Some persons are covered by more than one method of protection, or hold more than one insurance policy providing similar benefits. Steps have therefore been taken to avoid duplicate counting in the final totals for the various forms of coverage. An explanation of the methods employed in this case is given in the appendix, part III.

There are a number of types of protection against the expense of sickness and accident, some of a compulsory nature, that were not considered appropriate for detailed development in this study. Such types are listed on page 23.

VOLUNTARY PROTECTION AGAINST HOSPITAL, SURGICAL, AND MEDICAL EXPENSE

More persons were protected against the financial hazards of accident and illness at the end of 1952 than ever before, a decisive indication of the willingness and ability of the American people to meet their responsibilities to themselves and to their dependents. As in previous years, the increases for 1952 in the numbers of persons covered under hospital, surgical, and medical expense protection were counted in the millions. The gains under medical-expense coverage exceeded the year's gains in both hospital and surgical-expense protection.

HOSPITAL, SURGICAL AND MEDICAL EXPENSE COVERAGE

Nearly 3 out of 5 persons in the entire population of the United States are now protected through voluntary programs against the costs of hospital care in the event of accident and illness, representing the biggest single form of coverage in the field of health protection.

The total number with this protection exceeded 91 million at the end of 1952, an increase of more than 51⁄2 million, or 7 percent, during the year. Back in 1941, when the United States entered World War II, the number of persons with voluntary hospital-expense protection added up to slightly over 16 million, indicating the rapidity with which this form of accident and health coverage has grown.

Hospital-expense protection provides benefits toward the payment of hospital charges for room, board, and miscellaneous services. Benefits have been steadily liberalized and expanded since this form of coverage began its major growth some two decades ago. Present-day coverage usually includes payment for the use of an operating room, laboratory, and X-ray examinations, medicines, and all other services incidental to medical care and treatment which are furnished by the hospital.

SURGICAL-EXPENSE PROTECTION

The second largest form of protection in the field of voluntary accident and health coverage is surgical-expense protection. The total number of persons with this form of coverage at the end of 1952 totaled over 73 million. The increase during 1952 was more than 72 million persons, or 12 percent,

Little more than a decade ago, in 1941, there were less than 7 million persons with surgical-expense protection. A later development than coverage for hospital care, surgical-expense protection has shown the more rapid growth over recent years.

Most persons with surgical-expense protection are covered either by insurance companies or by Blue Shield. In the event the services of a surgeon are needed, the protection provides payments in accordance with a schedule of fees fixing maximum reimbursement for each type of operation.

MEDICAL-EXPENSE PROTECTION

In the evolution of voluntary accident and health coverage, medical-expense protection came third, following the development of hospital and surgical benefits. Its growth, therefore, has been essentially a post-World War II phenomenon. Eleven years ago, at the end of 1941, it is estimated that there were only about 3 million persons with medical-expense protection. By the end of last year, the number of persons with this protection had grown to nearly 36 million persons. Approximately 8 million more persons had medical-expense protection at the end of 1952 than the year before, and the gain for the year was 29 percent.

By far the greatest part of medical-expense protection is provided by Blue Shield, local medical societies, and insurance companies, and a wide range of benefits is available. The most common form of this coverage calls for the payment of benefits toward the expense of inhospital calls by doctors for other than surgical treatment. Likewise available are other forms providing for comprehensive medical coverage of home, hospital, and office treatment and examinations. In some cases, too, medical-expense protection provides benefits for paying the cost of special laboratory, X-ray, and other examinations for diagnostic purposes.

HOW HOSPITAL, SURGICAL, AND MEDICAL-EXPENSE COVERAGE IS DISTRIBUTED AMONG VARIOUS INSURERS AND OTHER AGENCIES

Long leaders in the voluntary health movement, insurance companies and Blue Cross-Blue Shield organizations together accounted for about 94 percent of all hospital- and surgical-expense protection last year, and about 87 percent of coverage under medical-expense plans. The balance was spread among plans provided by industrial employers, labor organizations, community groups, private group clinics, and colleges.

Insurance companies provided coverage to a majority of the people who had hospital- and surgical-expense protection. At the end of last year, more than 20 million persons were covered against hospital expense under group insurance, and 22 million persons under individual hospital expense insurance plans. Blue Cross and medical society plans had more than 43 million persons enrolled for hospital-expense protection last year, while some 5 million more were covered by industrial, community, and other group plans.

In surgical-expense protection, insurance companies covered nearly 30 million persons under group and 19 million under individual insurance plans, together about two-thirds of all persons with such protection. Blue Shield and medical society plans protected nearly 28 million persons, and nearly 5 million more persons were enrolled under independent plans.

Blue Shield and medical society plans continued to lead in medical-expense coverage with some 18 million persons, or more than half of all persons enjoying this protection. Insurance companies had about 15 million persons under

group and individual medical-expense-protection plans, and 5 million more were covered under independent plans.

Hospital, surgical, and medical expense coverage-Number of people protected, end of 1952

For sources of figures see appendix pt. I. For basis of estimated duplication see appendix pt. III.

MAJOR MEDICAL EXPENSE COVERAGE

Major medical expense coverage, the newest addition to voluntary healthprotection plans, is designed to help meet the catastrophic costs resulting from prolonged disability. Broadly speaking, it takes up where the customary forms of health protection-hospital, surgical, and medical care-leave off. It also covers such costly items as nursing care and use of special appliances. The development of major medical expense policies is further evidence of the willingness of the insurance business to experiment in the public interest.

Maximum benefits available under this form of protection range from $2,500 to $10,000. Major medical coverage is written with a deductible feature, as is automobile-collision insurance. It usually makes the person covered a coinsurer of expenses incurred above the deductible amount, requiring him to pay some portion of these expenses. The purpose of the coinsurance feature is to encourage the person protected to obtain as reasonably as possible only such health services as are needed, thus helping to keep down the costs of protection.

Along with the 689,000 persons covered by major medical-expense policies of insurance companies are others who have substantial protection against the catastrophic costs of serious disability. Some hospital, surgical, and medical expense plans provide coverage for the costs of prolonged disability. Other plans have such high maximum benefits that there is little need for major medical expense protection. No effort has been made to estimate the number of people so covered.

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GROWTH TREND OF HOSPITAL, SURGICAL, AND MEDICAL EXPENSE PROTECTION

There are few parallels in the annals of insurance or other fields that can match the spectacular growth of voluntary health protection in the United States in recent years. The record is the more notable in view of the pressures for Government-sponsored compulsory plans in the period, and it supplies decisive evidence of what the American people can do on their own initiative and responsibility.

A brief review of the period from the entry of the United States into World War II to the present indicates the extent that the voluntary health protection movement has swept the country. At the end of 1941, for example, there were slightly more than 16 million persons in the entire population with hospitalexpense coverage. By the end of 1952, the number multiplied nearly 6 times to more than 91 million persons with such coverage.

Surgical expense coverage was a newcomer to the health field at the start of World War II, and in 1941 there were fewer than 7 million persons with this protection. At the end of last year, over 73 million Americans were covered against surgical expense in the event of accident or sickness.

Medical-expense coverage, virtually unknown before World War II, now covers nearly 36 million persons. And major medical coverage for the catastrophic expense of serious disability, though new and still in the experimental state, has already made a significant impression on the public.

All major types of insurers and agencies have contributed to this growth record of voluntary health protection. Particularly outstanding has been the role played by insurance companies and the Blue Cross-Blue Shield organizations. GEOGRAPHICAL DISTRIBUTION OF HOSPITAL, SURGICAL, AND MEDICAL EXPENSE

PROTECTION IN THE UNITED STATES

The regional map of the United States on the opposite page gives a graphic picture of the nationwide ownership of voluntary health-expense protection by the American public.

The proportion of persons with such protection is higher in the Nation's more heavily industrialized areas since this is where the concentration of employed groups occurs. However, the figures also show a substantial and growing coverage in the rural sections of the country as the result of the activities of insurance companies, Blue Cross, and other organizations.

A factor that should be kept in mind with respect to the numbers covered by voluntary health protection is that there are a large number of people for whom this protection is neither necessary nor appropriate. For example, complete medical care is provided by Government for persons in the Armed Forces, those in public institutions, and to some extent, the Nation's veterans. Also, medical care of the indigent is generally provided by Government at the State or local level.

The map on page 1180 breaks down the United States into four major geographical regions, and shows the number of persons protected against hospital, surgical, and medical expenses compared with the population of each region. A table listing the State-by-State distribution of each form of coverage will be found on page 1181. This table for the first time gives the extent of hospital, surgical, and medical expense protection in the Territories of Alaska and Hawaii.