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operate their own hospitals and medical centers without Federal or State aid by means of a time-proven formula of cooperative ownership and nonprofit operation.

Members of your committee expressed a desire to have placed in the record definite information as to areas served by cooperative hospitals, and areas in which new organizations are being developed. I am very glad to comply with that request. I regret that there is no way of obtaining a list which we can verify as being complete, yet the following list comprises many more than the approximate 40 localities previously referred to.

Following are listed the five established hospitals:
South Plains Cooperative Hospital, Amherst, Tex.
Northwest Community Hospital, Moreland, Okla.
The Achenback Memorial Hospital, Hardtner, Kans.
Community Hospital, Two Harbors, Minn.
Elk City Community Hospital, Elk City, Okla.

Of these the Elk City Community Hospital is the oldest, having been established in 1929 and owning the distinction of being the first cooperative hospital in the United States. Located on the edge of the “dust bowl” it serves 10 counties in southwestern Oklahoma and has become one of the outstanding medical institutions in the State. It erected a new nurses' home last year and has plans underway to build a new clinic building, add ten new doctors and another dentist to the staff and provide the “finest medical, surgical, dental and hospital care available anywhere.”

A Northwest Cooperative Hospital Federation was recently formed by the representatives of the following six cooperative hospital associations in Washington, Oregon and Idaho:

Olympic Cooperative Hospital Association, Sequim, Wash.
Group Health Cooperative of Puget Sound, Seattle, Wash.
Cooperative Community Hospital, Sandpoint, Idaho.
Farmers Union Health Assn., Salem, Oreg.
Kitsap Cooperative Hospital Association, Bremerton, Wash.
Buhl Community Hospital, Buhl, Idaho.

Several communities are organizing hospital cooperatives in Wisconsin, notably a vigorous group in Barron.

At Pelican Rapids, Minn., 200 farmers and towns-people have incorporated the Pelican Valley Cooperative Health Center and have plans for the construction of a modern hospital to cost $100,000. It will be financed by the members and will furnish medical and hospital care on the prepayment of dues plan.

In Leola, S. Dak., the community has raised $18,000 toward construction of a 20-bed hospital for local service. There is no doctor nor hospital in Leola now.

The Texas State Legislature, impressed by the success of the South Plains Cooperative Hospital, passed a law last year providing for special charters for cooperative hospitals. The following list of communities has already requested aid in getting organized—testifying to not only the need of such facilities, but also to the eagerness of the people to help themselves when encouraged to do so by enabling legislation.

The localities marked by a star (*) have already received charters: Albuquerque, N. Mex. : Mr. Ralph E. Johnston, regional secretary. Post War

Planning Committee, Southwest Intermountain Region, Bureau of Agricultural

Economics. Amarillo, Tex.: Potter County, Mr. Frank Triplett, Cooperative Grain Growers

Association. *Amherst, Tex. : Lamb County, E. C. McDaniel, business manager, South Plains

Cooperative Hospital. Anahuac, Tex. : Chambers County, Mr. J. H. Sandlin, county agent. Andrews, Tex.: Andrews County, Mrs. R. A. Mosley, box 136.. Canadian, Tex.: Hemphill County, H. S. Wilbee. Centerville, Tex. : Leon County, Mr. Ray F. Christian, FSA supervisor. Channelview, Tex.: Harris County, B, N. Garrett. Cisco, Tex. : Eastland County, Mr. W. B. Starr. Cooper, Tex.: Delta County, Mr. Rube S. Wells, secretary, chamber of com

merce, box 444. * Crosbyton, Tex. : Crosby County, Crosbyton Cooperative General Hospital. Boyd, Tex. : Wise County, W. E. Munn. Brady, Tex.: McCulloch County, W. B. Hardin.

* Floydada, Tex.: Floyd County, Floyd County Cooperative Hospital., Lockney

Tex. ; Mr. John Lloyd ; Mr. M. D. Ramsey. Follett, Tex.: Libscomb County, Rev. Tilden B. Armstrong, the Methodist Church. Brookeland, Tex.: Sabine County, D. E. Willis, box 43. Bullard, Tex.: Smith County, Mrs. Ora Shipp, president, Women's Home Dem

onstration Club. Dallas, Tex.: Dallas County, Mr. J. B. Pope, Rural Life Insurance Co., 1108

South Ervay. De Leon, Tex.: Comanche County, Frederick G. Harmon, treasurer. Denton, Tex. : Denton County, J. H. Legett, 5275 T. C. Station. Devine, Tex. : Medina County, J. Travis Lilly. Dilley, Tex. : Frio County, John William Harris, box 156. * Dimmitt, Tex. : Castro County, Plains Memorial Hospital. Edcouch, Tex.: Hidalgo County, Sam D. Tayloe, general manager, Rio Farms,

Inc. Eden, Tex. : Concho County, Jack Davis; G. Y. Lee. Emory, Tex. : Rains County, Gilbert Barrow, FSA supervisor. * Fairland, Tex. : Freestone County, Garvin L. Holman, FSA supervisor. Falfurrias, Tex. : Brooks County, J. L. Murphy, county agent; Miss Pearl Taylor,

home demonstration agent; Rotary Club. Katy, Tex. : Harris County, Mr. E. B. Longenback., Lampasas, Tex.: Lampasas County, Mr. W. K. Glover. Leakey, Tex.: Real County, Mrs. E. E. Hill. Fort Stockton, Tex. : Pecos County, Mr. Don V. Purington, Pecos County Cham

ber of Commerce. *Friona, Tex. : Farmer County, Parmer County Community Hospital, Miss Lora

Mae McFarland, manager ; Mr. Elmer Euler, box 34; Mr. Sloan H. Osborn. Galveston, Tex. : Galveston County, Mrs. Ellen Helm Miller, treasurer, care of

Galveston News. Greenville, Tex. : Hunt County, Mr. T. P. Flaig, 2015 H. Stonewall. Groveton, Tex. : Trinity County, Mr. J. B. Courtney, manager of the Groveton

Chamber of Commerce. *Hale Center, Tex.: Hale County, Hale County Cooperative Hospital, Vic. Lamb,

editor, the American. Hebbronville, Tex. : Jim Hogg County, Mr. L. O. Wethersbee, county agricultural

agent, Cooperative Extension Work. Henrietta, Tex. : Clay County, Dr. A. Greer; Mr. Harvey Olsen. Houston, Tex.: Harris County, Mr. C. M. Albrecht, 2112 Providence Street. Iowa County, Tex. : Brazoria County, Rev. J. R. Jefferson, route 1, box 9. Itasca, Tex. : Hill County, Mr. Pat Hooks. Quitman, Tex. : Wood County, Mr. R. L. McClung; Mr. V. B. Shaw. Rio Hondo, Tex. : Cameron County, Mrs. Minnie Davidson, treasurer. Ropesville, Tex. : Hockley County, Mr. Otto L. Sims, mayor. *Leonard, Tex.: Fannin County, Leonard Cooperative Hospital; Mr. G. E. Car

penter, president, Leonard National Bank. *Lubbock, Tex.: Lubbock County, Cap Rock Cooperative Hospital; Nelson, Brown

& McClosky, lawyers, Lubbock National Bank; Mr. S. S. Allcorn, route 3;

Mr. Roy B. Davis, Plains Co-op. Gins. Madisonville, Tex.: Madison County, Mr. Ray F. Christian, FSA supervisor. May, Tex. : Brown County, Mr. W. R. Chambers, member of House of Repre

sentatives; Mr. M. W. Robson, secretary and treasurer; James W. Phillips,

president, Byrds, Tex. *Morton, Tex. : Cochran County, Cochran County Cooperative Hospital Associa

tion, Mr. Roy Hickman, Jr., county agricultural agent and secretary of chamber

of commerce. Muenster, Tex. : Cooke County, Mr. J. M. Weinsapfel, president, the Muenster

State Bank. Panna Maria, Tex. : Karnes County, Rev. Ed. J. Dworaczyk. Perryton, Tex.: Ochiltree County, Mr. Arthur R. Turner, FSA supervisor. Plainview, Tex. : Hale County, Mr. A. B. Tarwater. Post, Tex. : Garza County, Mr. J. W. Grider. Poteet, Tex. : Atascosa County, Mrs. William Smelly. Richmond, Tex. : Fort Bend County, Mrs. A. P. George; Mr. James W. Prude,

FSA supervisor. Rising Star, Tex.: Eastland County, Rising Star Cooperative Hospital, A. 0.

Winter, chairman, membership committee. San Angelo, Tex. : Tom Green Co., Mr. Felix Probandt, 222 West Harris Ave. San Juan, Tex.: Hidalgo County, Mr. W. Houston Gassage.

Silverton, Tex. : Briscoe County, Mr. Alvin Redin; Mr. Leo L. White, county

agricultural agent. *Spearman, Tex.: Spearman County, Hansford Hospital ; Dr. M. Ę. Gower, 2056

McLain Building. Stratford, Tex. : Sherman County, Mr. David F. Eaton, Jr., county agent. Tahoka, Tex.: Lynn County, Mr. Claude Danaldson, Box 477. Tuscola, Tex. : Taylor County, Mrs. Leo Standard. Wink, Tex. : Winkler County, Mr. Wendell E. Cook, Box 1. Winnie, Tex. : Chambers County, Mr. J. H. Sandlin, county agent. Winter Haven, Tex. : Dimmit County, Mrs. Ben Davidson. *Wolfe City, Tex.: Hunt County, Wolfe City Community Hospital ; Mr. G. Little,

director; Mr. R. L. Mullins, president, Wolfe City National Bank. Yorktown, Tex. : DeWitt County, Mr. W. L. Schorlemer, Box 14. Utopia, Tex. : Uvalde County, Mr. J. R. Kidwell. Vera, Tex. : Know County, Mr. Sam Goodrich. Waring, Tex.: Kendal County, Mr. Arthur Blaschke, Master of Comfort Grange.

For the foregoing list, which is up to date as of March 14, 1946, we are indebted to Mr. H. R. Schwecke, Assistant Secretary of Texas Federation of Cooperatives.

One of the facts your committee was interested in establishing was the size of a rural area that could be serviced by a well-equipped hospital, and indicated a willingness to use the Elk City Community Hospital as an example. This, and several other pertinent details, I was asked to obtain, and I have done so by contacting Dr. Michael Shadid, founder and medical director of that institution. His answers, with the questions omitted, are reproduced below:

1. The number of our families who are members of the hospital association are 2477.

2. The number of members who pay their annual dues each year is 1,731. A good many of those who do not pay have moved away. However many I do not now know.

3. The number of individuals in the member families is about 4 to each family.

4. The number of patients who have registered at the clinic to see the physicians and dentist is 34,604.

5. The patients who are hospitalized-40% are nonmembers and 60% are members.

6. Our last annual income was $51,917.66. About 50% comes from members and 50% comes from nonmembers.

7. Our hospital is an open hospital and every cooperative hospital I organized is an open hospital. I might mention the cooperative hospitals at Amherst, Texas, Mooreland, Oklahoma, Hardtner, Kansas.

8. Our doctors' salaries are $600 and $700 a month and at the end of the year we pay the doctors a bonus, the amount of which depends on several factors. Last year the bonus of the doctors ranged from $2,500 to $4,000. Our last year net profit at the hospital was about $51,000 after paying said bonus.

9. As to the distance between a hospital and a health center, this depends pretty much on whether or not you have patients' beds in the health center. For obstetrical cases, minor surgery and the like, if such is the case, then a hospital might be 100 miles away. If the health center has no patients' beds for obstetrical cases and minor surgery then I would think the hospital should be about 50 miles away.

10. Approximately 75% of our members live within a radius of 40 miles and about 25% of them live farther out, or within a radius of 100 miles.

To supplement the information furnished by Dr. Shadid I am enclosing further details for the attention of the committee in the form of two folders delineating fee schedules and operating plans of the Elk City Community Hospital, and of the South Plains Cooperative Hospital at Amberst, Tex. Except for minor details, all of the cooperative hospitals have followed the policies worked out by these pioneers. On a broad basis it can be summed up as follows: consumer ownership of the hospital and consumer direction of the medical service, with the technical operation in the hands of able, well trained medical personnel. Shares usually $50 per family and medical care costs as low as $25 per year for an average family.

On this basis the ownership is thinly spread throughout the community. This, and the prepayment, or budget, plan of financing operations, removes all of the risk of failure.

That medical and hospital care on a nonprofit basis, with control of the quality and scope of service in the hands of the people served, is the right answer is amply demonstrated by the spontaneous results obtained in the State of Texas when the way was cleared by enabling legislation. These people expect, and intend, to support their own institutions.

Federal grants in aid to partially meet initial construction costs? Yes. Such aid would speed up a badly needed program. As for subsequent care and support of the facilities, it is being daily demonstrated that a community can pay for its medical service and scarcely notice the outlay. Over ten million persons affiliated with the Cooperative League and National Cooperatives, Inc., would welcome the chance. Respectfully,

LUDWIG ANDERSON,
Cooperative League of the U. S. A.,

National Cooperatives, Inc.

Texas' First Cooperative Hospital

SOUTH PLAINS COOPERATIVE HOSPITAL AsSOCIATION, INC.

"A Non-profit Organization
Owned and Operated by the Members, for the Members”

AMHERST, TEX.

Please read this folder carefully as it will save confusion and misunderstanding

Dues: Are due December 1, each year.—Please pay your dues by December 1, or make satisfactory arrangements with the business office. If not, the free service plan will be discontinued and a penalty will be added when dues are paid.

A life membership is $50.-Nonmembers may avail themselves of all the hospital facilities and the services of the staff of physicians, the same as a private institution.

The South Plains Cooperative Hospital Management

SERVICE PLAN

To support our physicians, you pay: 1 person in family.

$12 2 persons in family.

18 3 persons in family

22 4 persons in family-

25 $2 additional dues for each member of family over 4. For the above dues you receive without cost: All examinations, treatments; (metabolism) test, except a charge of $1 is made for oxygen used. Laboratory tests—blood, urine, etc. Typhoid and diphtheria toxoid. Ultraviolet ray and diathermy treatments. The services of the physicians are free but you pay for all materials and medicines used. To support the hospital, all members pay: Room, board, and general nursing care as follows: Semiprivate, 2 beds.

$2. 50 Private room-

3. 00 Anesthetic-Operating room fees : Major operations (like appendicitis)

20.00 Minor operations (like tonsils).

10.00 Obstetrical cases.

10.00 Home calls are $1.50 plus 25 cents per mile one way. One X-ray picture $3, additional pictures $2 each.

Dye used in X-ray of the kidneys $3, gall bladder $1 additional. Above rates and services apply to the "family.” The family consists of father, mother, and all unmarried children living at home regardless of their number or age. If such a family has a father, mother, brother, or sister or other dependents living with them and dependent upon them for food, clothing, and shelter, they may pay $6 a year extra for each such dependent.

Every physician is on a salary. The money derived from nonmember business, benefits members by giving additional services and better medical care by employing additional doctors.

No family should be without membership in the South Plains Cooperative Hospital.

PLEASE COOPERATE WITH US

A regular check-up saves lives, saves time and saves money.

Members are urged to come in often for regular check ups. By doing so, you may save your life or prevent serious illness. Come in at least twice a year for examinations.

Confinement cases are urged to come in at least once a month for a check up of blood pressure, heart, kidney, etc.

The hospital is open to any qualified M. D., who wishes to bring his patients in for medical treatment or major and minor surgery. Members have the privilege of using doctors not on our staff, but they must pay his service fee.

Office hours: 8 a. m. to 5 p. m. No work on Sunday except by appointment or for emergency. Before 8 in the morning we must see all our patients who are bed fast in the hospital. After 5 p. m. we must see the same patients again. We have to work hard and are on call day and night. Therefore we do not see patients (except in emergency) after 5 p. m. and on Sunday.

Cases coming under the workmen's compensation law are not covered.

A cooperative hospital can only exist and continue to prosper and grow if founded on a dues paying system. Members cannot pay the usual charge of hospitalization and surgical operations and if not on free service plan they must have their work done on credit. A cooperative hospital cannot extend credit and continue in business. Credit is destructive to any cooperation and especially a cooperative hospital. Without a dues paying system, the board of directors cannot hire enough good physicians, for they cannot guarantee them adequate salaries. Without a dues paying system a board of directors cannot tell how much money a hospital is going to make, therefore they can never balance their budget and agree to pay a staff of doctors any specific sum.

INFORMATION ABOUT THE SOUTH PLAINS CO-OPERATIVE HOSPITAL, INC.

Q. How is the South Plains Co-operative Hospital built and who owns it?-A. It is built and equipped with $50 that each member paid. The members own the hospital.

Q. What is the purpose of the Co-operative Hospital ?-A. Its purpose is to make it possible for its members to receive adequate medical, hospital and dental care at a cost within their means.

Q. Who manages the affairs of the hospital?-A. A board of directors of nine members who meet from time to time as the need requires. According to the bylaws of the association they must meet at least every 3 months and oftener if required.

Q. Who hires the doctors and other employees?—A. The board of directors hire the chief doctor and the business manager. The chief doctor hires other doctors, nurses and technicians subject to confirmation by the board of directors. The business manager hires other personnel subject also to confirmation by the board.

Q. What becomes of any profits left after paying the expenses of the hospital? A. It is the purpose of the board of directors and the members to charge enough dues and hospital fees to defray the necessary expenses and not make profit. Our profits over running expenses belong to the association and such funds may be used for expansion, pay indebtedness, improve the service by taking on additional doctors, buy more equipment, etc.

Q. Can a member choose any physician on the staff to treat him?-A. Certainly.

Q. In event a member is dissatisfied what recourse has he?-A. He can talk to the business manager concerning financial matters. He can talk to the chief of staff concerning medical matters. He can appeal to the board of directors should he fail to reach an adjustment.

Q. Can a member sell his membership?

A. Yes. Memberships are transferable with payment of $10 transfer charge. Why pay dues

A dues paying system is very much cheaper. It is cheaper to pay so much a year to a staff of doctors and specialists than it is to pay them every time you have an examination or a treatment or a surgical operation. One case of serious illness in 10 years will save enough money to pay the dues for 10 years to say nothing about needed examinations and treatments and surgical operations.

A member not on free service comes to the doctors when he must. He puts off coming because of the cost. A member on free service comes as often as he needs to without waiting until it is too late. He has a lot of work done that the other member neglects. A dues paying system is preventive of ill health.

A doctor hired by the year and not by the visit or by the job is disposed to deal

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