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Mr. MYER. Outside of the area. We provide a minimum up to $11 a day if a person happens to be away from home, in some other part of We guarantee that his costs will be paid up to $11 a day for a semiprivate room and operating and anesthetist services.

the country.

Mr. HARRIS. What about in the District?

Mr. MYER. In the District, we provide the hospitalization through arrangement with the hospital, and pay the bills ourselves.

Mr. HARRIS. Without limitation of costs?

Mr. MYER. No limitation of costs, other than it is limited to the charge for a semiprivate room. If a patient would wish to have a private room, they would have to pay the extra charge.

Mr. HARRIS. You say you have 7,500 members. I suppose those are the members who have signed up and are paying dues?

Mr. MYER. That is right.

Mr. HARRIS. Now, 19,600 participants, does that mean that those others are their dependents?

Mr. MEYER. Family dependents; yes, sir.

Mr. HARRIS. What is your per-month charge?

Mr. MYER. For adults it is $4 and for children it is $2.75.

Mr. HARRIS. Per month?

Mr. MYER. That is right. I might add, Mr. Harris, that in addition to that, there is an application fee of $5 and a membership fee of $20, which is to be paid during the first 10 months. But that is out of the way at the end of the first year.

Mr. HARRIS. You gave a list, in your statement, of services which are not furnished by the association.

Mr. MYER. That is right. It is a rather limited list, but it is set forth here.

Mr. HARRIS. Are those usually termed the catastrophic illness group?

Mr. MYER. No, I would say for the most part those are services that are provided in institutions generally or under industrial insurance laws by governmental agencies. The first one I gave had to do with it not providing for industrial accident cases to the extent that they were already provided for. We would take care of the bills over and above what they do not provide for.

The next one has to do with congenital items, such as birthmarks and deformities and so on; unless they are malignant, and plastic surgery, which we do not provide.

The third one has to do with hospitalization for those diseases which are normally institutionalized, such as tuberculosis, alcoholism, and drug addiction, and similar diseases.

Mr. HARRIS. Thank you very much, Mr. Myer. I am very glad to know of your operations here in the District of Columbia.

(The following information was submitted for the record:)

Group Health Association, Washington, D. C.: Summary of medical services provided

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Number per 1,000 persons eligible.

OTHER SERVICES BY DOCTORS

Other office visits with doctors (outside office referrals with GHA staff physicians and other GHA consulting specialists

440

780

41

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Group Health Association, Washington, D. C.: Average income per capita per month by source for the years 1947-53

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Group Health Association, Washington, D. C.: Selected medical services, per

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Group Health Association, Washington, D. C.: Hospital utilization

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Group Health Association, Washington, D. C.: Family composition of member. ship, members and participants in given types of families as percent of total number of GHA members or participants, respectively

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SAMPLE LETTER OF AGREEMENT WITH PHYSICIAN ON FULL-TIME BASIS

DEAR DR.___ : In order to verify your employment agreement with Group Health Association, I am submitting for your review and approval the following outline of this agreement. In addition to the specific items outlined below, as a full-time physician, your employment relationship to the association is set forth in the personnel policy of the association.

Your classification is "practitioner of general and internal medicine." This position is included in the department of general and internal medicine and comes under the supervision of the chief of that department. The base salary for this position is $---- --- per year. Provision is made for automatic salary increases of $_____ per year for this position until a maximum salary of $_____ year is reached. Any change in this pattern requires a special recommendation and approval by the board of trustees. Your current salary is $--

- per

The duties for which you are responsible include consultations with patients in the clinic, making home calls on patients as required, making calls on the hos pitalized patients, and performing such medical practice as comes within the scope of your position and within the limits of your qualifications. In the performance of these duties you are expected to work in close cooperation with the physicians in your department and in all other departments insofar as applicable. You are privileged, on approval from the medical director, to call into consultation when necessary, physicians not on the Group Health Association staff.

You are employed as a full-time physician on a 44-hour-week basis exclusive of night-call duty. You are privilege to take 4 hours per week of this schedule for study leave. Home-call service, both during scheduled clinic hours and after clinic hours, will be rotated among the physicians in your department in accordance with a schedule set up by the chief of your department and approved by the medical director.

You are granted 26 working days, or 188.5 hours, per year of annual leave. Annual leave may be accumulated to a maximum of 60 days, or 435 hours. You are also granted 15 days, or 108.8 hours, per year for sick leave, as required, and

no maximum is applicable. In addition to the weekly study leave referred to in the preceding paragraph, you may be granted leave with pay up to 2 weeks per year for the purpose of attending professional meetings and postgraduate courses when approved by the medical director. In special circumstances, this leave may be accumulated to as much as 4 weeks per year.

As a benefit of employment you are a participant in the retirement program and the life-insurance program of the association, You have been provided a lifeinsurance policy and a statement that describes your individual status in these programs. As a further benefit of employment, you and your dependents are entitled to medical and hospital coverage provided by the association as set forth in the attached statement.

If this statement of the agreement between you and Group Health Association is in accordance with your understanding of the conditions of your employment, you will please sign the enclosed copy in the space indicated and return it to me. Sincerely yours,

SAMPLE LETTER OF AGREEMENT WITH SURGEON ON RETAINER BASIS

DEAR DR.___.

- In order to verify your employment agreement with Group Health Association, I am submitting for your review and approval the following outline of the agreement.

Your classification is "general surgeon." This position is included in the department of surgery and comes under the supervision of the medical director. You are employed as a part-time specialist on a retainer basis of $__

per year.

In the event that a Group Health patient is referred to you for a service for which the association does not provide coverage, or for a restricted condition, you are to establish a fee for your service in line with the District medical plan schedule of charges and bill and collect directly from the Group Health Association patient.

The duties for which you are responsible include consultations with patients in your private office and in the hospital, and performing such diagnostic and surgical procedures as come within the scope of your position and within the limits of your qualifications. In the performance of these duties you are expected to work in close cooperation with the physicians in your department and in all other departments insofar as applicable.

Toegther with the other surgeons in your department, you are responsible for providing 24-hour-service for the association.

If this statement of the agreement between you and Group Health Association is in accordance with your understanding of the conditions of your employment, you will please sign the enclosed copy in the space indicated below and return it to me.

Sincerely yours,

EXCERPTS FROM GROUP HEALTH ASSOCIATION MEMBER'S HANDBOOK

MEDICAL SERVICES

The practice of group medicine in which GHA engages offers many advantages to physicians and members. It gives the doctor and the patient ready access to the laboratory, X-ray, physical therapy, and medical records. It makes constantly available to each doctor consultation and interchange of ideas and techniques with other physicains and specialists. Further, when you need a doctor, there is always a group health doctor on call. He may not be the one you customarily see at the medical center, but he has all your health records available if needed. Every day, 24 hours a day, a group health doctor is on hand to respond to your call.

Adult medicine

As new members become acquainted with the doctors through consultation and treatment, they are encouraged to choose one of the staff for their regular family physician. Except in emergency-when your own doctor may not be on dutythe physician you thus select will give continuing medical care to members of your family, and you will benefit from his knowledge of your family's medical

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