Emergency care for accidental injury outside service area X-ray and laboratory work Doctors' care Necessary ambulance service when authorized When a member is accidentally injured, at a point more than 30 miles from the nearest authorized medical office or hospital, up to $250 will be allowed for services necessary before his medical condition permits travel to nearest medical office or hospital where health plan service is available. Such allowance will be on the basis of rates recommended by the California Medical Association for use by the Industrial Accident Commission of the State of California. Polio care Treatment and rehabilitation of polio cases following the contagious and acute stage will be provided up to a maximum period of 1 year or a maximum value of $2.500 at the California Rehabilitation Center at Vallejo or Santa Monica, Calif. For You and Your Family-Medical Care in the Home, Hospital, Doctor's Office Individual Membership Preexisting conditions.-Any illness, injury, or condition present at the time of joining the plan will receive the same services of physicians and surgeons as are provided for illnesses arising while a member of the plan. All other services such as hospitalization, X-ray, laboratory, etc., will be provided at half private rates, except that in-patient drugs and ambulance service will be provided at full private rates. Congenital conditions are considered preexisting. Exclusions.-Mental illness or disorder; attempts at suicide or other intentionally self-inflicted injuries or illnesses; tuberculosis; alcoholism; conditions covered by workmen's compensation; service-connected conditions; dental care; corrective appliances; conditions resulting from a major disaster or epidemic; contagious diseases and diseases requiring isolation, including poliomyelitis and its complications. Termination of membership.-If membership is terminated because of nonpayment of membership fees, all rights to service cease as of the date of termination. If a member is terminated by the health plan, the member will be entitled to continuation of service, in accordance with the provisions of the plan, for any condition under treatment at the time of termination for a period not to exceed 365 consecutive days from date of termination, provided membership fees are paid during the period of treatment. Who is eligible to be a member of the health plan.-The subscriber to the health plan may subscribe for himself alone, or for himself, his spouse and unmarried children under 19 years of age. Children upon reaching age 19 or upon becom ing married must apply for separate membership if they wish to enjoy further benefits. Newborn children become eligible for membership at birth, provided application for membership is made. A MEDICAL SERVICE AT A COST WITHIN YOUR MEANS The Subscriber and Family Dependents Are Entitled to— Hospital care Room and board (private room and special diet as required) Use of operating room Anesthetics and services of anesthetist Blood transfusions (no charge if blood is replaced) Necessary ambulance service within 30 miles of hospitals Sixty days of hospital care each calendar year without charge for each illness or injury, its recurrences and complications, arising while a member of the plan, plus an additional 51 days immediately following at half private rates. Doctors' care while hospitalized Operations Consultation and treatment by specialists All services of physicians and surgeons without charge while hospitalized. Doctors' care in the office Consultation and treatment by specialists Eye examinations for glasses 24-hour emergency service All office visits at a registration fee of $1 per visit. Doctors' care at your home Necessary home calls by doctors Necessary calls by nurses under doctors' orders 24-hour emergency service All necessary home calls by doctors and calls by nurses. A $2 charge is made for each home call by a doctor. No charge for nurse's visits. Drugs and medicines Prescriptions Drugs and medicines All drugs and medicines without charge while hospitalized for the 30 days covered by the plan. Private rates during the 81-day period. A reasonable charge is made for drugs and medicines furnished to patients receiving treatment at their homes or at the doctor's office. X-rays, laboratory work, and physical therapy X-rays and X-ray therapy Electrocardiograms Basal metabolism tests All laboratory tests Heat treatments, whirlpool baths, etc. All prescribed X-rays, X-ray therapy, laboratory tests, and physical therapy are provided at half private rates. Maternity care Hospital care Physicians and surgeons Drugs and medicines while hospitalized X-rays and laboratory work Caesarian sections Full care of mother before, during, and after pregnancy Full care of child during the mother's confinement Full maternity care at a charge of $95 if confinement occurs after 10 months' continuous membership. In the event pregnancy is interrupted or termi nated, a charge will be made for services rendered. Such charge shall in no event exceed two-thirds the charge above specified for obstetrical care. Removal of tonsils and adenoids Physicians and surgeons Laboratory Drugs and medicines while hospitalized All services provided at a total charge of $35. Emergency care for accidental injury outside service area X-ray and laboratory work Doctor's care Necessary ambulance service when authorized When a member is accidentally injured, at a point more than 30 miles from the nearest authorized medical office or hospital, up to $250 will be allowed for services necessary before his medical condition permits travel to nearest medical office or hospital where Health Plan service is available. allowance will be on the basis of rates recommended by the California Medical Association for use by the Industrial Accident Commission of the State of California. Polio care Such Treatment and rehabilitation of polio cases following the contagious and acute stage will be provided up to a maximum period of 1 year or a maximum value of $2,500 at the California Rehabilitation Center at Vallejo or Santa Monica, Calif. HOW TO JOIN 1. Applications for membership may be secured at the offices or hospitals listed, or by phoning the Kaiser Foundation Health Plan office. 2. Application and medical review forms should be mailed to the Kaiser Foundation Health Plan. Applications will not be accepted without the required registration and medical review fees. 3. Applications for individual membership are subject to medical review before acceptance. A qualifying physical examination is usually required. A registration and medical review fee of $5 for an individual applicant, or $7.50 for applicant and family, is payable in advance. Of these amounts, the registration fees will be refunded if aplicants are not accepted for membership. 4. Applications for individual membership will not be accepted from persons over 60 years of age. The Permanente Health Plan accepts applicants over 60 only through group membership. 5. After acceptance into the plan, new members are required to pay 3 months' dues in advance before their membership is in force. Thereafter, dues may be paid monthly or quarterly. Doctors' offices: Richmond Walnut Creek Pittsburg Concord Napa San Leandro San Francisco South San Francisco Hospitals: WHERE SERVICE IS RENDERED Hospitals-Continued San Francisco South San Francisco Los Angeles San Pedro Portland, Oreg. Vancouver, Wash. Main office: Kaiser Foundation Health A REPORT ON PERMANENTE'S FIRST 10 YEARS (Sidney R. Garfield, M. D.)1 In September 1942, a group of men, high up in an office building overlooking San Francisco Bay, had just finished outlining a plan to meet the serious dearth of facilities and medical services in the bay area created by the mass dislocation of people into wartime shipbuilding. They chose "Permanente" as the name of that plan. It is a Spanish word meaning firmly established-lasting-stable, and the name of an ever-flowing stream in the San Jose hills of California. It was not by chance that these trustees could formulate and put into action the complicated mechanisms involved in creating a medical and hospital service practically overnight. For a decade preceding this event (1932-42) they had struggled and worked with the problem of bringing the best possible medical and hospital care to average workers at a cost they could afford. By study ing the work and mistakes of others, by trial and error on several projects in divergent areas of the country, they had evolved a set of principles that worked. The first widespread application of this plan came about in this fashion. The result was an extermely impressive demonstration of its effectiveness, and probably the most outstanding wartime medical service outside of the armed services. At the end of war in 1945, shipbuilding was discontinued and the shipworkers dispersed throughout the country. From the relatively few remaining, however, arose an insistent demand sufficient to warrant continuation of the health plan on a community basis. Today, 6 years later, Permanente serves 250.000 members in California, Oregon, and Washington, as well as countless numbers of others in these areas. The steady growth (after end of war) of the Permanente Health Plan has been gratifying, and certainly indicates public acceptance. In fact, more rapid growth is limited only by ability to secure facilities and physicians fast enough to keep up with public demand. It is important to realize this growth was accomplished mainly of its own impetus, since active solicitation was carefully avoided. In addition to the membership shown on the graph for the bay area, there are at present approximately 50,000 members in southern California, and 25,000 in the Portland-Vancouver area. It is anticipated that the new medical centers being constructed will enable the membership to be increased from an overall figure of 250,000 to 400,000. BASIC PRINCIPLES The effectiveness of the Permanente plan is relatively simple to understand. Early in the developmental decade (1932-43), it became increasingly evident that much of the high cost of medical care was due to waste resulting from poorly planned facilities, insufficient coordination between physicians and institutions in which they worked, and between physician and physician. The simple solution was to bring the physicians into coordinated group practice, operating in medical centers and hospitals geared to serve them efficiently. This improved quality as well as produced economy. The solution to the problem of ability to pay is a prepayment plan (insurance principle), and the elimination of waste permits the 1 Medical director, the Permanente Foundation, Oakland, Calif. prepaid dollar to do the necessary, comprehensive medical job. Finally, it is necessary to have these prepaid funds go directly to the physicians and hospitals, abolishing fee for service. This results in a reversal of the usual economics of medicine. The well person becomes an asset to the hospital and doctor-the sick person a liability, thus heralding the preventive medicine of the future. GRAPH 1. Total Membership, Bay Area Permanente Health Plan, January 1943 Through January 1952. In spring 1945, the Richmond shipyards began to close. In the next 10 months 53,000 health-plan members were discharged from shipyard employment. As a result, the healthplan membership reached its lowest point (14,500) in October 1945. At this time the plan was extended to other bay area residents. By December 1946 there were no longer any shipyard plan members. Present bay area membership includes the San Francisco, Oakland, Richmond, and Vallejo areas. The Permanente concept of a medical care program includes all of the elements comprising medical care today-physicians, nurses and auxiliary help, hospitals and medical centers. It includes teaching and training of nurses and doctors, and also provides for research and charity. In this completeness and integration, it stands alone among the health plans in this country, being the only one providing all these services. ORGANIZATIONAL FORM Simply stated, the Permanente system is composed of four separate but coordinated organizations: 1. Permanente Foundation 2. Permanente Health Plan |