4. New facilities and additions New facilities now approved amount to 1,411 or 59 percent of the total number of projects; additions or alterations to existing facilities comprise the remaining 41 percent. 5. Size of communities Of the new general hospitals approved, the majority (58 percent) are located in communities of less than 5,000. Only 8 percent are in cities of 50,000 or more people. Additions and alterations to existing general hospitals tend to occur in the larger communities: 19 percent are in communities of less than 5,000 people; 31 percent are in communities of over 50,000. 6. Prior availability of facilities Of the 925 completely new general hospital projects, 511 (55 percent) are located in areas which had no hospitals prior to the hospital survey and construction program; 200 (22 percent) are located in areas which had only nonacceptable facilities; the remaining new facilities are being built in areas which were deficient in facilities prior to the program. 7. Regional distribution This The majority of approved projects are located in the Southern States. census region has 1,237 projects, or 53 percent. The remainder are distributed as follows: 511 (22 percent) in the North Central States; 322 (14 percent) in the North East States; and 281 (11 percent) in the Western States. 8. Bed capacity New hospitals are relatively small in bed capacity: 57 percent have fewer than 50 beds; 22 percent have from 50 to 99 beds; only 21 percent have 100 beds or more. Hospitals to which alterations or additions are being made are larger65 percent of these projects are hospitals with 100 or more beds. 9. Remaining need The bed deficit of the Nacion is still great. Estimates by the States, reflected in current State plan revisions, indicate that over 838,745 additional beds are still required to meet the Nation's total peacetime needs. It is interesting to note that there are 79 projects which are a combination of hospital and public health center in the same building. These projects are mostly in Ohio, Kentucky, Tennessee, Alabama, and Mississippi, but are also seen in many other States in lesser numbers. It is believed that a high quality of medical care can be facilitated by the closeness in their daily experiences of the clinician and the public health officer. The patient will be the recipient of more complete attention to his health problems through this closer relationship of those in the health field. This type of project works out well at the county level in rural and lesser urban areas. The large number of projects in the communities under 5,000 population will help get hospital services to the rural areas and in time of national catastrophe these hospitals could be the evacuation destinations of the target cities. Physicians are being attracted to and retained in the rural areas due to these new hospitals. Nurses are returning to their professions in these small hospital and are serving their communities well. It is also of interest to note that about 20 percent of the total funds have been used to build hospitals and related health facilities which are used as teaching institutions. In fact, 32 States have allotted the Hill-Burton funds to its university and other medical school hospitals. Some of these are located at Birmingham, Ala.; Charleston, S. C.; Little Rock, Ark.; Jackson, Miss.; Minneapolis, Minn. These, among others, will be available for the training of physicians, dentists, nurses, dietitians, technicians, and other health personnel so urgently needed. At the present time there is a shortage of about 839,000 beds in this country This figure is that reported in the respective State plans. At the present time we have about 1,150,000 acceptable beds and about 7,000 hospitals in the United States. This does not include the beds in the facilities of the Army, Navy, Air Force, nor those of the Veterans' Administration, Public Health Service, and Bureau of Indian Affairs, Department of the Interior, which are all federally operated. 62284-55-23 In 1946 when the Hospital Survey and Construction Act was passed the estimated bed deficit was 900,000. This great deficit had accumulated due to very little hospital construction from 1929 to 1939, the years of the economic depression, and from 1940 to 1946, the World War II years, when the materials and manpower needed to construct hospitals were absorbed in the prosecution of that war. Currently the Hill-Burton program accounts for 34 percent of all the hospital construction in the Nation. A total of 114,000 beds have been added or approved under the program and that number added to those built without Federal assistance only permits us as a Nation to almost keep up with current annual need. We are not reducing the accumulated deficit from 1929 to 1946. The reasons, of course, are annual population increase and obsolescence. The population increase last year was 2,700,000. At the estimated rate of need (12 beds per 1,000 population) we would need 32,000 more total beds due to our population increase. Obsolescence can be divided into physical and functional. It is estimated that 50 percent of our hospitals are over 50 years of age and 50 years is the anticipated life expectancy of a hospital. These hospitals and many others were built to answer specifications of yesteryear's medical programs. They have features of design which do not fit todays demands. Many of them are faced with the problem of remodeling, modernization or replacement. The financial outlay is frequently prohibitive particularly when the end result is at best an improvisation. We, in the Hill-Burton program, firmly believe no hospital should be designed until a written program of operation is acquired. Our major interest is in hospital services not solely architectural attractiveness. A well designed project will have both, plus economy features relating to operations. The design should be such as to permit flexibility to meet changing medical care trends as these relate to physical facilities. Functional obsolescence is related directly to the features of modern medical care and hospital services. Modern teaching utilizes electronic devices such as television in operating rooms, facsimile transmission of X-ray films, television for transmission, pathology slides, among other items. Air conditioning is increasing. The use of color is probably not only for decorative purposes. The average general hospital bed costs about $16,000. The medical center and university teaching hospitals will cost about $23,000 or more per bed. The most accurate way to compute costs is on a square foot basis but bed costs are usually used since it is more tangible to the average person and therefore more understandable. operational program of any hospital will directly determine the ultimate cost of the project. That is why a written operational program is essential. The It is estimated that the loss through obsolescence in the general hospital field is about $150,000,000 annually. This accounts for about 8,000 beds. Add this 8,000 to the 32,000 beds due to population increase and we have 40,000 beds as our base annual need without reducing our accumulated bed deficit of 839,000. A national inventory showed that there are about 180,000 beds in the 7,000 nursing homes, affording skilled nursing care in this country. About 92 percent of these nursing homes are proprietary in character. Some are excellent, some good, some poor, and some terrible. There is a place for good nursing homes which accord to the patient skilled nursing care, adequate and appropriate nutrition, and physicians' services. In the mental institutions of this Nation there are many patients who could be adequately cared for in a good nursing home. The shortage of psychiatrists and the existing demand for their services is great. The use of nursing homes for some of the patients we find so frequently in the mental institutions would assist in helping the services of psychiatrists be more available to those essentially in need of psychiatric attention. Some of the authorized diagnostic or diagnostic and treatment centers could be psychiatric in type and would be of help to the ambulatory patient in his striving for better mental health, as well as answer a great need in the mental health field. The Hill-Burton program is a coordinated and cooperative endeavor between the local community, the State, and the Federal Government with the initiative for acquiring hospitals and medical facilities, and for operating these facilities resting with the local community sponsor. HILL-BURTON ACT EXPENDITURES Senator HILL. Do you have any questions, Senator Potter? Senator POTTER. Mr. Chairman, I regret that I came in when Dr. Cronin was in the middle of his statement. How much money was spent last year on the Hill-Burton Act by Federal funds? Dr. CRONIN. Well, the annual appropriation last year was the year we are in now? Senator POTTER. Yes. Dr. CRONIN. Was $75 million for the older aspects of the HillBurton, and $21 million for the new aspects of the Hill-Burton for a total of $96 million. Senator POTTER. The request this time is for $60 million under the old, under the original Hill-Burton Act. Is that correct? BREAKDOWN OF REQUEST Dr. CRONIN. No, sir. The request at the House level was $65 million for the older aspects, the older Hill-Burton program, and $60 million for the newer Hill-Burton program. The testimony here today that I presented before you came in, Senator Potter, was to the effect that the Secretary is requesting that this committee consider an appropriation of $75 million for the older aspects of the Hill-Burton, which coincides with what the House Committee on Appropriations passed. And $50 million for the newer aspects of the Hill-Burton, which is $29 million more than what the House gave for the newer aspects of the Hill-Burton. They gave $21 million. Senator POTTER. Yes, I see. But to the request of the Bureau of the Budget you would add $10 million to the old Hill-Burton Act. Dr. CRONIN. That is right. Senator HILL. And take $10 million off the new portion of the bill. Is that correct? Dr. CRONIN. That is correct. It comes to $125 million. It is a question of how you split it up. Senator POTTER. Yes. But you are requesting this committee that we earmark $75 million for the original Hill-Burton Act. Dr. CRONIN. Yes, that is right. REHABILITATION FACILITIES Senator POTTER. Do I understand you make funds available for rehabilitation facilities? Dr. CRONIN. Yes. Under the provisions of Public Law 482 of the last Congress-under the new amendment to the Hill-Burton program. Senator POTTER. The Vocational Rehabilitation.Act. Dr. CRONIN. That is another act. Under Public Law 482, 83d Congress, funds are authorized for rehabilitation facilities complementary to the total rehabilitation endeavor. There is an authorization for $10 million for rehabilitation facilities which are comprehensive in character. Senator POTTER. But that comes under your supervision? Senator POTTER. Those are all the questions I have. |