Abstract
With the curtailment of the federal EMS system program, former grantees have been expected to sustain the same level of program performance developed during the five year finding cycle. This study, performed during the latter years of the federal EMS program, found that many grantees were having difficulty supporting even their am regional management organizations (RMO) following federal funding. The study involved site visits to six grantees that had completed their eligibility and nine grantees at least at the level specified in Section 1203f.2) of the 1973 EMSS Act. A t each site the sources used to support the EMS system components, particularly the RMO, were studied. Also, organizational, management, and fiscal factors were analyzed in terms of their political impact on the regional systems' financial self-sufficiency. Analysis shows that two of six former grantees and four of nine present grantees were self-sufficient (securing ongoing financial support of the RMO) or likely to become self-sufficient. In two instances of multicounty system grantees, the less populated counties split off following the federal finding period. There were only a few grantees that succeeded in convincing the political jurisdictions within their regions to support financially the RMO. One grantee developed taxing authority over the entire region, and another successfully obtained support from a consortium of hospitals.