l.
Certificate of Need issued to contractor: and
2.
Health
Services
Administrator
assumed
respondibility
and
commenced full-time management of the health care sistem; 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
as
the
Health
Services
assume responsibility October
1,
Adminiskrator,
1980.
Fred
Alfcopy 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
Bnd efficient
health care delivery system.
There already appear to be differgnces between
the contractor and certain government officials with regard to
[the degree of
control/responsibility the contractor has in the delivery of
§ealth 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 Hel 1th Services
is $3,035,500.
Marshall
A copy of the preliminary draft is provided| below.
Islands government
$1,920,000 of this total.
is
showing
DOL is
the funding
While budgeting is done on a
The
source for
frational
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
fto line item
budget and is a function of who gets to the “money pot" first Jand how long
funds are available.
It is understood they ran out of money affer 10 months
in FY 1980.
Related to the problems presented by this approach is the
of accounting and finanical reporting at the operational level.}
Apparent lack
Reports are
sent to Trust Territory and summary financial information is ayailable.
It
does not apear, however, to be tied into the budget at the opera jonal level.
little,
example,
there
if any, accounting for receivables and paypbles.
is
$334,000
payable
Vn
There is
for
referrals
that
fhe
(For
hospital