Statement on Signing the Health Manpower and Nurse Training Bills.

IT IS with special pleasure that I am signing into law today H.R. 8629 and H.R. 8630, the Comprehensive Health Manpower Training Act of 1971 and the Nurse Training Act of 1971. These acts follow substantially the recommendations I made to the Congress last February-and they constitute the most comprehensive health manpower legislation in the Nation's history.

But legislation is only a first step. These new programs must now be adequately funded and effectively carried out. I am, therefore, asking the Congress for a new supplemental appropriation for health manpower programs. This new appropriation would bring our overall spending for health manpower programs in the current fiscal year to $530 million, a level which is $100 million higher than in fiscal year 1971.

Expanded manpower programs are an integral part of the national health strategy which I outlined in my message to the Congress last winter. One of the cardinal principles on which this strategy was built was that of balancing the supply of medical care with the growing demand for services. For--as I pointed out in that message--our failure to achieve this balance can only result in lower quality medical care at increasingly inflated prices.

I am pleased that the Congress has responded to this concern and has enacted a number of my recommendations regarding the expansion of our health manpower resources. The actions which have been taken will enable our Nation to train critically needed medical personnel, to improve the distribution of such personnel-both geographically and by medical specialty---and to promote the more effective use of health manpower.

The chief provisions of these two new acts are as follows:

1. Per Capita Assistance. The Comprehensive Health Manpower Training Act takes a new approach to the financing of medical and dental training, one which is along the lines of the approach I recommended last February. It incorporates the principle that dollar support for a given institution be tied to numbers of students, thus providing a strong incentive for medical schools to expand their enrollments. This new form of assistance will also enable schools to innovate and experiment more readily, since they will be working from a more stable fiscal position. In 1972, this program will benefit 275 schools.

2. Special Project and Financial Distress Grants. In my message to the Congress, ][ also asked for a new program of "special project grants to help achieve special goals." By following this recommendation, the new legislation will permit institutions a considerable degree of flexibility in reforming their curricula and undertaking special training projects in areas such as alcoholism and drug dependence. This legislation also embodies our proposal for a separate grant program for schools in financial distress, one which will assist these institutions in diagnosing the causes of their fiscal weakness and which will provide for appropriate operational and financial reforms.

3. Construction Grants and Interest Subsidies. The new legislation provides authority for direct grants for the construction of facilities to educate health personnel. It also establishes a new program of guaranteed loans and interest subsidies which will generate additional private capital for this same purpose. Together, these two actions--which have also grown out of Administration recommendations will help us achieve a substantial increase in the number of new first-year students who can be enrolled in our health profession and nursing schools.

4. Student Assistance. Under the legislation I have signed today, loan and scholarship assistance will continue to be available for students in the health professions, and special emphasis will be given to increasing opportunities for disadvantaged students. In addition, the Federal Government will forgive student loan indebtedness for physicians, dentists, nurses, and other health personnel who practice in medically underserved areas. As I pointed out last winter, this policy can do much to help us meet the special needs of remote rural areas and urban poverty neighborhoods where medical care is often difficult to obtain at the present time.

5. Health Manpower Education Initiative Awards. A number of Administration goals will be furthered by the new program of health manpower education initiative awards for deserving institutions. These awards will be used to stimulate a variety of improvements in the supply, the distribution, and the efficient utilization of health manpower. They will be used, for example, to support more training in out-of-hospital settings so that the experience of students in clinical situations, in outpatient facilities, and in ambulatory care settings will be broadened. Under this authority, incentives will also be given to schools of medicine and dentistry for the training of paramedical personnel such as dental therapists, nurse midwives, family health nurses, and pediatric nurse practitioners. In my message last winter, I described the expanded use of such allied health personnel as "one of the most promising ways to expand the supply of medical care and to reduce its costs."

The actions I have been discussing today demonstrate the Government's response to the challenge of expanding health manpower. But this response will mean very little unless our health profession schools now move forward with their own strong and aggressive programs for increasing enrollment, reforming curricula, reducing the length of training, and placing more health professionals in scarcity areas. The Federal Government will now be providing a much stronger helping hand. But the central responsibility still lies with health education schools and those who direct them. The American people are looking to them to meet this challenge.

A sound and fair health care system which meets the needs of the American people will require the right kinds of manpower, in the right amount, and in the right place. With the signing of this legislation, we have made great strides toward meeting these requirements. And further strides will be possible if my request for supplemental funds is approved by the Congress.

It is also true, however, that an integrated national health care system entails more than adequate manpower. We must now address ourselves in earnest to the other important elements of the Administration's national health strategy. Specific proposals for achieving these goals have already been submitted to the Congress, and I hope they, too, will receive prompt and favorable attention.