NIH MORALE

Mr. CONTE. Mr. Secretary, there have been continued newspaper accounts of morale problems at the National Institutes of Health, particularly with regard to the allocation of funds between the institutes. There have been charges made that such allocations are made by the Office of Management and Budget on political grounds, rather than for any particular medical or scientific basis. Could you respond to these cases?

Secretary WEINBERGER. First of all, the Office of Management and Budget does not, except for the Cancer Institute, decide what funding level each institute should have. That is done by NIH within a total allowance set by the President.

I also have read and heard of the so-called morale problems at NIH. Frankly I do not believe that the picture is as grim as it is made out to be. The problems that there are, though, are caused by many factors the primary one, I think, begin the fact that in the past, NIH received just about everything they asked for. But this is no longer possible concerning the current economic crises. There are going to have to be restraints on spending and the researchers will have to share in them.

MATERNAL AND CHILD HEALTH

Mr. CONTE. Mr. Secretary, you are proposing a fairly large cutback in maternal and child health programs of the Health Services Administration. As you know, I have a special interest in these programs, particularly as they affect research into the sudden infant death syndrome. Would you tell me why you are proposing such large cutbacks in this area?

Secretary WEINBERGER. We are not proposing that the level of services be cut back. What we are suggesting is that more of the responsibility for financing activities such as these should be assumed by the States and localities. For the maternal and child health programs, we have submitted legislation to change the Federal matching rate from 50 percent to 40 percent. Research into the cause and prevention of sudden infant death syndrome, though, isn't affected by our proposal. I believe that NIH will be spending about $5 million on SIDS research in 1976, about the same level as this year.

NIH FELLOWSHIP AND TRAINING GRANTS

Mr. CONTE. Mr. Secretary, the National Research Act authorized fellowships and grants for training at both the predoctoral and postdoctoral levels in biomedical fields. Particularly as they affect the National Institutes of Health and the Alcohol, Drug Abuse, and Mental Health Administration, have regulations for these fellowships and grants been issued yet? If not, why not? If they have been, do they cover both predoctoral and postdoctoral training, and grants to both institutions and individuals?

Secretary WEINBERGER. Both regulations and announcements have been issued covering both predoctoral and postdoctoral training and institutional and individual awards. However, discussions are still

being held regarding the precise mix of funds among the various training categories you mentioned.

Mr. CONTE. Mr. Secretary, for the past 3 years the Department has been trying to phase out most training programs in the health field. When we had hearings on the health rescissions, we were told that there were funds available for such training in the Office of Education. Would you care to tell us what funds, and how much money, is available in the Office of Education to provide training fellowships and grants for predoctoral and postdoctoral training in the biomedical fields? Would you compare this with the amount available under existing training programs in the health agencies?

Secretary WEINBERGER. What we referred to was the guaranteed loan program where students go to private lending sources for an educational loan. The Federal Government then will guarantee up to $2,500 per year, $10,000 in total. And, depending upon his family income, the government will also subsidize the students interest while he is in school. This program is available to any eligible student and there are no limits on the number of students who can recieve loan guarantees under the program.

PROJECTED NEED FOR HEALTH MANPOWER

Mr. CONTE. Mr. Secretary, would you supply us with an estimate of health manpower needs for the next 5 years or so? How would such needs be affected if we pass a national health insurance program?

Secretary WEINBERGER. Estimating requirements for health manpower is extremely difficult largely because there is no consensus on the number of various types of health care workers needed to provide optimum, adequate, high quality, or any other acceptable level of health care. However, the Department has projected that the 1980 requirements for physicians could range from 394,000 to 478,000. For dentists, the 1980 requirements could be between 118,000 and 156,000.

A major study on the impact of the administration's comprehensive health insurance proposal is nearing completion and it will probably show that manpower requirements might increase on the order of 12 percent in physicians and 6 percent for dentists.

DECENTRALIZATION

Mr. CONTE. In recent years there has been increasing decentralization of many of your programs, particularly in the mental health field. As I understand it, your regional office administrators are responsible not to the agencies whose programs they administer, but directly to the Assistant Secretary for Health. I think that this system suffers from a lack of accountability. There is no way, for example, to make sure that the funds appropriated for mental health programs are actually going for mental health. There have been complaints about the competence of the regional office administration. If decentralization is increasing, could you tell me how you propose to maintain and/or restore both program and funding accountability?

Secretary WEINBERGER. When we reorganized the regional offices in 1974, we established the position of regional health administrator to

serve as the principal health official in the region. We felt at the time, and we still do, that it is important that there be a single focal point within the regions to assure an integrated approach to the region's particular health problems. Close coordination is maintained, though with the various health agency programs to assure the accomplishment of their program objectives.

REDUCTIONS IN HEALTH PROGRAMS

Mr. CONTE. Mr. Secretary, you are proposing a reduction of about 20 percent in grant programs for the direct delivery of health care, including neighborhood health centers, alcoholism, and community mental health centers. Would you explain why cuts have been made in these areas, in which there appears to be increasing rather than decreasing need?

Secretary WEINBERGER. Yes sir, we agree that these health activities are important. We have proposed reducing the amount of direct Federal support but are not suggesting that the level of services be cut. In most instances we believe that the reduction in grant funding will be made up by increased reimbursements from third party sourcesmedicare, medicaid, private insurance, and so forth. What cannot be met by increased reimbursements, the States and local communities should be able to pickup.

Mr. CONTE. You are proposing a reduction in project grants for communicable disease prevention and control activities and funds targeted toward the prevention and control of substance abuse and mental illness. Do you believe that we have already solved these problems? If not, how do you justify a decrease in support for such programs?

Secretary WEINBERGER. No; we are not implying that these problems are solved because of the proposed reductions. There are two things involved. In many of the programs we have been funding demonstrations and we believe it is now time for the local communities to pick up the ongoing support. Second, it reflects our judgment that the Federal Government, in this time of economic crisis, needs to carefully consider all its funding priorities. And in this case, we believe the States are in a relatively better position to assume more of the responsibility for funding.

HELPING GRANTEES TO OBTAIN THIRD-PARTY REIMBURSEMENTS

Mr. CONTE. I have seen reports that HEW will assist affected grantees in recovering third-party reimbursement for services covered under medicare, medicaid, and private health insurance. Would you explain this?

Secretary WEINBERGER. We don't directly assist the grantee by helping him to actually bill the carriers. What we are doing is to help them set up their financial systems and procedures so that they can claim benefits, explaining to them what benefits can be claimed, eligibility criteria, and the like.

I think that these efforts have had a significant payoff. In the community health centers, for example, reimbursements are expected to go up from $18 million in 1974 to $62 million in 1976. Also as a result of our providing technical assistance, we have been able to help the