ecologically accessible
B U I L D T R A D I T I O N
INTRODUCTION
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“Experience gleaned from primary care practice-based research networks
confirms that the adoption of innovations often depends
on individualized support provided within the context
of trusting relationships.” (17)
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The opening statement appeared as a COMMENTARY published in the June 24, 2009 Edition, Journal of the American Medical Association. Submitted by Doctors Grumbach and Mold, it describes the precedent established by the Cooperative Extension Service for our nation’s agriculture industry. Congress authorized the Smith Lever Act for the Cooperative Extension Service “… in 1914 as a collaboration among federal, state, and county governments; agricultural experts at land grant universities; and farmers.” (17) In the COMMENTARY, the authors propose a similar effort for Primary Healthcare. Promoted by NATIONAL HEALTH, each Community HEALTH Forum would include an obligation to support the community’s connection with the NATIONAL PRIMARY PHYSICIAN EDUCATION PLAN of NATIONAL HEALTH. To emphasize the importance of the Cooperative Extension Service as a model, it is important to recognize that our nation’s agriculture industry is the most efficient among the 51 advanced/developed nations of the world. In contrast, our nation’s healthcare industry is the least efficient. Importantly, they are both the most and the least by a wide margin.
As proposed, each Community HEALTH Forum would be semi-autonomous and serve a community of between 100,000 and 700,000 citizens. A Community HEALTH Plan formulated by each Forum would promote local efforts to assure that Primary Healthcare is equitably available to each citizen, neighborhood by neighborhood. Eventually, each Community HEALTH Plan would promote Primary Healthcare that is also HEALTH SECURITY certified. Eventually, the annual revision of its Plan would also include the community Forum’s involvement in its local adversities that substantially affect the HEALTH of its citizens. Along with the equitable availability of enhanced Primary Healthcare, each Community HEALTH Plan would include 1) collective action projects, known also as collective impact projects, for certain improvements of its local Common Good and 2) an overall assessment of the community’s disaster planning readiness.
Given collaboration, transparency and trust, the options open to the Board of Trustees for the new strategy along with a local initiative to sponsor enhanced Primary Healthcare will initiate a level of collective thrust projects with nationally unprecedented dimensions. The challenge represented by this level of collective action, community by community, would create a level of focus and accountability never before contemplated for any healthcare industry among the world’s 51 developed nations.
CONGRESSIONAL CHARTER PROVISIONS FOR THIS GLOBAL TASK
A. The Board of Trustees shall review any report from a Regional Council describing substantial health services received by a citizen that was not a covered benefit according to the NATIONAL PRIMARY HEALTHCARE BENEFITS PLAN and was not prepaid by a payment source specifically allocated for non-covered health services. This review process shall identify the strategies necessary to minimize the level of non-covered health services that may be directly or indirectly supported by resources associated with the NATIONAL PRIMARY HEALTHCARE BENEFITS PLAN. The reports shall be reviewed also with an intent to determine if any federal or state legislation is necessary to prevent the substantial occurrence of a similar pattern of significantly unfunded non-covered health services.
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B. The Board of Trustees shall establish an Operational Statement for the Regional Councils that will define a set of decision tools for the determination of whether or not the healthcare of an individual citizen represented covered or non-covered health services under the NATIONAL PRIMARY HEALTHCARE BENEFITS PLAN. The Board of Trustees, for itself, shall establish an Operational Statement for responding to requests for assistance by a reimbursement source when a citizen appeal is in question.
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C. The Board of Trustees shall commission from time to time such studies as may be necessary to more carefully define Basic Healthcare Needs under the NATIONAL PRIMARY HEALTHCARE BENEFITS PLAN.
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D. The Board of Trustees shall establish and regularly revise an Operational Statement for improving the level of collaboration, transparency and trust during and between its deliberations including those of the Regional Councils, District Coalitions, each Community HEALTH Forum as well as the Board of Directors, itself.
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E. Each of the nine Regional Councils shall be responsible for establishing nine District Coalitions. Each District Coalition shall also be responsible for promoting 9 or more Community HEALTH Forums within its District. Primary Physicians, community hospital systems, public health departments and regional medical schools shall participate along with ‘stakeholders’ from among the community residents. Each Regional Council shall approve an Operational Statement for its own District Coalitions and their Community HEALTH Forums:
1. to assure that Primary Healthcare is equitably available to each Community’s citizens
and
2. to specify that Primary Healthcare clinics eventually qualify as HEALTH SECURITY certified.
[ COMMENT: This planning and implementation process is likely to vary in character among the District Coalitions. Special funding may be necessary and the proscribed involvement by the other levels of government may also be necessary to promote equitably available, enhanced Primary Healthcare for each citizen. The federal Department of Health and Human Services has a history of involvement in regional health planning for the implementation of the Community Health Centers. ]
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F. The Board of Trustees in association with its Regional Councils and the related nationally based private and public institutions shall develop the criteria for the certification of any Primary Physician group or other facility offering Primary Healthcare as being HEALTH SECURITY Certified. This definition shall evolve, over time, as necessary to:
1. support each Regional Council’s ability to promote the coordination of health services
for any citizen with Complex Healthcare Needs, such as for chronic pain, homelessness,
a pregnancy or childhood onset disabilities
and
2. promote Primary Healthcare for citizens who experience patterns of health care that is
not equitably available nor ecologically accessible because of socioeconomic, geographic or
environmental adversity.
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G. The Board of Trustees shall initiate a national planning process to assess the future evolution of NATIONAL HEALTH starting five years after the initial Meeting of the Board of Trustees and every ten years thereafter. Any possible changes proposed to Congress for the Congressional Charter of NATIONAL HEALTH shall begin within five years after starting each successive long-term planning cycle.
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H. The Board of Trustees shall appoint a special Advisory Commission to define a NATIONAL PRIMARY PHYSICIAN EDUCATION PLAN with an intent to assure the stable availability of adaptive professional resources for Primary Healthcare, community by community.
[ COMMENT: This Commission should include representatives of the related institutions currently functioning with an intent, already in place, to the support the Plan, such as the Board of Medical Specialities, the American Association of Medical Colleges, American Medical Association, as well as professional development sources of expertise. The Commission should produce a long-term plan within two years with its full-implementation in four years. The initial Operational Statement for the STRATEGIC PROJECTS PLAN of NATIONAL HEALTH should include a provision for one Regional Committee from the Northeastern, Southeastern and Western groups of states to offer advice and consent to the Commission. ]
