To meet increasing public sophistication and demand with respect to quality of medical care, it is argued that group practice must be extensively promoted so as to obtain more effective use of available physician services. Such group practice would permit the coordinated teamwork of physicians, social workers, and public health nurses. Some demonstrations have indicated that where group practice is in effect hospitalization requirements are decreased. In the area of hospital care, emphasis on progressive patient care which seeks to classify patients according to their needs and to adapt hospital services and facilities to those needs requires increasing emphasis. The elements in such program of patient care are described by the U.S. Public Health Service as follows: 1. An intensive care unit for the critically ill. 2. An intermediate care unit for patients whose condition has stabilized and who require remedial care. 3. A self-care unit for patients who are physically able to care for themselves but who require restorative care or diagnosis. 4. A continuation care unit for long-term patients who require prolonged care. 5. An organized home care program. It now seems possible to reach a cautious conclusion that there is increasing agreement that, to secure comprehensive health care, some method of financing medical care which will adequately support a broad range of services without more or less undue emphasis on hospitalization is required. As is not uncommon in human affairs, the "economics" of medical care hold the key to rationalization. V. BRIEF HISTORICAL PERSPECTIVE Thirty years ago the Committee on Costs of Medical Care, after 5 years of study, concluded that the needs of those days were: 1. For such an organization of physicians and related practitioners as to maintain high standards of care. 2. For the distribution of costs and services of medical care over groups of people and over periods of time, and 3. For a more effective coordination of facilities and services for medical care. The first response, in a sense, to the report of the committee were the references to health insurance in President Roosevelt's message on economic security of January 17, 1935, to the 74th Congress which, while making no specific legislative recommendations, promised such recommendations later in the year. In November 1935, after much maneuvering within the Committee on Economic Security and vis-a-vis the American Medical Association, the committee presented to President Roosevelt a series of recommendations which outlined fundamental goals for health insurance and envisaged the role of Federal Government as establishing standards for health insurance practices and to provide subsidies, grants, and other financial aid and incentives to the States which undertake the development of health insurance systems which meet those standards. These proposals were referred to the Social Security Board when it was organized with the suggestion that it give further study to the subject. Over the years, beginning in 1939, a number of proposals were put forth in the health care area, many of them without administration support. The range of benefits suggested in these proposals are interesting. The Wagner proposal of 1939.-Under the general direction of the Social Security Board, Federal matching funds would be provided to the States for the purpose of extending and improving medical care. Such State plans could include all services and supplies necessary for the prevention, diagnosis, and treatment of illness and disability. The Flanders-Ives proposal, introduced first in 1949.—This proposal would have subsidized nonprofit health care plans which would offer a range of health services including hospital room and board, service of physicians, dentists, and nurses and other auxiliary personnel, and related drugs, appliances, and ambulance service. National compulsory health insurance.-These were the Wagner-MurrayDingell bills introduced first in 1943. Administered by the States under Federal directives a wide range of benefits would be provided to employed individuals and to recipients of public assistance. These benefits would include physicians, dentists and home nurses services, hospital services for a period up to 60 days per year, prescribed auxiliary services and appliances, and drugs. The program would be financed through payroll taxes. The Forand proposal, introduced in 1956.—This legislation was essentially similar to the King-Anderson bills, except that surgical services in the hospital were included. SUGGESTED READING LIST 1. "Developments in Aging, 1959 to 1963": Report No. 8, Special Committee on Aging, U.S. Senate, February 1963, 224 pages. 2. "1963 Handbook on Hospital Insurance for the Aged Through Social Security": AFL-CIO Department of Social Security, May 1963 (revised), tab indexed. 3. "Health Service for the Aged Under the Social Security Insurance Systems": Hearings before the Ways and Means Committee, U.S. House of Representatives, 87th Congress, 1st session (July 24-Aug. 4, 1961) 4 volumes. 4. "Hospitalization Insurance for OASDI Beneficiaries": Report submitted by the Secretary of U.S. Department of Health, Education, and Welfare to House Committee on Ways and Means (April 1959). 5. "Meeting Health Needs by Social Action": The Annals, September 1961, 337, 145 pages. 6. Somers, Hermann, and Somers, Anne R: "Doctors, Patients, and Health Insurance," Washington, D.C.: The Brookings Institution, 1961, 576 pages. 7. Witte, Edwin: "The Development of the Social Security Act," Madison, Wis. University of Wisconsin Press, 1962, 220 pages. WHAT SOCIAL WORKERS AND CHAPTERS MIGHT DO First: Be familiar with the general details of the legislation, what it proposes to offer, how it would be financed, how it would be administered. This summary seeks to provide this information in a general fashion but, since health insurance has been debated for over 30 years, an extensive literature has developed, reference to some of which is made in the appended reading list. Particular attention is drawn to volume 1 of the hearings before the Committee on Ways and Means of the House of Representatives, held in 1961, which contains the testimony of Health, Education, and Welfare Secretary Abraham Ribicoff on the then King-Anderson bills and an extensive cross-examination of the Secretary. Noted also should be the study "Hospital Insurance for OASDI Beneficiaries," submitted to the House Ways and Means Committee by the Secretary of HEW in April 1959. Second: Request one or two particularly knowledgeable social workers with clinical, public health, or medical administration experience to review what material is available on the adequacy of public assistance, Kerr-Mills, and private insurance in meeting the health needs of the aged in your community. If a report is available or can be produced within the next month, send to NASW Washington office for possible inclusion in NASW testimony before the House Ways and Means Committee. Third: There is an acute need for case material illustrating crises or problems that have arisen, when older persons without sufficient resources have been faced with expensive and extensive hospital care. Some material of this sort was gathered from some chapters in connection with the Forand bill in 1960 and was sufficiently effective so that it was inserted in the Appendix to the Congressional Record by Congressman King, Democrat, of California, now ranking Democrat of the House Ways and Means Committee after the chairman and by former Congressman Machrowicz of Detroit, also a member of the House Ways and Means Committee. If such case material is available or can be quickly secured, send it to the Washington office. Fourth Where appropriate, agencies and organizations concerned with services or programs for older people should be encouraged to study the health needs of their clients or members and urged to consider supporting the contributory social insurance approach to meeting those needs. Encourage and welcome also opportunities to discuss legislation before community groups. Fifth Even though the issue of hospital care for the aged and contributory social insurance may not be active as of the moment before the Congress in terms of hearings or debate, interest should be registered in the King-Anderson legislation in face-to-face contact or in correspondence with Congressmen or Senators in connection perhaps, with other legislative issues. Ask about the present status of this hospital legislation and when it may receive consideration. Sixth There should be organizational machinery established within the chapter to produce quickly letters from a representative and informed group to Senators and Congressmen when the hospital care legislation is placed on the congressional agenda for action. 27-166-64-pt. 2-21 A FEW COMMONLY ASKED QUESTIONS Is this a program of governmental or socialized medicine? This is, of course, the most common accusation against the King-Anderson bills, and, of course, has no reality in fact since there is no provision for the payment of private physicians in the legislation. Not a single doctor would be added to the Government payroll as a result of this bill. Why pay hospital bills for well-to-do persons? Only a very small proportion of retired persons can be considered affluent while only about 20 percent of the elderly have annual incomes of more than $2,000. Regardless of income status, however, all persons covered under social security are entitled to its cash benefits as a matter of right. Any attempt to differentiate between the few relatively well off and the great mass of aged with low income would require an income test and some form of investigation which is completely contrary to the purpose of social security. Is this program the foot-in-the-door for governmental health insurance for everybody? The 30-year history of trying to secure some form of health care through contributory social insurance should be a sufficient argument that KingAnderson legislation will not be easily translatable, if at all, into a governmental insurance program for everybody. As a matter of fact, it is held that picking up the tab for the relatively high cost programs for the aged may enable private programs to widen their benefits for persons presently in the work force. With the great growth in health and medical care expenditures, do we really need governmental intervention? The fact that in the period from 1928-29 to 1960-61 private and public expenditures for health and medical care, including medical facilities-construction, has increased from $3.6 billion to $29 billion, an eightfold increase, and represents 5.7 percent of the gross national product has been put forward as an argument that no further governmental intervention is required. However, it should be noted that in the last decade there has been a significant shift in sources of financing for medical care. In the 1949-50 period insurance benefits and public expenditures represented about one-third of medical care expenditures while in 1960-61 insurance benefits and public expenditures were about one-half of all medical expenditures. There is thus evolving a system of financing health care that chooses the principles of group payment and tax support, the essence of the National Association of Social Workers policy statement on a national health program. However, as has been indicated earlier in this special memorandum, group payment systems which provide comprehensive health care are limited in number and are inadequate as far as provisions for the care of the aged are concerned. Governmental intervention is required to bring older persons within the medical care economy and thus enable them to secure a share of the services related to their needs. The CHAIRMAN. Thank you, Dr. Linford, for bringing to us the views of the National Association of Social Workers. Are there any questions of Dr. Linford? Thank you again, sir. Dr. Hampton, will you please identify yourself for the record by giving us your name, address, and capacity in which you appear? STATEMENT OF H. PHILLIP HAMPTON, M.D., VICE PRESIDENT AND CHAIRMAN, COUNCIL ON LEGISLATION AND PUBLIC AGENCIES, FLORIDA MEDICAL ASSOCIATION, INC. Dr. HAMPTON. I am Dr. H. Phillip Hampton, of Tampa, Fla., where I am engaged in the private practice of medicine. Ian vice NOTE. Data from November 1962 Social Security Bulletin. president and chairman of the council on legislation and public agencies of the Florida Medical Association. Since 1956, I have been chairman of the advisory committee to the State board of health on the State and county program of hospital service for the indigent and the same committee is now advisory to the State welfare board on the program of medical assistance to the aged. For 8 years Florida has had a program providing hospital care for the needy sick of all ages through a State and county matching fund which pays hospitals actual per diem costs for those considered eligible for taxpaid health services. In 1958, the 12 months' expenditures for hospital services through the fund amounted to $4 million, which was less than a fourth of the estimated cost of hospital care given indigents in Florida. The remainder of the costs for health services to all those considered in need was provided by individual counties at an estimated annual cost of over $15 million. After enactment of the Kerr-Mills law, Federal funds became available to reimburse the State for health service expenditures to public assistance recipients. In calendar year 1961, a total of $35 million of tax funds were expended in Florida for health services to the needy sick of all ages and categories, not including State psychiatric and tuberculosis hospital care, and medical service programs of vocational rehabilitation and crippled children's commission. These tax funds were derived from sources as indicated in chart I in comparison with expenditures estimated for 1958 and budgeted for 1964. You will see in 1958 we estimated expenditures of better than $20 million with some county and some State funds, $1,025,000. 1961, expenditures of $35 million, $8 million of Federal funds, and $3 million of State funds and $23 million of county funds. In 1964 we have budgeted $46 million, $17 million of Federal funds, $7 million of State, and if the counties continue to expend the same amount it will be $23 million of county funds. On 1 July 1963, a medical assistance for the aged program was inaugurated in Florida whereby 60 percent Federal reimbursement would be available on expenditures made for hospital care and home nursing visits to the aged needy sick. A total of $8 million in State and Federal funds have been budgeted to provide those services during this biennium. For the next 24 months, the tax funds budgeted by the recent Florida Legislature to provide health services to the needy sick amount to $13,272,099 in State funds and $30,822,676 in Federal funds. If the counties spend sums similar to those spent in the past 2 years, a grand total of $90 million will be available to provide health services to the needy sick in Florida for the next 2 years (chart II). The present population of Florida is estimated at 5,350,000, and those 65 years of age and over number about 600,000, or 11 percent: 70,000 are old-age assistance recipients and receive State and Federal tax-supported hospital services, nursing home care, and drugs. However, of those needy sick of all ages (not public assistance recipients) receiving hospital care from State and county tax funds, 16 percent in 1962 were age 65 and over. The percentage of elderly needing taxsupported health services in Florida has declined in the past 3 years, 466.46 Dental college scholarships; state board of health to select list of communities needing dentists. Penalty for violation of scholarship contract. 466.47 466.48 Rules and regulations. 466.50 Objects and purposes. 466.51 Dental laboratory defined. 466.52 Registration. 466.521 Ownership, address; change. 466.53 466.54 466.55 466.56 466.57 466.58 Board of dental examiners. Periodic inspections required. Penalties. 466.01 Objects and purposes of chapter.-The practice of dentistry in the state is hereby declared to affect the public health, safety and welfare and to be subject to regulation and control in the public interest. It is further de clared to be a matter of public interest and concern that the dental profession merit and receive the confidence of the public and that only qualified dentists be permitted to practice dentistry in the state. All provisions of this chapter relating to the practice of dentistry and dental hygiene and to the registration of dental laboratories shall be liberally construed to carry out these objects and purposes. History.— 1, ch. 20240, 1941; § 1, ch. 57–181. 466.02 Persons entitled to practice dentistry.-It shall be unlawful for any person to practice dentistry or dental hygiene in the state, except: (1) Those who are now duly licensed and registered dentists, pursuant to law; (2) Those who are now duly licensed and registered dental hygienists, pursuant to law; (33) Those who may hereafter be duly licensed and registered as dentists or dental hygienists, pursuant to the provisions of this chapter. History. § 1, ch. 14708, 1931; § 1, ch. 16971, 16973, 1935; CGL 1936 Supp. 3534(1): § 2, ch. 20240, 1941. Cf.- 458.16 Furnishing coples of mental or physical examination reports. 466.03 Persons exempt from operation of chapter.-Nothing in this chapter shall apply to the following practices, acts, and operations: (1) To the practice of his profession and to surgical procedures involving the oral cavity by a physician or surgeon licensed as such under the laws of this state; or, (2) To the giving by a qualified anaesthetist or registered nurse of an anaesthetic for a dental operation under the direct supervision of a licensed dentist; or, (3) The practice of dentistry in the discharge of their official duties by graduate dentists or dental surgeons in the United States army, air force, marines, navy, public health service, coast guard, or veterans' administration; or, (4) The practice of dentistry by licensed dentists of other states or countries at meetings of the Florida state dental society or components thereof, or other like dental organizations approved by the board, while appearing as clinicians. (5) To the filling of work orders of a licensed and registered dentist as hereinafter provided by any person or persons, association, corporation, or other entity, for the construction, reproduction, or repair of prosthetic dentures, bridges. plates, or appliances to be used or worn as substitutes for natural teeth or for the regulation of natural teeth, provided that such persons, association, corporation, or other entity, shall have complied with the provisions of this chapter respecting registration of dental laboratories and shall not solicit or advertise, directly or indirectly, by mail, card, newspaper, pamphlet, radio, tele vision, or otherwise, to the general public to construct, reproduce, or repair prosthetic dentures, bridges, plates, or other appliances to be used or worn as substitutes for natural teeth or for the regulation of natural teeth. (6) Students in Florida schools of dentistry and dental hygiene approved by the board, while performing regularly assigned work under the curriculum of such schools. (7) Instructors in Florida schools of dentistry or dental hygiene approved by the board while performing regularly assigned duties under the curriculum of such schools. History.-3, ch. 20240, 1941; (5) by § 2, ch. 57-181; (1), (3), (5) a., (6) and (7) D. by 1, ch. 61-471. |