,t4ttivions  iticlueinE,
                                                                      all -@dical  sci@colz,                                  v,,arie'v  of  '.,late  ,ild voluntary
                                                                      health                         no-.,                    in  tl:i-s  e@'@'ci-t  to  improve  thL
        9 raJor ,@                                                                   are  an(!  th2  alopti.cn  of  the  I.,itcst                  in  the  delivery
        Of  he                Ini                                     quality    of    c
                                                                      of  health  services.
                              re
        all        ,meric,
                     ins.
                                                                         T'ne Regicn@)l              PrOF'r"lrs  Ser.1 ce  sect-.s  to  assist     t'ne  estzblisl)ed
                                                                      Regional                         Lo  Jcvelo,  a  frai-.,-@crk  of  cooperative  relationships
        effort  t@'@  "-'cal  E.-c-dical
                                                                      for  i:7pro,.,ir@7  trip,               and  Ieliv(-ry  of  services  to people.           I'his
        llezlth  care  or                                             franewor'y.  Is  styuctur@ b-@                   the  voluntary  cooperation of  the
        problc,-       I   -Ifder@                                                                   -
                     cor_4;
                       _ -tnents,                                     varic@us  provi6e.-r  of  EE&rv,'@cc,  both  pv.',Iljc  ard  priN'aLe,  In  identifying  the
        I    end    t,@h@,lical     r                                 arlc-.)ts'                   -1@Lse  li@ve         cleter,.ithei,  t@.c  local  pro,.tps  and
                              ,Ssf@
                                 , t;:nce                             p
                              7nd                                                                  @j
                                                                                                -@-7- 'OCTS           @l', '.S to
        vc',L,-,tar,                 of                               inst-'   ti-tio-is                                  l@        ,,-t  ttie:,ct needs.    T, -, c
                                   cti@,r
                                                                                     of                                    include  tlic  full  sr@ectru.-,i of  l@c-,.Ith
        i%'c    ,,     of'                                                                                                                                                                                 I    .
                                                                                                                           Ize,l  care           tl-.-  latest  scienti@i6
                                      s                               t ccqrA qttc a ,  a 1:(i  I 1 i t zz. t i c.@n .        @dical                 provide  fun@'r    for
                     I,c-a I  t,@                                                                        L'i  car--  locill-,  ;%.ccel,table  and  responsive,  but
                                                                      c,rzo.-Uzlnc, a b@,sten ,@ hcal
                              care
                                                                      retired      to      recionEtl      resources      not      ziv@,ilible       Toothy.
        C'Eiii-r l@@"'Latcs and
        d                        'Ind
                            ilea"
                                                                      proz     f r r,71
        o r
                           proi
        t;f,ich      -litilifi rates                                     riftv-five     FcR!on-'@ Xetilcpl                    are now cotieULtin',Operational
                              tca.')t
                              he                                      activities.
                                                                         r-iring  the  1),i7t  vcar,  exent@  lr.  the  various  regrets ItLivc-  pr(,vi.eoLi
                                                                      sli;i@lf5cant eircc,.ic-ns f@,r the                  The            c-7@crgin.@ cooperative
                                                                      arrangements  wiz'riii   t',-.                   demonstrated the role! Ile lzcFic,,i3l
                                                                      Y.ei!ical F,-cFra:,@s car, nit,j as a recc,-,ni.z-@ble an@- locally acceptable force
                                                                      not cnlv for health                  t,ut -ior iiiproving rho orFPnization @nd dc@livery
                                                                      of liepl                        These cliang4-n9        tterns in the health care system
                                                                              th   care   as   well.                    @,   pa
                                                                      brouFlit about ttiro,,?g@, @.DCrational activities are affording the consumer
                                                                      Irnicdia-,e and direct benefits.

                                                                      C2-@se        71 Vt. 2
                                                                             0


                                                                                                                                             641

                                                                                                            @ns t!irct,L@                                                                               f the
         ft c          tle  f.-,c t  Lli -It                                    Icrvice for p'iy@-ici                          the   cooperation    -f    ttic:    ;)ei,r,,Icvical    staffs    o
                            ',!@                                                                                                                                                 -@;nLd    to    li(!Ip
         1-d    f,.3r   i,roi   ts    %;',IiLl@                                                                                      -11,ltiO',It
         ic,                                             -US
                                fr,,.            plevic
                                                                                                   their f,@r@ilies Ic@,.liii  to  coi)L,  t!itti  t!ie        I(,ng-tc-rui  cffticts   of   sti-c-ee

                  rcze
         .tl rules,                                                                    A br@c! ari7ay ol                       activities     is     bel.n6    developed    to    JZT,p3Ct    Oil     the
                                                                                                                                                          of   liciltii  prcf,:ssio@,iits  i:lio   will
                                                                                I-.CalLh coi-e t;clivery
                                                                                I-e             in ll,'71 as a re,-il(7 of                                     IlroZr.,:ri  act@,@'v@'@ties  arc   as
                 -',e       rcelonalizatic,@       of
                     of      care      at      the      cc
                                                                                                                       T)oct,,rs                               31,628

                                              -rc.     for
                                                                                                                                                               55, 295

                      S  c,n      Llit!       plani-.,i@.,

                                                                                                                                           1                125,9@3
                         went   of    sucli    !,:)cal                                                                               Tot,
                                    fleL  I  Lh                    I
                                                                                                      -or 25,OC)O c-ir2r,    cr,.cy   heiltli   pe                             am'
                                                                                In z!,Idftiot-,,  o%                                                rsc,iinel  (f;..               )Ltlence      drivers,
                                    s     rcci,,-;-ocal
                              rcuire                                            liolice-.n(-n, etc.) %:ill receive? trrit,.itig.              These   prLtr@,r.!s   will   include    both    tl:c
                              plot,-.Iinc
                                                                                teaching of nc@, skills                  ilso     @,he                of    cmi."till?    SI-.ills     qs     well     as
                                                 ApL-ncizs                      trz?itii,,ig new people  :n  the allied iiid                        health rrel!',.
         ,Irc,grom F-ar-t  prol,osais      to      @..@ure
                                                                                       l,iny     Pepionil      I!c-dical               Iiiv(,    conducted    studies    to     determine     trick     need
                                                                                for    wi- I I in@nes s  to a-.c@?t  and  fee s ib I 1 i ty of  t ra iiiin i7, cn t c@cr i(,s  of ira                   r t 0
              and     -upport     one      anott,er      s         i                                                                                                                                                               .  I i.-
         arc-a,    close     coo,,icr.Lin     wf-ll     be                      extend  the services  of  r,,yl-icii!@,.s.            @lost        of       are     related     to      the      physicians'
                                                                                assistant  c(,ncc?t.          So-.,L,              ?,'odicil                   irp    designing     such     I)rc.@it-cts
         a     colic-tion     c-ffots     and      opinion                      and  several have  funded opc!rz:tioral  i,rcjects  in  this  area.
                                                                                       in Al,.b3@,  tt-,e                                 llror.,rari is  sponsoring a  prc,i-@r.,7in to  fLr,-@tIaLe
         ozc-d in California                  for
                                                                                                                                                                                 I)rotiCli the cc-7,era-
                  y       vidc-d     both     fir,:,:Icial                      tiv@ I!se  of                          Fares  for illicd I-eIlLh  tech:iici,,ns  t
         i t-ccnti   i,ro                                                                          funj's,                                          @,lrc@idy   in    (@xistc@nce    iL    ,lie    jui4@r
         ,-,cil of  the  l,os Argcle,                                           co'@lete                             ter                            .clioo's  level.     1,y  lirLkiig  tl-.e  resources
            t 'it-s  in  Y'ast   I,c,s                                          of  the r;iiversity of                                     Teclin!cal         Institute,         the         Appolichier.
                     i@calth       needs        ori::Inate                                                          and  17  @tate su@,port(:d  junior  collci@cs,  Alzibar,@i  is  taking
                                  it a
                                                                                                                  'ution    of    its    health     n     -4er shortage.
                                                                                a  giant  step  toward so,
             -nLs     are     r.Tijor     tijea.c,s     rf                             A    Cuest    7',csidcT,.cy    f,rc@r@@,n,    qtErted    two    years     ago     %.,itti     Fegicnal     Yedical
                                                                                FroCra-,z             has   hel:.,c@d   ,@vc    t@,c-    way    for    what    is    a    significant    innovation    in
                             among            co=iiu:-.ity                                                                                          tic     practicality     Of     its      decc-.itraliza-
                                                                                rtdicale-duciti@n      (WA'a)      b-@      e@c-,n:,nstri,,ing      t
                    are                              pri-Ory
         cei@ters         ar.."qe,  the
                                                                                t   ion.    he  -,:c   ..-.ic@l    education    plii,     talin,,,     its     name     from     the     icu.-     Stores
         .t,clalizf.d     bealt'i     rt-sourcc@-     irid
                                                                                ir,volvpd                        AlaF'@zi,                              rec@-itl),     received     a     @,l     million
                                    ones     is                                 -rant  f-                  n                  :I-.   AlaEka    w2s     selected     as     the     first     State     to
                                                                                          ,O=  t  e                        ru
         of certain 'resources,  arid  .tic-reby'                                                                                                                   y
                                                                                       ---nt   ',lie                           of  ttic- close  ties  alrei,.d          created    b,,-    the    l,,ish-
         ,r zccessz"  fifty.                                                    2.    gto-.i/Alis@,a                                        bccwcc:-.i      the      Uiiversity       of       W2shingt@i
                                                                                i,c-dical School  and                                and rizdical  co=--,iun!Lies.
         il   and   i.-.stittitio-lal
         :h  arid   education   w-'@tl@in   ,n   f-.-)Eire
                                                                                       Virtually    all    Rc-ioi,.zl     I-ledicil     Ilrograms     have     projects     designed     to     aug::.enz
         :ion. it    ilso    helps     to     e.-7.'t@size
                             @iijo       proj@o.tir,g                           the    kno@@-led-.e    and    love!    of     perfLrr.-,ince     of     health     y,rofessio-,iils     ,nd     pir-1pro-
         .=r,rnity level                                                        fessioials.                of    these     prlj'eCtS     lead     Lo     the     utilization     of     rersowinel     in rcw
                                                                                I:als  .  Perl-@,3ps  the  great                                    I   Pro
         @.-itcr   azicL   larger    cc=,,uniLy                                                                      est    R<,     iLnal     liedica     grari    thrust     in     this     irea     is the
                                                                                treating     of     coronary     care     Unit      nurses;      over 7,OGO  registered nurses arid
                                                                                @ractical     nurses     hz@-e     been     trained     Lo      date.
         r      c@,,,-chensive       stroke       programs
         t;nit    at    t.@e    EL@:in    Cray     Sc,4oul
                                                                                       Althcup.li    pegic,-,ial    i:ediczl    rrogri!L,.s    does     not     provide     for     patient     se.-vices
         inF,      urL'etta@en,      including      V-bii-
             t-,lvcati                                   tuch                   directly,    I,    of,,e;-,    gets    involved     in     planning     for a-,id     helping     to     establish     those
                        o,val        activities                                 lcaltli    care     co@ponc,.its     which     @:ill     deliver     service.   This    includes    a    broad     ra,.i7
                                                                                                                                                                                                        _,a
         ,or'r,shops,         stroke          consultation
                                                                                of patient  care de,-onstrat4c,ns,  including screening and  early diagnos,@s@acti-ities,
                                                                                projects  relati.-)[;  to coro.,i;ry care,  and  strokc. rc-halilitation r,ro,@,,Tam,,;


                                                            6112

                  Currently demonstrations are being funded for activities such              as:
                                                                                                                                                The increase in total f,
                                                                                                                                           provide  $75,OOC,OC.I)  in  197,
                                    Co@(, -a@rv ad                  -c         $13,200,000                                                 striation of a rcgic7.,ii C,;nc,r
                                      care - 111, coronary care                                                                            States.   The   balince   -@ill
                                      i@its and 8            units                                                                         selected programs based on r,l:

                                    A            care - 24 neighbor-          3,"C,0,000                                                        In exercising tie
                                                                                                                                                                      c  jrre@,t
                                      I,.c,od health centers, clinic@                                                                      plriiiirg and  evall-,.ltlcn
                                      and out-patient departments
                                                                                                                                           a.-i? contracts, these
                                                                                                                                           se;-.,ices reqttir(.,.l to
                                              an3 loan                        2,200,000                                                    Such   consultative   ser%,iCC3
                                                         care
                                                                                                                                           of  part-time  .,r
                                   other - such as emergency and              1,300,000
                                      transportation serjices
                                                                                                                                           Pegional    Medical     Prnrams.
                                                       Tot.,II                 $21,200,GOO

                  As a result of these dctronstrati.ns, communities cn@' hospitals no- directly
            involved it. thete projects bive I?ec:-i spurred  to  =.-4kc  --,icii  necic-d iriprovc-.-.cilts.
            For  examp'Le,  in  1966  there  were  o-.iiy  375-425  coronary  care   un'Ls end 1,100 other.                                (b)    Direct     operations
            Intensive care units in the United States.          By 1969 tie@c had increased to 2,101
            coronary care units and 2,556 other iqtcnive cc-re units, corresponding to.
            500 perctrt and 150 percent increases, respectively.
                  Tl,.is range of activity and the tymps of operational components            l,citil,                                     Personnel     co=penaqtic-Ti
            carried on varies fron revion to                  In  n.-oviding  4             for                                              qzid    benefits ........    Si
                               and  sharing  li=ited  health  u,.anpower  a-.id                LIIC Stress
            has been on local iiiitiaive .2nd control to match local                     prol@IC-Ll--,, nrd                                G@lier    expenses ........
            available resources,
                                                                                                                                               Total     ..............   91

                  It -'@s expected that an increasing portion of available funds during 1972
                         -cted toward the following general nrcas:
             -11  be dirt

                     Activities which lead to more effective and efficient utilization of
                     health catipiywer, especially in Patent care scttin@,s.                      for new                                     'This   actiitty   srnz:crts
                     ty@es of health r-.anp"er (e.g., p:iysiciiii assistants) will be
                                                                                                                                           ad=-.Inistratior. oz-  3:-17ts;
                     as will new organizational patterns which rare -,re-itrr ucc- of ".3rame,lical
                                                                                                                                                 nel @lec!ical
                                                                                                                                           develops and
                     Operational activities with ir,.,:rcascd er.,Iiasis on rc@,ionali7atio-.i ol                                          a;encies   concerned    with
                                                                                                                                           De-vices.
                     be@Iti resources and services, -with the focus on strc-.i,.cleiiing lill'@.3ges
                     between tho5c institutions providing specialized care,              such as tl)e.
                     r--c!ic3l centers and ,iffiliatcd hospitals, and Pririry care, being
                     provided by smaller corz,-,jnity hospitals, ncii;hborheod health ccr.Lers
                     and other co-=j,@.ity health facilities.

                     Conjoint and collaborative efforts with Art-awie@e C_-rip,-eiensi%,e iizilth
                     Planning agencies and similar ape:,.cies which foster ccl.-@,lj'.IiLy-bsed
                     planning and programs that can be,;in to martially effect resource allo-
                     cations/distribution for health a, the local level.

                     Projects which emphasis disease prevention and early detection,
                     including early a-,id easy access to care.

                                                                   the                   operation and
                     Activities Haiti encourage an,] su",ort
                     success of the c-u@rging lic,31t'i -@:,3interiarce O.,E;--;r,,izatic,ns.