466.04 What constitutes practicing dentistry.-Any person shall be deemed to be practicing dentistry who performs, or attempts or professes to perform, any dental operation or oral surgery or dental service of any kind, gratuitously or for a salary, fee, money, or other remuneration paid, or to be paid, directly or indirectly, to himself or to any other person or agency; or who is a proprietor of a place where dental operations, oral surgery, or dental services are performed; or who directly or indirectly, by any means or method, takes an impression of the human tooth, teeth, or jaws; or supplies artificial substitutes for the natural teeth, or who furnishes, supplies, constructs, reproduces or repairs any prosthetic denture, bridge, appliance, or any other structure to be worn in the human mouth, except on the written work order of a duly licensed and registered dentist; or who places such appliance or structure in the human mouth, or adjusts or attempts or professes to adjust the same, or delivers the same to any person other than the dentists upon whose work order the work was performed; or who professes to the public by any method to furnish, supply, construct, reproduce, or repair any prosthetic denture, bridge, appliance, or other structure to be worn in the human mouth, or who diagnoses, or professes to diagnose, prescribe for, or professes to prescribe for, treats, or professes to treat, disease, pain, deformity, deficiency, injury, or physical condition of the human teeth or jaws, or adjacent structure, or who extracts, or attempts to extract, human teeth, or corrects, or attempts to correct, malformations of teeth or of the jaws; or who repairs or fills cavities in the human teeth; or who uses a roentgen or x-ray machine for the purpose of exposing dental x-ray films or roentgenograms, except under the direction of a dentist licensed in this state, or who gives, or professes to give interpretations or readings of dental x-rays or roentgenograms; or who administers an anesthetic of any nature in connection with a dental operation, except as provided for in § 466.03 (2), or who uses the words dentist, dental surgeon, oral surgeon, or the letters D.D.S., D.M.D., or any other words, letters, title or descriptive matter which in any way represents him as being able to diagnose, treat, prescribe or operate for any disease, pain, deformity, deficiency, injury, or physical condition of the teeth or jaws or adjacent structures; or who states, or professes, or permits to be stated or professed by any means or method whatsoever that he can perform, or will attempt to perform dental operations, or render a diagnosis connected therewith.

History.-§ 2, ch. 14708, 1931; CGL 1936 Supp. 3534 (2); § 4, ch. 20240, 1941; § 2, ch. 61-471.

466.05 Proprietor defined. The term proprietor as used in this chapter shall be deemed to include any person who:

or,

(1) Employs dentists or dental hygienists in the operation of a dental office,

(2) Places in possession of a dentist or dental hygienist or other agent such dental material or equipment as may be necessary for the management of a dental office on the basis of a lease or any other agreement for compensation for the use of such material, equipment or offices; or,

(3) Retains the ownership or control of dental equipment or material or office and makes the same available in any manner for the use by dentists or dental hygienists or other agents; provided, however, that nothing in this subsection shall apply to bona fide sales of dental equipment or material secured by chattel mortgage or retain title agreement. A licensee of dentistry who enters into any of the above described arrangements with an unlicensed proprietor may have his or her license certificate suspended or revoked by the board. History.-§ 5, ch. 20240, 1941.

466.06 Florida state board of dental examiners; terms of office.(1) For the purposes of this chapter, the state shall be divided into five geographical districts, which districts shall be designated and comprised of the counties named below:

(a) Northeast district: The northeast district shall be composed of the following counties: Jefferson, Madison, Hamilton, Suwannee, Lafayette, Columbia, Baker, Nassau, Duval, Bradford, Clay, St. Johns, Putnam, Union, Dixie, Flagler and Taylor counties.

(b) Central district: The central district shall be composed of the following counties: Alachua, Levy, Marion, Citrus, Sumter, Lake, Seminole, Orange, Volusia, Brevard and Gilchrist counties.

(c) West coast district: The west coast district shall be composed of the following counties: Hernando, Pasco, Hillsborough, Polk, Manatee, DeSoto, Glades,

27-166-64-pt. 2-17

which we expect to continue with the increase of voluntary health insurance and pension plans.

Our experience has convinced us that successful operation of taxsupported health care programs for the needy sick requires the cooperative effort and responsibility of several State agencies and nongovernmental associations. Our advisory board on these programs has been strengthened by the inclusion of representatives of the State medical association, State hospital association, association of county commissioners, and members of the Florida Legislature. The State board of health has administered the hospital care programs by contract with the department of public welfare.

The definition of eligibility for aged residents to receive medical assistance as stated in the Florida statute:

Has not sufficient income, resources, or assets as determined by the State department of welfare to provide needed medical care without utilizing his resources required to meet his basic needs for shelter, food, clothing, and personal expenses

is flexible enough to meet the need of all aged who require help.

Medical assistance for the aged should act in the manner of major medical insurance but with a variable deductible. That is, an aged person should not be eligible for taxpaid health services until he had used his own resources (above those required for basic needs) to pay for needed care-but taxpaid health care would be available to insure against his having to expend for medical care those funds needed for the necessities of life.

Florida has a program of tax-supported health services for the needy sick of all ages which we believe is adequate. Additional Federal law or Federal funds are not needed to fulfill the constitutional responsibilities of local and State governments in providing for the needy sick.

The Mills-Kerr law has aided and stimulated development of the Florida health care program. Minor changes in the law or regulations may provide the States further latitude in developing and improving their programs of health services for the needy.

Therefore, we recommend that Federal law (1) permit administration of health care programs by State agencies other than the agency administering welfare; (2) permit the programs of medical aid to the aged to encourage voluntary health insurance among the nearneedy aged by cooperating with them in the payment of health insurance premiums; and (3) prescribe the manner of collection from the State of residence for health services rendered their eligible transiently absent residents.

We believe recommendation (1) would encourage the cooperative effort needed within the State to provide a successful program of health care; recommendation (2) would encourage self-reliance and obviate the necessity of welfare investigation at the time of illness; and recommendation (3) would aid medical care for transient elderly sick and the States providing it.

Mr. Chairman, I wish to thank you on behalf of the Florida Medical Association for this third opportunity of presenting a summary of our efforts in this very difficult field.

The CHAIRMAN. Doctor, you have attached to your statement some charts. Without objection, those charts will appear in the record at this point.

(The charts referred to follow :)

CHART II

Budgeted tax funds for health services to needy sick in Florida

Dr. HAMPTON. Thank you.

Federal

$9,829, 759
8, 633, 229

7,478, 042

4,881, 646

0

30, 822, 676

13, 272, 099

The CHAIRMAN. We appreciate your bringing to us the views of the Florida Medical Association today. Are there any questions?

Mrs. GRIFFITHS. Have you ever made a survey on the number of elderly people in Florida, over 65, who have lived in Florida throughout their working life and those who have moved into Florida after they were 65?

Dr. HAMPTON. I can give you this most recent report concerning the aged in Florida. In 1958, we had a State population of 4.5 million. In 1963, we had a population of 5.5 million, a 22-percent increase.

In 1958, those 65 and over numbered 480,000. In 1963, there are 620,000. That is a 30-percent increase. So, we have had an increase of 140,000 in the last 5 years who, I presume, had not spent their working years in Florida.

During this period of time, incidentally, the number on old-age assistance rose. It was 69,839 in 1958 and 70,182 in 1963. This is an increase of only 343, or only one-half of 1 percent.

In 1958, 20 percent of those 65 and over received hospital services for serious illnesses from tax-supported sources. In 1963, only 16 percent did a reduction of 4 percent in that period of time.

Mrs. GRIFFITHS. Would you not think it is correct to assume that the aged populace in Florida is not a typical example of the aged in other States? It might be comparable to Arizona or California but it really is not comparable, for instance, to West Virginia, or Michigan, or some of the other States? Would you think that is true?

Dr. HAMPTON. It is difficult to say. The chamber of commerce would like, I am sure, to have the rich elderly retire to Florida, but I know a number of elderly people who have retired on basic pensions.

They can get along fine until they get seriously ill. They have trouble, too. So, I think that still applies. I believe in Florida our problem with the elderly is just about the same as in other States. Mrs. GRIFFITHS. Thank you, sir.

The CHAIRMAN. Are there any further questions?

Doctor, again, we thank you, sir, for coming to the committee.
Dr. HAMPTON. Thank you, sir.

The CHAIRMAN. Rev. John Cronin and the Right Reverend Raymond J. Gallagher.

We appreciate having you gentlemen with us today. If you will identify yourselves for the record, we will appreciate it.

STATEMENT OF REV. JOHN CRONIN, SOCIAL ACTION DEPARTMENT, NATIONAL CATHOLIC WELFARE CONFERENCE, AND THE RIGHT REVEREND RAYMOND J. GALLAGHER, NATIONAL CONFERENCE OF CATHOLIC CHARITIES

Father CRONIN. Thank you, Mr. Chairman. I am Father John F. Cronin of the Social Action Department of the National Catholic Welfare Conference.

With me is Msgr. Raymond Gallagher of the National Conference of Catholic Charities.

I wish to thank the committee for the opportunity to present the views of my organization on the vital subject of medical care for the aged.

In regard to the proposed Hospital Insurance Act, I would like to expand on the following three points:

1. The need for medical insurance for aged persons.

2. The difficulty of financing such insurance exclusively on a private basis.

3. The desirability of covering the basic costs of institutional care for aged persons through the social security system.

Regarding the desirability of health insurance, I quote the analysis recently presented by the National Committee on Health Care of the Aged:

Insurance is appropriate and effective as a method of dealing with health care costs because these costs tend to be unpredictable and beyond the control of the individual as to the time or the amount in which cost is incurred.

Health care expenses, moreover, are spread unevenly among individuals and the amount of expenditure required tends to fluctuate sharply from time to time. For these reasons, health care is distinctive from other items entering into the cost of living such as food, rent, and clothing.

Spending required by a family or individual for these latter items can be managed and controlled as to the timing and amount of expenditure and consequently the expense involved can be predicted and budgeted.

This is not generally the case with respect to illness expenses. The need for and advantages of insurance against medical and hospital bills is borne out by personal experience of most people. It is attested to by the widespread acceptance of health insurance by the American people.

For aged persons, the importance of having protection against their healthcare costs would seem even greater than it is for those who are younger, because the aged are more likely than the rest of the population to be sick, to be sick for prolonged periods, and to require more expensive services particularly hospitalization.

Findings in 1960 of the national health survey of the U.S. Public Health Service show that almost 4 out of 5 aged persons in the noninstitutional population have one or more chronic health problems.

One out of seven elderly persons is completely limited in activity by chronic conditions. On the average, aged people are sick in bed over two and a half times as many days per year as younger people.

The aged require hospitalization more often than persons under age 65 and length of their stay in the hospital per admission is twice as long on the average.

For 1 out of 10 hospitalized persons, the length of stay is 30 days or longer. The hospital bill alone for the average length of stay of an aged person would, according to the President's Council on the Aging, in most instances amount to $500 or more.

In essence, medical costs are substantially higher for aged persons. At the same time, income is generally lower and liquid assets are normally irreplaceable. For these reasons, the aged present a prob