PROGRESS REPORTS TO SEVENTH ANNUAL MEETING OF CHFA, JUNE 29, 1953

COMMUNITY HEALTH CENTER, TWO HARBORS, MINN.

This year, we of Two Harbors Community Health Center have much to report. Probably not since our beginning has any single year been more crucial. We hope that what we have to present here today will be a report of progress, but it will be up to all of you-as well as to all of us-to make it so.

As you know, at our annual meeting held last January, we decided to build a new health center. Our present frame building, with which most of you are very familiar, has been condemned by the State Fire Marshal. It was ordered closed as of last December, but because of our efforts toward construction of a new center, nothing has been done to implement this order.

We began our fund drive with a local goal of $125,000-this, on the theory that the Duluth, Massabe & Iron Range Railroad Co., the major employer in the area, would contribute substantially to such a drive. But what has happened? A self-appointed citizens' committee met with Paul H. Van Hoven, president of the railroad, and with much condemnation and innuendo, the voice of the railroad said, "No money." Not so long as we were controlled by "that group." Not until we were approved by the St. Louis County Medical Society.

Here, then, was the final straw that drove us to legal battle with the medical society. Eight years of boycott, we felt, was about all any one group should have to take. So we filed suit, with Thurman Arnold, Walton Hamilton, Lee Loevinger, Horace Hansen, and Walter Egeland as our attorneys. The 45-day extension, granted the medical society for their reply will not be up until late next month. We'll know then how much of our efforts must be expended in court instead of in our fund drive.

Those of you who have filed such suits before us know what we are going through. We do have your fine example of courage, and for your eventual triumph to sustain us in our difficult hour; we thank you very much.

Right now, our fund drive locally totals $90,000. We have contacted the railroad brotherhoods and have talked with Roy Reuther of the CIO. Through them by the middle of next month, we will have met with the State CIO, and arranged an interunion conference with CIO, AFL, railroad brotherhoods, the Grange, and the cooperative organizations to see what can be done jointly to keep our plan alive.

The opopsition is deadly. All the old prejudice, the name-calling, Red-baiting slander is on again. We started our drive in a spirit of friendship, hoping that our town's great need for a new hospital would heal the cleavage between our side and the anti-co-op forces. But they prefer to see the town forever without a hospital to seeing us succeed in our plans.

One thing which the reactivated controversy has done for us is the inspiring of many of our lukewarm members to more active, more definite roles. Not many people are on the fence in this battle-and those on our side are militant.

One more constructive step is the widening of scope, the greater awareness among our members that this is not an isolated plan, that what happens in and to Two Harbors is of vital importance to the rest of the country. They will waken more slowly to the converse proposition, that what happens to the rest of the country affects Two Harbors also. When they do fully realize this, CHFA will have made progress, too.

We run a regular weekly column, titled "For Our Community's Ache," in our local paper. This column attempts to inform readers of the purposes and advantages of a prepaid consumer-sponsored health plan. Further publicity has been carried on, on a more or less regular basis, with news releases, display advertising, and letters to cooperatives and to labor groups.

We've helped to carry our story outside Two Harbors, too, by attending the regional conference of the President's Commission on the Health Needs of the Nation, held last September in Minneapolis, and by taking an active part in the regional outgrowth from this conference—the recently organized regional health committee sponsored by Group Health.

Perhaps one of the most dynamic records of progress has been chalked up by the women of the Community Health Center Guild. Organized last February, the guild--presided over by Mrs. William Kosiak-has, through bake sales, candy sales, rummage sales, and dances, made over $1,500. Their plans for the immediate future include a food stand on the much-traveled North Shore Highway through the summer tourist season and a giant carnival-bazaar for which they've been making beautiful articles these past months. Proceeds from their

activities are earmarked for the new health center construction, toward which they have already donated $1,000.

There has been no decrease in our membership in the past year, in spite of 25 percent increase in rates. Now that we have a full staff (for purposes of financial stability, we are temporarily regarding a staff of five as full), we expect membership and utilization both to increase. Our total number of outpatient visits (including both home and office calls) was some 3,000 more than the previous year. We averaged 80 daily outpatient visits for 1952. For a good part of that year we had only two doctors handling the load.

Our staff picture has never before looked so bright. We have 4 general practitioners and 1 surgeon, all of us young and all in sympathy with our purposes. Dr. Kosiak, Dr. Moyer, and myself have been in Two Harbors for 1 to 5 years. And the Drs. Hanson-Dr. William Hanson and his wife, Dr. Millie Hansoncame this spring from the University of Minnesota. Dr. William Hanson is a surgeon and Dr. Millie is a general practitioner.

We have the nucleus for a tremendously successful cooperative health centera congenial working staff, an aroused membership, enlightened labor organization, an extremely active women's guild, and a growing publicity program. But we have the possibility, too, of a thudding collapse-discord within the community, violent opposition from industry, subtle boycott by organized medicine, the constant prodding of a much-pressured fire marshal, and an unfriendly legislature which hampers us with restrictive laws.

We can succeed and we believe we will succeed, but we cannot do it alone. We need the help-moral and financial-of every individual and every group within this, our parent organization, the Cooperative Health Federation of America. We'll be big boys one day, but right now we need "Mama." Presented by Robert Painter, M. D., Community Health Center, Two Harbors,

Minn.

COMMUNITY HOSPITAL-CLINIC, ELK CITY, OKLA.

Membership education.-Our educational activities consist of a monthly bulletin and an annual membership meeting. Our bulletin carries news about memhers and employees as well as articles on medical subjects. The annual memhership meeting lasts a whole day. The morning is usually devoted to business, the afternoon to a guest speaker and discussion. Last September we had a barbecue with over a thousand members attending.

Between membership meetings the members can express their wishes through their grievance-suggestion committee. This committee is composed of a plan member, a board member, a nurse, a doctor, and a lay employee.

Utilization.-Dues-paying members have been as follows: 1950, 1.772; 1951, 1.707; 1952, 1,698. Our ratio of member to nonmember volume runs about 50-50. Our patient-days are about 45 percent members while our clinic visits are about 55 percent members.

Financial status.-Because of an $82,000 bequest we have been able to retire our mortgage and are now air-conditioning the hospital. On April 30 we had $65,000 in liabilities and $115,000 in the bank.

Community relations.-Since settling our suit last spring our doctors have been admitted to the local medical society and community relations have improved considerably.

One of our doctors is now vice president of the local medical society. All the nonclinic doctors in town have staff privileges in our hospital, but rarely use them.

Our doctors have now been admitted to all the three service clubs in Elk City. We are active in the community chest and the chamber of commerce. Our administrator has been elected to the board of directors of the State hospital association and is president of the district association of hospital administrators. This would have been impossible 14 months ago.

Plans for 1953-54.—Our plans for next year include the completion of airconditioning our hospital. We also plan to have an architect and landscape artist prepare master plans for the development of our hospital and grounds. As money becomes available we will improve our physical facilities.

The

Next year we also hope to offer our members an alternative plan which will broaden this prepaid coverage to include hospital expenses. The membership is being surveyed at the present time to determine interest in this move. board will probably review this survey and make its decision in July. Submitted by Milton Sugarman, M. D.,, Community Hospital-Clinic, Elk City,

Okla.

1

COOPERATIVE HEALTH ASSOCIATION, KANSAS CITY, MO.

We realize that Cooperative Health Association's operation is somewhat different from the average member of Cooperative Health Federation of America in that we are limited in our growth and our scope of operations.

1. Membership growth.-Our membership growth has been small and at the present time we have approximately 1,600 members, with a total family coverage of members and dependents of 6,500 persons. It is practically impossible for us to expand and increase our membership, inasmuch as we were organized to cover the members of Consumers Cooperative Association and its subsidiary organizations.

2. Utilization. Our people are utilizing their association to the fullest extent and we are, at all times, trying to get them to advise the board of directors of any changes which they would like for use to make in our policy agreement so that the Cooperative Health Association could be of greater service to our members and their families.

3. Financial status.-During the past year we began to have trouble, particularly in financial status, as claims were increasing in number, as well as amounts, so that the end of May 1952 found us with a loss of approximately $7,000. On June 1 we increased our membership fees approximately 20 percent and at the same time increased our benefits by increasing the per day allowance for hospital rooms from $7 and $8 and miscellaneous expenses in hospitals from $45 to $60, so by the end of the fiscal year, which was December 31, we were able to recuperate to some extent so that we showed a loss of $3,800.

At the end of May 1953 we were able to show a net savings for the 5 months period of approximately $175, which leads us to believe that by the end of December we will be able to overcome the deficit of the prior year.

4. Community relations.-Our relations with hospitals and doctors in the communities where our members live have been excellent. We find, however, that a large percent of our members show their membership agreement to their doctor, particularly on the surgical schedule of benefits, so their doctor might know how much he would expect to receive from Cooperative Health Association for services rendered. We sometimes feel that doctors are taking advantage of our association by increasing the amount which they might charge the member for services rendered, thereby collecting a larger fee than they might normally do. This is supposition, of course, but we find different doctors in the same communities have different fees for the same type of service performed, which leads us to believe that the one who presents a larger bill has seen the amount which we might allow, thereby realizing more money for his services than he otherwise might receive.

5. Plans for 1953-54.-Our plans for 1953-54 are to concentrate our efforts on advising our members of how the Cooperative Health Association can be beneficial to them and rendering better service to our fellow employees. Submitted by E. O. Gillespie, president; presented by Edwin White.

COOPERATIVE HEALTH ASSOCIATION, SUPERIOR, WIS.

The Cooperative Health Association of Superior, Wis., remains as one of the smaller plans which are members of CHFA. It may be one of the oldest, however, having held its 15th annual meeting this year. It was initially started by a group of six co-ops, with the cooperation of the Douglas County and of the State Medical Society of Wisconsin. It was an "experiment" on the part of the

doctors, and they shortly withdrew.

It is still controlled by the six member co-op stores, but since they participate little if at all in the annual meetings, the thought of changing to a subscribermember plan has beeen advanced several times. This year steps are being taken to study the legal angles and if possible bring a proposal to the next annual meeting.

Our prepayment plan pays 75 percent, up to a maximum of $100 per case per year, for all types of medical services, from office calls upward, and 25 percent on laboratory procedures, X-rays, etc., directly to the subscriber. Dues are $1.85 per month for individuals, $2.75 for unit of 2 and $3.70 for family units: with reductions for annual payments and for group enrollments. We have several co-op employee groups under group enrollments, and studies in the past year indicate a more favorable experience under group enrollment, the same as other plans have found. We intend to look for more group enrollments this year. to boost our subscriber total, which is now 283 in individual units and 188 in group units.