or the $4 billion figure in 1964, which would be upgraded and modernized and brought in conformity with present day needs. Secretary CELEBREZZE. Of course we can furnish that. Modernization, of course, does not mean that you will create greater hospital beds, as I tried to point out. Mr. DINGELL. Yes. Secretary CELEBREZZE. Your operating room may be absolutely obsolete by today's standards so that wouldn't reflect any increase in hospital beds. Mr. DINGELL. The reason was I was trying to achieve some standard of objective comparison; in other words, to find out just how much of this need would be taken care of and would be met by the bill which is before the committee, and I will permit you, if you choose, to submit this for the record. Secretary CELEBREZZE. I will submit it for the record. (The information referred to appears on p. 107.) Mr. DINGELL. I think by way of comparison it would be very helpful to us to have a comparison with the amount of new construction in terms of beds or some other figure which you have set forth in your testimony in relation to the need which exists at this time. I note that the two overall figures in terms of construction and modernization come out to the same figure, being $840 million, but I know that in the one figure, as in H.R. 10041 before the committee today, we have a situation where there is a significantly less expenditure going into modernization than is going into new construction. Perhaps, Mr. Secretary, in order to perfect the record you might find it desirable to make available to us a contrast between the new construction and the modernization which would take place in terms of upgrading facilities. I will let you use any standard you choose, between H.R. 10041 and the other proposal, the administration proposal which was originally sent up here. Mr. Secretary, I would like to conclude by asking you just one more question, if I may, and that is on page 6. This was discussed previously and I noted this. Since we are today creating legislative history it appears to be quite appropriate to discuss this. Secretary CELEBREZZE. Page 6 of the bill? Mr. DINGELL. Page 6 of the bill. It appears on line 13, Mr. Secretary. You mentioned that the Surgeon General would make allotments in connection with three criteria. Secretary CELEBREZZE. Yes. Mr. DINGELL. You mentioned the last of the three being financial need of the respective States. The first question, Mr. Chairman, is this: Has that standard ever been applied in connection with HillBurton before? Secretary CELEBREZZE. Every year. Mr. DINGELL. It has been every year? Mr. DINGELL. I had the impression that that standard there was per capita income as opposed to financial need. Dr. GRANING. Per capita income is used as an index for financial need, sir. Mr. DINGELL. But the previous Hill-Burton statute did say per capita income, did it not? Dr. GRANING. Yes, sir. Secretary CELEBREZZE. The Hill-Burton statute just took the formula of population times per capita income factor squared. The one that we are proposing for modernization will take the population, financial need of the State, and the extent of need for modernization of the facilities. Mr. DINGELL. The thing that concerns me is what is the financial need? Secretary CELEBREZZE. There is no doubt you would get less money under the present bill which the chairman has than under the administration bill for modernization purposes. Mr. DINGELL. What I am trying to figure out, though, is what is financial need. How do we interpret financial need? We are giving you a responsibility. I want to be sure that we define that responsibility sufficiently, Mr. Secretary, so that you will be able to determine what your responsibility and duties will be pursuant to that. Dr. GRANING. Mr. Dingell, sir, it is essentially no different than it has been in previous legislation. We get these figures from the Department of Commerce and we are talking about the per capita income of each State and use this as an index of financial need. Mr. DINGELL. Do you intend then to use financial need of the tive States as synonymous with per capita income? respec Dr. GRANING. We obtain the information from the Department of Commerce on per capita income and this factor is squared in the formula and is used as an index of financial need. It is no different than it has been since 1946. The CHAIRMAN. Would the gentleman yield? Mr. DINGELL. Be happy to yield to the chairman. The CHAIRMAN. The matter of financial need in the modernization proposal, insofar as it is applicable to that part, is exactly the same as financial need under the previous formula for the hospital construc tion. Mr. DINGELL. Let me then ask you one more question, if I may. Do you have elsewhere in the bill a restatement of similar standards insofar as grants to the several States under perhaps another section? Dr. GRANING. On page 5, sir, are the State allotment factors. Mr. DINGELL. We have been dealing with construction grants here. What I was wondering was do you have a similar formula or perhaps a similar formula change from the previous Hill-Burton formula for grants to the several States. I would like to see whether or not you might have made a change similar to this elsewhere in the proposed statute? Dr. GRANING. There are no changes, sir, except as they relate to the modernization category. Mr. DINGELL. What are the standards, for grants under modernization? Are they substantially the same? Dr. GRANING. They are set forth on page 6. Mr. DINGELL. What is the standard then for your financial need with regard to construction? Dr. GRANING. On page 5. Mr. DINGELL. That is the population of each State and the square of its allotment percentage? Dr. GRANING. Yes, sir. Mr. DINGELL. Is that the same as had previously been under HillBurton? Dr. GRANING. Yes, sir. Mr. DINGELL. That is just a reenactment of existing Hill-Burton language? Dr. GRANING. Yes. Mr. DINGELL. Why do we insert different language for modernization as regards financial need from what we do with regard to the other section, the construction section? Dr. GRANING. As the chairman indicated, the financial need portion of the modernization money is exactly the same as in other allotments of the act. The modernization category is a separate, new category and as such induces a concept of need of modernization. Mr. DINGELL. What you intend to do, though-I am talking about financial need of the respective States-is you intend to construe that section the same as you always do. Dr. GRANING. Yes, sir. Mr. DINGELL. Very well. Thank you, Mr. Chairman. The CHAIRMAN. Would it be convenient for you to come back at 2 o'clock, Mr. Secretary, for a while? Secretary CELEBREZZE. Yes. The CHAIRMAN. I was hoping the time wouldn't run out on us. Mr. ROGERS of Florida. Mr. Chairman, I wonder if we could have prepared for us by the Department, as they did with the mental health bill and retardation bill, a chart showing the three bills, the new programs, the formula, and how it applies. That was most helpful I think to the committee in the consideration of the mental health bill, and I think it would be very simple to do. The CHAIRMAN. That will be all right. Mr. ROGERS of Florida. I thought it would be helpful in chart form, and would aid the members in understanding them. The CHAIRMAN. I think probably in view of the record this morning and under the circumstances, so we have all the information before us, it might be all right to go ahead and do it and have the three results. Secretary CELEBREZZE. So that I understand you correctly, Congressman, you want a chart showing the differences between the three bills? Mr. ROGERS of Florida. In other words, the various programs in each bill, the amounts allocated in each bill. The CHAIRMAN. Let's have an understanding, not showing the differences in them in a sense, but showing what each one of them will do. Secretary CELEBREZZE. Dollarwise? Mr. ROGERS of Florida. Dollarwise and how the formula applies, Mr. Chairman, whether there is any difference or not. Secretary CELEBREZZE. All right. (The information referred to appears on p. 94.) The CHAIRMAN. We will adjourn until 2 o'clock. (Whereupon, at 12:10 p.m., the committee recessed to reconvene at 2 p.m. the same day.) AFTERNOON SESSION The CHAIRMAN. The committee will come to order. STATEMENT OF HON. ANTHONY J. CELEBREZZE, SECRETARY; ACCOMPANIED BY WILBUR J. COHEN, ASSISTANT SECRETARY (FOR LEGISLATION); BOISFEUILLET JONES, SPECIAL ASSISTANT TO THE SECRETARY (HEALTH AND MEDICAL AFFAIRS); DR. DAVID E. PRICE, ACTING SURGEON GENERAL, PUBLIC HEALTH SERVICE; DR. HARALD M. GRANING, CHIEF, DIVISION OF HOSPITAL AND MEDICAL FACILITIES, BUREAU OF STATE SERVICES, PUBLIC HEALTH SERVICE; AND WILLIAM B. BURLEIGH, SPECIAL ASSISTANT, DIVISION OF HOSPITAL AND MEDICAL FACILITIES, BUREAU OF STATE SERVICES, PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE-Resumed The CHAIRMAN. Mr. Rogers, you may proceed. Mr. ROGERS of Florida. Thank you, Mr. Chairman. Mr. Secretary, I join with others in saying how fine your statement is. I am interested, however, in a few points. As I understand it, general hospital beds are about 83 percent of what is required right now. Secretary CELEBREZZE. That is correct. Mr. ROGERS of Florida. I think it is stated that we need 132,000 general hospital beds. Secretary CELEBREZZE. That is according to the State reports, yes. Mr. ROGERS of Florida. What other beds are needed? I notice you have long-term care beds listed. Secretary CELEBREZZE. You have general hospital beds. Of course, you have mental hospital beds. Mr. ROGERS of Florida. What is the need for mental hospital beds? I just want to get a brief picture. Secretary CELEBREZZE. For example, let's start with all categories, give you the total and then I will break it down. I think that will help. These are 1965 figures. Additional needs needed in all categories is 1,116,067. That is broken down as follows: General hospital beds, 132,936; mental hospital beds, 448,598; tuberculosis hospital beds, 2,330; longterm care beds that is, primarily the chronically ill-532,203. Mr. ROGERS of Florida. That is the total breakdown? Secretary CELEBREZZE. Yes. The CHAIRMAN. Would it be all right for that table you are reading from to be included in the record so that we will have it in the record? Secretary CELEBREZZE. Yes. I think it will be very helpful, because it goes all the way back to 1948, and you can see the gains that we have made under the Hill-Burton, too. I will submit it for the purpose of the record. |