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Well, the policy was to pay $300 for a weekend.

Senator JAVITS. How much?

Dr. VIGLOTTI. $300 for a weekend for coverage for a physician.

If you are talking about $600 a month for physician coverage, that is a big chunk of money.

If I were to stay on there in private practice, would I want to pay that money out of my own pocket, or would I leave, and leave the community unprotected in terms of medical care.

These are the problems.

Senator JAVITS. Is $300 too much?

Dr. VIGLOTTI. I think that is the going rate.
Senator JAVITS. That's what you have to pay?

Dr. VIGLOTTI. If you are going to get a competent physician.

Senator JAVITS. Who covers you today?

Dr. VIGLOTTI. Right now, there is a general practitioner-he is from Waterville who is not yet really involved in practice, who was able to come up at the spur of the moment, probably in 2 months he will be unavailable.

Senator JAVITS. Is the difficulty recruitment of compensation?

Dr. VIGLOTTI. Both. I also feel it is the Government's money, and I do not want to be held personally accountable for spending $600 a month of their money.

Senator JAVITS. Nevertheless, you think the Government does allow you the going rate right now?

Dr. VIGLOTTI. There has been nothing written. There have been no directives from headquarters, directing me to do this, in terms of what fee would be paid.

It has been impossible to really get some kind of definitive statement on that matter; how much am I allowed to pay for a physician to cover, so if I wait for something like that, I could be indefinitely with no time free.

Senator JAVITS. All right.

Thank you all very much. I appreciate your testifying, and I thank you for appearing.

Senator JAVITS. Our next witness is Mr. George Blatti, president of the Student American Medical Association, from the University of Minnesota.

STATEMENT OF GEORGE BLATTI, PRESIDENT OF STUDENT AMERICAN MEDICAL ASSOCIATION, STUDENT AT UNIVERSITY OF

MINNESOTA

Mr. BLATTI. Mr. Chairman, my name is George Blatti. I am a senior at the University of Minnesota Medical School, and am here in my capacity as national president of the Student American Medical Association.

With me is Patricia Falcao, a junior at the University of Maryland Medical School, a regional trustee and member of the executive committee; and Bill Rimm, sophomore at the University of Virginia Medical School and chairman of our committee on legislative affairs.

A basic tenet of the Student American Medical Association (SAMA) is that quality health care is a basic human right and should be equally available to all citizens regardless of geographical location. It is for this reason that SAMA has supported the objectives of the U.S. Public Health Service since 1968.

In 1969, SAMA resolved itself to encouraging the expansion of the Public Health Service or other Federal programs in order to provide adequate continuous health care delivery to those areas which need them, utilizing community involvement and participation in planning, and to provide for an adequate influx of personnel especially through financial support for students in return for service in the Public Health Service.

Mr. Chairman, I would like to request this resolution be included in the record.

Senator JAVITS. So ordered. Without objection. (The information referred to follows:)

84-847 O- 72 - 6

APPENDIX A

RESOLUTION #4A EXPANSION OF THE PUBLIC HEALTH SERVICE 1969 BE IT RESOLVED, That it is the consensus of this meeting that the USPHS or other Federally-administered or approved programs be expanded to accept all interested and qualified volunteer medical and paramedical personnel into their ranks to provide adequate continuous health care delivery to those areas which need them, utilizing community involvement and participation in planning; and be it further

RESOLVED, that finanical support be provided to medical and paramedical students while in school in return for service in the Public Health Service or the aforementioned organizations after graduation, in the same fashion as this is offered by the armed services; and be it further

RESOLVED, that this service would complete the national service obligation and that the real pay and privileges would be equal to that of military service; and be it further

RESOLVED, that the Student American Medical Association use its resources and powers of persuasion to see this brought before the Congress of the United States, enacted into law, and adequate funds provided for it, and that each SAMA chapter be encouraged by the National SAMA Office to send letters to the appropriate Congressmen and Senators of its respective district demanding affirmative action on this.

Mr. BLATTI. With this brief summation of our involvement in and commitment to this program, we should like to thank you for this opportunity to present testimony with regard to the further expansion and continued growth of the National Health Service Corps. One of the major issues now confronting the health care system is distribution of health services.

Significant numbers of people live in areas which can be described as having "critical health manpower shortages" and we feel that Public Law 91-623, Emergency Health Personnel Act of 1970, was a long needed step in the correction of this maldistribution problem. S. 3858 under discussion today is another step in the rectification of this problem, and will hopeful lead to the development of a more lasting solution. It is for this reason that we generally support S. 3858 with the following noted exceptions, suggestions and comments. We shall address the Emergency Health Personnel Act Amendments of 1972 somewhat in the order in which they appear.

We suggest that the provision requiring the certification by the local government, the State, and district medical society, or other appropriate health society, that health personnel are needed by the area, Section 2(b) amending section 329 (b), be retained.

This would enhance the involvement of the local medical societies and encourage cooperation, especially when licensure and hospital privileges are under consideration.

A cooperative environment is essential for the effective utilization of Corps personnel and all possible efforts should be made to assure and maintain such a working relationship. This is not to say that we endorse the exercise of an absolute veto power, pocket or otherwise, by any one person or group of persons.

Therefore, we suggest that an appeal mechanism utilizing the National Advisory Council on Health Manpower Shortage Areas be established.

This would offer some recourse for those communities which have either been denied designation as a critical health manpower area, or have been denied certification that health personnel are needed for that area.

We wholeheartedly endorse the assignment of personnel on the basis of need and "without regard to the ability of the residents of the area to pay for health services."

Section 23.5 (a) (6) of the rules and regulations of the National Health Service Corps, as published in 36 Federal Register 242 dated December 16, 1971, and promulgated under Public Law 91-623, would seem to strike a blow at the very purpose of the act by considering the "potential ability of persons in the area to pay the cost of providing health care services ***" before designation of such area as having a critical manpower shortage.

With regard to the provision on charges, we believe the criterion used in determining the ability to pay for services in order to qualify for reduced rates or for no charge, should be based on an annual income level higher than the current Social Security Administration poverty income level.

This would qualify more people for at least reduced rates and further extend the availability of health care to those who cannot afford it. I call your attention to section 23.6 (c) (2).

Further, we suggest that any funds collected under the act be returned to the Corps program in a different fund and not be counted as part of the Federal appropriations to the program.

Depositing such funds in the Treasury would seem only to avoid the possibility that areas would be selected on an ability to pay basis, a consideration which has already been precluded earlier in these amendments, and we feel that more could be gained by a continued expansion and improvement of the program by the use of such collected funds.

This would then demonstrate a definite long-term commitment of the Government in fulfilling the purposes of the act. Under the present act communities could lose the program next year and under the proposed amendments in 3 years, and we believe the communities would respond more favorably to the program if they could be made to realize that the Government will not abandon them in their quest for adequate health care.

HMO's and HSO's, as discussed in S. 3327, might provide a viable replacement, but until a workable system for the implementation of such organizations is devised, medically deprived areas should be made to realize that health care is and will continue to be available. In furtherance of HMO's and HSO's, we might comment that Corps project areas might further serve as prototypes of such organizations and be used to define possible problems, and hopefully resolve a great many of them, as they relate to direct health care.

We applaud the proposal of recruitment programs, section 2(d) (2) and recomment that SAMA be used as a valuable instrument in the dissemination of information on the program and serve as a contact point for representatives of the Corps-a task we would welcome. Inasmuch as SAMA played a role in the development of the Corps. we would be eager to work for its expansion.

With reference to section 2(f), regarding the establishment of guidelines with respect to how the Corps shall be used in designated areas, we feel that it fails to consider the recommendations of the communities so designated and should provide a mechanism for their participation in project discussions and local policy.

While general guidelines for the overall use of the Corps are necessary in order to insure the purposes of the act, each community has its own special problems.

To insure consideration of these problems and to maximize the effective use of the Corps, each community should have a say in its own destiny.

Section 3, regarding the preconditions before closing or transferring control of a hospital or other health care delivery facility, further assures communities of the continuation of the program once established.

Again, however, we would suggest that some sort of review or appellate procedure be established before such a facility is closed or transferred or, more importantly, before terminating or modifying an assignment of Corps personnel to an area.

I direct your attention to section 23.7 of the rules and regulations. This would serve the purpose of bolstering public confidence even further and preclude possible arbitrary decisions. The National Ad

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