In the maternal child health area, as in several others, we urge you to carefully review the ever-changing administrative charts. You will notice at once the low placement on the charts of content specialists of all disciplines. The lines are somewhat unclear, as it is said they can go in several directions. The professional staff of the maternal child programs are scattered throughout. This, in our opinion, will weaken the programs and will create unnecessarily complicated program development. The move to deemphasize the role of health professionals by replacing them in policy positions with nonhealth personnel has been very evident for the past 4 or 5 years. In the Maternal and Child Health training unit, for example, there are to be no health professionals. Therefore, program decisions about the use of millions of health dollars are being made by businessmen, systems analysts, and economists. While there is a place for this kind of expertise, care must be taken to maintain a proper balance to assure that professional considerations about health care are safeguarded. This is essential to develop and maintain effective health programs. The lack of really effective evaluation of the programs carried out by HEW lately has been noticed by many groups, including this committee. There are numerous other questions about reorganization and decentralization that are as yet unanswered. One important one that we would just like to raise is in relation to cost. With the duplications that seem almost inevitable with programs administered in 10 regions instead of centrally, we think that the cost factor is one that should be carefully investigated. One question we have yet to hear answered is what is the total cost of the reorganization going to be? Also, the cost of decentralization is not spelled out. How many health professional positions are to be eliminated and what are the long term budget considerations of this change in structure? We hope this committee will get answers to these questions before it is too late. I would like to thank you for holding these hearings on this important topic at this time, and I appreciate the opportunity to appear here today. Mr. ROGERS. Thank you, Dr. Jacobi. We appreciate the points you raised and will try to find out the answers to some of these questions which I think are important to know before we move into that kind of a change. Thank you so much. Dr. Roy? Mr. Roy. I thank you for your statement and apologize for being a bit late. I have no questions at this time. Mr. ROGERS. Dr. Kerr? STATEMENT OF DR. I. LAWRENCE KERR Dr. KERR. Thank you, Mr. Chairman, for allowing us the opportunity to participate in these hearings and I would say we echo much of what has been said earlier. My name is Dr. I. Lawrence Kerr and I am appearing today on behalf of the American Dental Association. In addition to my responsibilities as a trustee of the American Dental Association, I also had the honor to serve as chairman of the Advisory Committee on Dental Health to the Secretary of Health, Education, and Welfare. This committee was established in 1970 to review the dental health programs of the Department and suggest ways in which they could be improved. Our activities were concluded in December 1972, with the submission to the Secretary of the Advisory Committee's final report and recommendations. Although we were privileged to meet with Secretary Weinberger since that date, we have received no formal response to these findings. I believe that Congress, my colleagues on the advisory committee and, most importantly, the taxpayer, deserve a statement from the Department. Yesterday we were presented with the latest program alinements for Health, Education, and Welfare. Unfortunately, nothing in this announced reorganization plan of the Department suggests that the conclusions and recommenations of the Dental Advisory Committee report have been considered. Briefly summarized, our advisory report indicated that the department's goals for dental health are ill-defined; the administrative structure for dental programs is not coordinated and generally buried so far below the policymaking level that its voice is not heard at the top; and finally, the financial resources allocated to dental activities are inadequate. We might illustrate that by saying that dental disease is a universal disease. That is, 100 percent of the people have some form of dental disease. Yet dental activities in HEW were 3 percent in 1960 and has been decreased to 2 percent in 1971. This critique embodies no new facts. The situation described existed many years before the advisory committee's report and still exists today. Individuals and organizations in and out of government have long recognized the problem. Three years ago, the Secretary of Health, Education, and Welfare told Congress that he was ". shocked to find after coming into office that we have not really had a national dental health policy." Indeed, the advisory committee was established in recognition of these deficiencies. Its central task was to develop ways in which order could be introduced in the department's dental activities. It is interesting to note an observation from the advisory committee's 1972 report. "So far as dental health is concerned," the report stated, "reorganization and program integration has all too often meant the submerging of legitimate dental interests and the exclusion of dental health experts from policy decisions." The accuracy of this prediction is reflected in the current reorganization proposal, as well as the repeated efforts of the Department to remove the budget visibility of the Division of Dental Health; the exclusion of dentistry from the administration's research training plan; a lack of any dental participation in the development and administration of PSRO's for medicare/medicaid; the absence of dentistry from the administration's previous national health insurance proposal; and the fact that the statutory position of the Chief Dental Officer has remained unfilled since 1967. Our association believes that dental health is an integral and essential part of total health. As the principal agency in making this concept a reality, the Department of Health, Education, and Welfare must recognize and include dentistry at the decisionmaking and policy levels. Full implementation of the recommendations outlined in the Dental Advisory Committee report would be a notable first step. Where dental activities have a measure of visibility, as within the National Institutes of Health, they must be strengthened. We are completely opposed to the dismemberment of any of these existing components. Our concern is shared by the House Appropriations Committee which recently stated, in part: The Division of Dental Health is the only agency in the Department, except the National Institute of Dental Research, that has identifiable responsibilities in dental health... Over the years, the Division has conducted a broad range of programs that have had a positive impact on improving the oral health of Americans. This success is in large measure the result of placing the responsibility for these dental activities in a single organizational unit-the Division of Dental Health... The Committee believes that these Divisions should be retained and strengthened as a focal point for these important programs if the Department is to meet its responsibilities in these areas. In those areas where there is little dental input, as is generally true within the health delivery programs, and the Office of the Assistant Secretary for Health, we recommend an administrative structure able to guide and monitor dental activities; the placement of qualified dental personnel in positions of responsibility; a strong statutory advisory committee, and, sufficient financial resources to insure viable dental programs. In conclusion, I would like to provide copies of the advisory committee's report for the information of this subcommittee. And, again, we thank you for the opportunity of sharing this time with you. Mr. ROGERS. Thank you very much, Dr. Kerr. We appreciate your presentation and without objection the report you referred to will be received and made part of the record. We will try to get a response from the Department on that report. [Testimony resumes on p. 189.] [The report referred to follows:] REPORT AND RECOMMENDATIONS TO THE SECRETARY DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE FROM THE ADVISORY COMMITTEE ON DENTAL HEALTH December, 1972 LETTER OF TRANSMITTAL December 29, 1972 Honorable Elliot Richardson Secretary Department of Health, Education, and Welfare Dear Mr. Secretary: I am pleased to transmit herewith the final report of the Advisory Committee on Dental Health. Since early 1971, we have learned much about dental health activities within the Department and, as we conclude our work, we are both pleased and disheartened. The Department has several fine dental program elements but as a whole dental activities are underfunded and suffer from a long-standing lack of attention at the highest policy-making and planning levels within the Department. We believe that corrective action is essential and that adoption of the recommendations which were developed from the Committee's deliberations would do much to strengthen the Department's capacity to deal effectively with the Nation's dental health problem. Serving on the Committee has been a pleasure. It is our earnest hope that what we have done will be of value to you. |