PODIATRY, A NEEDED DIMENSION IN MEDICAL CARE It is clear that the practice of podiatric medicine is becoming better understood by the physicians of this nation. Within the thoughtful and detailed article by Podell, "Issues in the Organization of Medical Care: An illustrative case study podiatry in the United States," many of the repeated inquiries referring to the manner in which podiatry should be practiced have been carefully presented. The lack of interpersonal and interprofessional communication has hampered earlier podiatric involvement and growth in the nation's health-care systems and institutions. It is hoped that other specialty groups will learn through the experience of podiatry, so that the transition will be a smoother one, as they become more involved in total patient care. Podiatry as we know it today has evolved as a result of the need for specialized foot care. It is a field whose practitioners have acquired a knowledge of the relation between the clinical problems of a special area and those of the total patient. With the development of comprehensive health planning and the concern for delivering care from a multiservice base or medical center, podiatry is emerging as a necessary part of this system. An indication is the increasing number of podiatrists appointed to the staffs of the nation's hospitals, health departments, extended-care facilities and medical schools. Among 613 these is the recently established full-time Podiatry Section of the Hitchcock Clinic and DartmouthHitchcock Medical Center, Hanover, New Hampshire. This Section has been planned and integrated within one of the oldest established group practices in the country. Consistent with the present-day system of care, the podiatry service has been incorporated in the Department of Medicine, where its specialized methods best serve the broad spectrum of referring sources. Because of this step, special relations have developed in a natural manner in the outpatient clinic, the hospital and medical school. The freedom of exchange in this atmosphere has produced referrals from the diabetologist, vascular surgeon, dermatologist, rheumatologist, orthopedist, general surgeon, neurosurgeon and pediatrician. The initial inclusion of this specialty five months ago has demonstrated, by its rapid growth, both the need and overwhelming acceptance of the podiatry dimension as part of the team in both service and education. In this setting, in addition to the primary function of keeping normal feet in good condition, protecting high-risk feet from injury and detecting and treating abnormalities of the foot, the podiatrist rapidly became involved in a teaching capacity for staff and house officers, in developing foot-care protocol for the Hospital nursing staff, training visiting nurses and extended-care personnel, instructing patients in the specialty clinics and most recently teaching the fundamentals of foot care to trainees in the MEDEX program. Across the nation we are now beginning to include various health specialists in a comprehensive system. An effort should be extended to establish podiatrist appointments in centers, hospitals and related facilities providing health care. We must recognize that individual parts are essential in the make-up of the "whole" of the health community. Attaining this objective is in the best interests of those who benefit from and contribute to the medical care of this country. DONALD C. HEIMS, D.P.M. AMERICAN PODIATRY ASSOCIATION 20 Chevy Chase Circle. N W Washington, DC 20015 (202–962 2700 July 26, 1971 Proposals for National Health Insurance Status of Podiatrists' Services A Summary · This is another in a series of APA special reports on proposals for national health insurance and the status of podiatrists' services therein. Even though there are more than 40 separate proposals pending in the Congress at this time, many of these are identical measures. Among the 40, however, nine (9) distinct forms of NHI emerge and serve as the bases for this report. Further details about any one or several of these bills are available upon request from APA Headquarters. Most observers agree that NHI will be a major political issue during the '72 campaigns, thus eliminating the possibility of any action by Congress on the issue this year. Hearings on the subject are nonetheless scheduled in September by the House Ways and Means Committee, and APA fully expects to testify at that time. 1. National Health Insurance Standards' Act and Family Health Insurance Plan (Nixon Administration) A. Principal Sponsors: Senator Bennett (S. 1623) B. Intent: c. D. Representative Byrnes (H.R.7741) Maintain compulsory health insurance furnished by employer to employees and family; finance health insurance for the poor. Podiatrists' Services: Covered as physicians' services in all aspects of the proposal. Special Note: Exclusions now a part of Medicare are carried forth in this proposal. 2. National Health Care Act, '71 (Health Insurance Association of America) A. Principal Sponsors: Senator McIntyre (S. 1490) B. C. Intent: Representative Burleson (H.R.4349) Provides comprehensive health care services to all on a voluntary basis through private health insurance. Podiatrists' Services: Neither measure originally covered the services of podiatrists. Senator McIntyre has since amended his bill to include full participation of podiatrists as physicians alongside doctors of medicine, osteopathy, and dentistry. Rep. Burleson is expected to also amend his bill, but this has not been accomplished to date. D. Special Note: Medicare exclusions prevail in this bill 3. National Health Insurance and Health Services Improvement Act, 171 A. Principal Sponsor: Senator Javits (S.836) B. Intent: system. Comprehensive NHI program under an expanded Medicare C. D. Podiatrists' Services: Professional services of podiatrists included as physician services. Special Note: Medicare exclusions prevail in this bill. Health Security Act, '71 (AFL-CIO-UAW) A. Principal Sponsors: Senator Kennedy (S.3) B. C. D. Representative Griffiths (H.R.22) Intent: Proposes to restructure the delivery system. Compulsory, comprehensive NHI through providers under contract with federal government. Replaces Medicare and Medicaid. Podiatrists' Services: Professional services of podiatrists are covered. Special Note: The potential for "prior authorization" is clearly evident in the proposal with respect to cosmetic, elective, or other non-life threatening procedures. All health professionals, including medical specialists and podiatrists, would be affected by this concept, which the proposal authorizes the federal government to implement if necesary. A. B. C. D. Principal Sponsors: Senator Hansen (S.987) Representative Fulton (H.R. 4960) Intent: Make comprehensive health care insurance available to all by federal sharing in premium through vouchers or tax credits. Podiatrists' Services: Professional services of podiatrists are covered in the same manner as Medicare. Special Note: The AMA proposal does not recognize podiatrists' services in its proposal for persons under 65. A. Principal Sponsors: 7. Representative Dingell (H.R.48) B. Intent: Compulsory, comprehensive health care would be extended to all Americans with public agencies (federal, state and local) exercising considerable administrative controls. Podiatrists' Services: Professional services of podiatrists are covered. C. B. C. D. Intent: Through a nationwide system of "Community Health Corporations" (HMO's), subsidized by federal funds and private insurance, comprehensive health care benefits would be extended to all. Podiatrists' Services: Professional services of podiatrists are covered. Special Note: Group practice is the total thrust of this 8. Catastrophic Illness Insurance Act A. Principal Sponsor: Senator Long (S.1376) B. C. D. Intent: Expands Medicare program to cover costs of catastrophic illness. Podiatrists' Services: Same as present Medicare program. Special Note: Medicare exclusions remain intact in this 9. Ameriplan (American Hospital Association) A. Principal Sponsor: B. (Not yet introduced) Intent: "Health Care Corporations" would be organized throughout the country to furnish comprehensive health care benefits to all, utilizing public and private financial resources. C. D. Podiatrists' Services: Preliminary information available on Special Note: Until a specific bill is introduced, special comments are necessarily reserved. Preliminary information is based on published AHA reports on its intended proposal. |