0 0 @O Cal in univorzities local V.: D@ Lt J'.'v r the :r,,z,,crons4bility fo L ould erve C:Ijt.,Lre to til,@ WrLich v Qp. the (,,Overal com-.)onents Of the r,@,twor%. Pros,. Veto co@vrol o-L' t,,-,o nctvo@-l@ In tha lianda 06@ the co.,,%,@znent -t@ith 'IV-he highest profos3ionil thereby faci3.itating r,,,iintenance of hiea E;-Ilandarez o-.1' cn-ro in the d@oatic and treatment Xnr@arel.; a strone, conr,,,,, co ,@tencLes tb,-, -bf in w iv or @l C-' b@r a 'UY rrov" cl:c;c(--,---iliva utilization Darr 'otan cluo in Medical 1, ho c.Lc-' rc, dram,).tic over@ul it th@ nd Avoid-[; irtvolvc,,r@r.". in coc@al,,;'andieconomio-,-):prob ems quality of State an Pollticall;r the Sttlte =(I local profession,,! oocio'c,@. C@el, hospital and inatitutiOnss rolitiCO-1 OPPOsitiOn '4bich this vLpproac is curc to arirc froia ti-4* rctvork into being* oz (zlialifiod =npowor in the medical corxplexec to t@ on this aaci ,ibility. medical schools rrd completed might ,,@oo tn p, on the Vale r. '6ition of this vast r-,-,tnonsibil.ity would b-'! ii,-, -id sorvica. a-,I ofi',C!fl r,-rati-ol@ on c by BY conco the proole dt:atant, to c Ms en f,@ e'Lfec-L@ive participating by vol=tary in k,.L I",kilo to of rrcial and political forces of tl-,o 3:,o-ion in date@nizi7 tl,.e n@-e'@n for @-mO ai net-wo-r'fo These political and forces Often the controlling factors in tho distribi.,-r,".on of zervice. V@o goo,-rv-phic dictri'vation of medical cbmplox,-ao especially is no,- coil-4cd@t -with distribution Of eomard for iiod,,Ical core. Since this alternative @,ould on the villinSness of existing medical comple),,er, to t-,.Iz-- c@i thin responsibility, a likely i-4--.-,ult vould be a r,-Asing of tlio standards of medical care and practice in those arcas ubaro the is alrdady above the ntttion43. eLverage and vhorc there is alrcFtdy ,fdod access to medical complexes, of superior Vality. An a resur,,, the exittinZ gap in the quality. of medical care available in different areas of the country might actually viden for somo y@-a.-c bc'L@ora a truly national network could 'b established Political forces c@ld not be c@cted to tolerate@, this @tem if guch neti,7orks are financbd vith r@oderal @d$* By lp-4ring State @nd local govor=ents., thio a@ct@rnative t4 b Might further voak the 5"-@ role of tb6 Stores an@d d6i on at a m ajar.n there is toncid6tii@io is @C'@uo Sion t Gov r=eiit s ti v* O*o OL the nu t, co to a vact I.,h-@ ar4@a et-,@ and practice. Ierr,,-@tive 2 This a ti@o-@ror, ed approach,, 0 both the StT,.,cc @ovQrr,7 on"z- r,.nd the rrcdical corn- utilizin clia=ols for @ndr;. for the dic%@,iostic' as, ."hieh and tre,"*tment ztationc,; @,,Ould bc- -4ould distribute thL% accoi-dinf; to a Statd plan (analogous 0 the Ilill-Burton aiid "o -.Ti:=-ni'y @,@ntal Health Contors pros plannint7, on an basis be required for states@ vithout a medical school c.- :Cor ll%read (such as certain matropolitiva areas vhic,.,. cro-@o Stie4o liDes) vhere ".'itate planning -t@oul(:@ crL,,,ite a riore effective network. The Fcderal would deal dirc-c@tly iiith the =dicdl coraplexas oLnd tho regional centers in providing C.-@s for the strengthening Of the rc- carch.. teachinrl cLnd service capacities of tl,,o =dical complexes and for constructing and Staffing the regional centers. lirr@se grants would have to provirZc for auo@ented staff and for Ot'i.,; r lzduce=nts Sufficient to r,.otivate the Medical co-,%ilex in establishing relationships vith the diagnostic and treatment stations.@ 91 pro 3:n;volvoo State and local C.@ver=---nts in the ple=ing of an@ imrdztant illilovatidil in @Mdicdl date4 ib a ti@ apabi-litioa,-@' ie V in being* thorobZr en 0,9,-O,-@unity tO and onacAtra'sinrr their of the State and loca'@ h@,@,ith of t,icrc innovation* loc,-,,l institutions in involv'iig,, tho @OV the planning aCw-,iniatratio-.i o LI and trcat.-,cnt c ttll- tent -.iith Arw-rican pi@tldoa and trcditioiin4 Provides the oppor.-,unity., in 2tal@les to use the State eovor=L-nt as the link botiieca the @@,f@,f7..i-.0-rluppoxted =dical complex and the n@;ork of diaVo5-@ic and treatment stations within t@.c,, State* Provides greatdr O-pi)oe,;unit:Lcr. for the integration of the planning of these categorical diiC;,io@@tic and trc atment stations vith the State planning and other he-@-al-Va matters, including the distribution of hospital faci3.ities. cons: lt@t@iods seen' be devised to ro,quire ,,.he dia_MO$tic and tate. ment stations to ois@iablish A relationship 14iih amedical c X It vt'tild v e rv 4 -i @i$ br,c )ICX to pl' .y a equivalent incentive fc>r th n; Col C significeLnt rolo in the i7@,vto or @on if such a nttvor'A- thero ,ro lil@y to bo considerable @-dminirtrati,,,re and frictions bdtvedn the di,,ir@noztic and trca+ nt and the wdical complexes and categorical centers. The addition ok@ qualified to staff the diagnostic and treatment stations proz enta c@ insuperable problems for 4oresceable @turc. The medical societies are lilalcly to Oppose this system even @,tbough such opposition miCli-t be less strong than in the case of Alternative 10 By r,,@iking less of a brealt v-.'Lth t;a@ status quo in modica:L<@ care than Alternative I., this a-,oi@ro-@ch vill probably, be less Afective in raising the @ity of medical practice made avail able to the local co=mmity. The capability of E;tate eovc,@@ntr, is variabll- and their involvement vil.1 be accompanied by political interference in M=Y of the States. @Becau A. an betveen se of@the spit in @.-@r4istration d flmding the medical complex and the dia,@.ost'@c and treatment stacion tbe@ of professionalic@rtize =d the time3,y application of s eo 0 vill be le a o:C:roctiv