l.
Certificate of Need issued to contractor; and
2.
Health
Services
Administrator
assumed
responsibility
and
commenced full-time management of the health care system; and
3.
Completion
of those “steps
agreed
to
by the
parties"
in
a
Transition Memorandum.
While the documents
appears
to
Schlehuber
be
did
in
in 1 and 3 were not available, the transition
effect
assume
as
the
Health
Services
responsibility October
1,
Administrator,
1980.
Fred
A copy of the
agreement is provided in Appendix F.
The initial contract term is until September 30, 1982 with provision
for successive five year renewals. The contract is ambiguous in certain
areas and will present problems in administering an effective and efficient
health care delivery system.
There already appear to be differences between
the contractor and certain government officials with regard to the degree of
control/responsibility the contractor has in the delivery of health care.
As discussed previously,
this may be a moot issue if the proposed
organizational structure is adopted as the contract in its present form
would not be compatible and would have to be amended.
C.
Finances
For FY 1981, the proposed budget for the Department of Health Services
is $3,035,500.
Marshall
Islands
A copy of the preliminary draft is provided below.
government
$1,920,000 of this total.
is
showing
While
DOT jis
budgeting
is
the
funding
done
on
a
The
source
for
national
and
departmental basis, once approved, the funding method appears to be in the
"recovery pot" approach.
presently breaks down.
It
is at the operational
level
that budgeting
Spending is done with little regard to line item
budget and is a function of who gets to the “money pot" first and how long
funds are available.
It is understood they ran out of money after 10 months
in FY 1980.
Related to the problems presented by this approach is the apparent lack
of accounting and finanical reporting at the operational level.
Reports are
sent to Trust Territory and summary financial information is available.
It
does not apear, however, to be tied into the budgetat the operational level.
There is
little,
example,
there
if any, accounting for receivables and payables.
is
$334,000
payable
for
referrals
that
the
(For
hospital