to practice medicine in any State in which the plan operates. Each physician engaged in the practice of a specialty shall be required to have adequate qualifications for that specialty. The personnel and facilities of the plan shall be adequate to insure a high quality of medical care. 7. The plan shall provide all services as set forth in the agreement with the beneficiary. When, in the opinion of the medical staff, a professional service set forth is not available because of an emergency or because of the need for highly technical procedure, or for any other reason, then such service shall be otherwise provided by the plan. 8. The plan, in its agreement entered into with the beneficiary and which shall be distributed to each beneficiary, shall state clearly the services and benefits to be provided and the conditions under which they will be provided. All exclusions, limitations, waiting periods, and deductible provisions shall be clearly stated in the agreement with the beneficiary and in promotional and descriptive literature. 9. The plan shall, in its agreement with the beneficiary, state clearly the amount of dues or subscriptions to be paid. The amount of dues or subscription shall be adequate to provide for the benefits and services offered, and to insure proper financing of the risks involved. 10. No promotional material shall invite attention to the professional skill, qualifications, or attainments of the physicians participating in the plan. 11. Participating physicians may be compensated in any manner not contrary to the principles of medical ethics of the AMA relating to contract practice (on a salary, per capita, fee for service, or minimum guaranty basis or combination thereof, as may be mutually agreed upon between the physician and the plan). 12. Any duly licensed physician in the community who wishes to participate in the plan, who meets its professional and personnel standards, and who agrees to abide by its terms and the requirements of its beneficiaries, shall be admitted to the plan. 13. The names of all participating physicians of the plan shall be made available to the prospective beneficiary. The beneficiary shall, within reasonable geographic and professional limitations, have free choice among participating physicians. 14. There shall be no interference by the governing body with the medical staff in the practice of medicine. The traditional and confidential relationship of the physician and patient shall be preserved. 15. Adequate provision shall be made for effective participation of the medical staff in the deliberations of the governing body. It is recommended that the membership of the governing body include representatives of the medical profession. 16. Participating physicians shall be permitted to serve persons other than beneficiaries of the plan to the extent practicable in sound patient interest. All services rendered by the participating physician, not included in the beneficiary's contract, shall be payable by the beneficiary to the participating physician on a fee-for-service basis. 17. Any hospital owned or operated by the plan shall be available for the use of physicians and patients in the community who are not participating in the plan to the extent its facilities will permit. The method of operation of any hospital owned or under contract to the plan shall be in accordance with sound public policy. 18. The plan shall provide for like rates, benefits, terms, and conditions for all persons in the same class. 19. Investment of reserve funds shall be made only in securities deemed prudent for such purposes. 20. Any plans desiring to qualify under these principles shall agree to such periodic review and to abide by such regulations as may be deemed necessary by an appropriate accrediting body of the American Medical Association in consultation with representatives of the sponsors of the plan. Mr. UMHEY. The only thing that does not appear here, this is the 20 principles agreed upon by the members of the committee of the American Medical Association and participating from the lay-sponsored groups were the American Federation of Labor, whom I represented by designation of then President Green. The CIO was nationally repre 39087-54-pt. 6-27 sented, the National Association of Machinists represented by Mr. Hayes, just previously a witness. The Committee of Cooperative Medical Care of which Jerry Vorhis was then the executive secretary was in that group. It was probably the biggest group of organizations interested in the provision of medical care that you could gather together under one roof. We agreed on this 20-point program, and the only thing that does not appear there is point 21; that was the amendment which they stuck in at the house of delegates which said, "This is for the guidance only of our societies, and it is not binding upon State or local medical societies." The CHAIRMAN. Was there any report that accompanied those 20 points? Mr. UMHEY. Well, I have no no access to the records of the American Medical Association and its house of delegates. The CHAIRMAN. I saw you looking at a typewritten statement from which you took the date, and I thought perhaps that was a report. Mr. UMHEY. That was my report to President Green on the results of the conference, and I reported back to President Green of the American Federation of Labor and I got the date from that report. In fairness to the members of the committee, they tried their best to get that adopted, and they tried to kill that amendment, but they were not strong enough to do that. The CHAIRMAN. Are there any further questions, gentlemen? If not, we want to express to you on behalf of the committee our very great appreciation for your willingness to be here, and to be so patient as to remain at this late hour in the afternoon in order that you could present your views to the committee. I think the background of experience that you have had similar to those who have preceded you as witnesses is such as to enable us to attach a great deal of importance to the statement you make. We certainly appreciate your presence, and look forward to your continued help and advice and counsel as it may be called upon. Mr. UмHEY. I am delighted to give it. The CHAIRMAN. I think it would be appropriate that I should also recognize that during these hearings we have been benefited by the presence of our former colleague on this committee, Mr. Andrew Biemiller, who in the preparation of these hearings and in his consultation with members of the committee, and by his active participation in the hearings, and bringing to our attention important witnesses, has indeed been very helpful to us. It is characteristic of the interest that he has always had in matters of public health. He was a member of this committee and rendered distinguished service while he was on this committee. We feel grateful to you, Mr. Biemiller, for the interest you have taken in this matter, and the help that you have given to the committee. Mr. BIEMILLER. Thank you, Mr. Chairman. The CHAIRMAN. The committee is adjourned until Monday morning at 10 o'clock. (Mr. Umhey later submitted the following information for the record :) TABLE 1.-Physicians' services provided in general medicine and specialty clinics, Union Health Center, New York, 1947-521 1 Average number of persons eligible for care during year: 1952, 196,700; 1951, 202,450; 1950, 201,200; 1949, 195,350; 1948, 191,360; 1947, 190,210. 2 Union members were entitled to unlimited services at the health center beginning July 1, 1952. Prior to that date, each member was entitled to a specific amount of credit for service at the center, the amount varying among locals. 3 Excludes sick benefit referrals. Source: Union Health Center, New York, 1953, Unpublished data. TABLE 2.-Ancillary services provided at Union Health Center, New York, 1 Average number of persons eligible for care during year: 1952, 196,700; 1951, 202,450; 1950, 201,200; 1949, 195,350; 1948, 191,360; 1947, 190,210. 2 Union members were entitled to unlimited services at the health center beginning July 1, 1952. Prior to that date, each member was entitled to a specific amount of credit for service at the center, the amount varying among locals. Includes sick benefit referrals to diagnostic and specialty clinics. Source: Union Health Center, New York, 1953, unpublished data. INTERNATIONAL LADIES' GARMENT WORKERS' UNION, A. F. of L., Hon. CHARLES A. WOLVERTON, Chairman Committee on Interstate and Foreign Commerce, House Office Building, Washington, D. C. DEAR SIR: Your letter of February 5 addressed to Mr. Fred Umhey was turned over to me for reply. 1. The medical care and health plans of the ILGWU for its members are fairly uniform, as (a) All of our plans provide weekly cash benefits during periods of illness (the first week's illness is not paid for). These cash payments range from $15 to $26 per week for 13 weeks in any one sick benefit year. (b) Hospitalization is provided by all our plans, ranging from $4 to $5 per day for from 30 to 90 days. (e) Most of our funds also pay $50 on the birth of a child. (d) Surgical benefits are paid; from $10 to a maximum of $50 with 1 or 2 of our funds paying up to $100. (e) Many of our funds also operate health centers which give complete diag nostic care to our members. Some of our health centers also provide therapy, where required, to ambulatory cases. (f) Dependents of our members are not included in any of the above-mentioned benefits. 2. None of our locals have contracts with medical groups for services. We employ physicians and technicians in our health centers, the technicians are employed on a full-time basis; the physicians are employed on a part-time perhour basis, with some being employed full time. 3. The number of members eligible for surgical and hospital care is 337,914. As stated above, dependents of our members are not eligible. 4. We are enclosing a summary in accordance with your attached forms. Hoping this is the information you require, I am, 1 Union Health Center at 275 7th Ave. supplies health services to our members; this does not include the family. These services are provided without limitation. Doctors are not sent to the home. (Thereupon at 4: 50 p. m., a recess was taken until Monday, January 18, 1954, at 10 a. m.) |