the previous fiscal year, a base rate of $4 per medical center hour to pay for medical-center and routine hospital services.

In addition, $1 per medical center hour was added to the base rate of $4 for all LHI dentists employed by the LHI for 1 year or more. This increase was an attempt on the part of the LHI to recognize dentistry as an integral part of medicine and thus entitled to fees comparable to that received by physicians.

The going rate for dentists does not, as yet, reflect status equal to that of physicians. The LHI believes that it should. Therefore, the going rate was not considered a legitimate income standard for this section.

This section does not receive the seniority increment.

The separated medical center and hospital hourly rate plans

Description: Total fees allocated to each section provide sufficient funds to pay LHI doctors the going rate. Medical-center hours are paid at an established rate per hour. Home and office calls are paid on a fee-for-service basis. The amount of money remaining is allocated to hospital hours and a hospital hourly rate is computed. (See table B for the method of arriving at the numerical rate.)

Sections covered:

Gyn-obstetrics. In order to compensate LHI gyn-obstetricians according to the 1951 going rate ($15,918), hospital hourly rate was changed from $9 per hospital hour to $10.45 per hospital hour.

Medical center hourly remained at $5 plus 25-cents-per-medical-center hour for each year of employment, up to 4 years (seniority increment).

In addition, the seniority increment was applied to hospital hours as well as medical-center hours. This had not been done the previous fiscal year. Section-head fees remained the same, $1 per medical-center hour. Orthopedics. In order to compensate the LHI orthopedists according to the 1951 "going rates" ($16,693), a reduction in fees would have been necessary. Therefore, the orthopedists were given a minimum guaranty that they would receive the same rate for work performed during the 1952-53 fiscal year as they received during the previous 6 months, $10 per medical-center hour and $20 per hospital hour.

This section does not receive the seniority increment.

Monthly fee plans

Description: A monthly fee is set to cover scheduled medical center hours and specified nonmedical center services required by the patients.

Sections covered:

There

Pediatrics. In order to compensate LHI pediatricians according to the 1951 "going rate" ($12,325), a reduction in fees would have been necessary. fore, the pediatricians were given a minimum guaranty that they would receive the same rates for work performed during the 1952–53 fiscal year as they received during the previous fiscal year. In addition, these rates were increased by a sum sufficient to obtain pediatricians in the St. Louis area on the LHI staff (scarcity factor).

All pediatricians now are to receive a monthly fee to pay for their medicalcenter and routine hospital services, prorated according to the number of medical center hours scheduled. (See table C for the method of arriving at the numerical rate.)

Previously, the pediatricians received $5 per medical-center hour, $10 per newborn care, $3 per hospital visit (nonnewborn). The section-head was the one exception. He formerly received $12 per medical-center hour to cover his medical center, hospital, and section-head services to the institute. His monthly rate has been determined by the minimum guaranty principle, that there shall be no cut in the rate of fees paid.

This section does not receive the seniority increment.

Section-head fees are changed from $2 per medical-center hour to $75 per

month.

General surgery.-In order to compensate LHI general surgeons according to the 1951 "going rate" ($17,019), the equivalent full-time general surgeons estimate was changed from 0.76 to 1.00 upon the medical conference board's recommendation, and to include administrative hours.

The distribution of the money allocated to this section was changed from the method as outlined below to a flat monthly rate, prorated according to the num

ber of medical-center hours scheduled. The monthly rate included payment for all medical-center, hospital, home, office, and administrative services rendered (See table D, for the method of arriving at the numer

by the general surgeons.

ical rate.)

1 Based on LHI time estimates for nonmedical center doctor services.

3 Rounded: $7.25.

2 Adjusted to exclude factors existing in 1951 which will no longer apply in the 1952-53 fiscal year.

TABLE C.-St. Louis Labor Health Institute pediatrician medical center and routine hospital fees computation, July 1, 1952, to June 30, 1953

TABLE D.-St. Louis Labor Health Institute determination of general surgeons'

monthly rate, July 1, 1952, to June 30, 1953

(Thereupon at 3 p. m., a recess was taken until Thursday, January

28, 1954, at 10 a. m.)

HEALTH INQUIRY (VOLUNTARY HEALTH INSURANCE)

THURSDAY, JANUARY 28, 1954

HOUSE OF REPRESENTATIVES,

COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,

Washington, D. C.

The committee met, at 10 a. m., pursuant to adjournment, in room 1334, New House Office Building, Hon. Charles A. Wolverton (chairman) presiding.

The CHAIRMAN. The committee will come to order.

We are privileged to have with us today representatives of the American Medical Association. We are privileged and honored in having their presence. We look forward to their statements.

I wish to make this introductory statement with reference to the American Medical Association. If my statement is in any sense incorrect, I would want the witnesses to feel free to correct it.

The American Medical Association is made up of 53 constituent State and Territorial medical societies, representing 1,987 component county and district medical societies, and currently has a paid-up membership of over 140,000. Each component county medical society selects delegates to the house of delegates of the State medical association. Each State and Territorial medical association in turn selects 1 delegate for every 1,000 American Medical Association members, or fraction thereof, to represent that State in the house of delegates of the American Medical Association. In addition each of the 21 sections representing a particular branch of medicine in the scientific assembly of the American Medical Association elects 1 representative to the American Medical Association house of delegates, and a delegate is appointed by the Surgeons General of the Army, Navy, Air Force, and Public Health Service, and by the Chief Medical Officer of the Veterans' Administration.

The house of delegates of the American Medical Association is the policymaking body of the association. It elects 7 officers and 9 trustees. The board of trustees, the president, and the president-elect serve as the interim governing body of the American Medical Association.

Both the house of delegates and the board of trustees maintain standing committees and councils. The councils of the house of delegates include a judicial council, a council on constitution and bylaws, a council on medical services, a council on medical education and hospitals, and a council on scientific assembly. The board of trustees maintains standing committees on foods and nutrition, industrial health, legislation, mental health, national emergency medical service, pharmacy and chemistry, physical medicine and rehabilitation, and rural health.

39087-54-pt. 7—17