Total income in 1952 amounted to $14,490, with $12,832 paid out in benefits. With operating expenses, we had a loss of $1,002 for the year. Dues were raised about 10 percent at the beginning of this year, but we are still running slightly in the red, though it is expected that it will be made up through eased claims during favorable summer weather. Services covered included about 2,500 home and office calls, 150 physical examinations, 50 eye examinations, 100 minor surgery, over 50 major operations and confinements; for total services representing over $22,000 in medical service costs. At present we have no educational program beyond our annual report, but have had a membership newsletter in the past. Our community relations are reasonably good, and doctors accept our existence, although they do not go out of their way to assist us. If we can enlarge our membership during this year, we hope to have a better report for you next year. Submitted by Taisto Hayrinen, president, Cooperative Health Association. GROUP HEALTH MUTUAL AND GROUP HEALTH ASSOCIATION, ST. PAUL, MINN. 1. Membership education.—This is carried on through : (a) Membership participation in the affairs and activities of the organization. Attendance at local group meetings, district and annual meetings, conference on health, etc. (b) Group Health magazine, which goes to all of our policyholders six times yearly. It endeavors to (1) keep them informed on significant happenings in the health field generally; (2) keep them informed on the work of their organization and its problems: New coverages offered, services such as the credit union, Celo Laboratories' vitamins, etc.; the problems and threats posed by commercial competition; (3) convey to them an understanding of the cooperative philosophy of the organization, its goals and objectives, and the meaning these goals and objectives hold in terms of eventual improvement of medical services. (c) Group Health Information Letter, which goes to about 1,000 key persons: Group Health officers, Group Health collectors, local group officers, district committeemen, etc. This letter endeavors to deal with any problems of the moment on which information to our representatives in the field can be helpful: Legislative problems, operational problems, changes in home-office operation, overall plans for local, district, and annual meetings, etc. (d) District committee meetings. The 10 district committees, covering Minnesota and Wisconsin, are composed usually of 5 members elected at the district meetings. They customarily meet with a representative of the home office and the directors and supervisory committeemen from their district. These meetings, in addition to arranging for the regular delegate meetings, air problems of the organization, clear information and grievances from the membership to management, convey a better understanding of management problems from the home office to membership representatives, and seek to work out programs for the advancement of the organization in their district. (e) Local group and community meetings, usually annual meetings of the groups. Two hundred and ten local groups held annual meetings and filed reports during the past year. Information is brought to the local members through motion pictures, slides, and charts. A speaker from the home office is nearly always present to give information about the organization, to answer questions, and to deal with grievances. (f) Annual meetings of the 10 districts, made up of delegates from the local groups. In addition to electing officers, these meetings originate resolutions and carry on discussions and exchange of information at a higher level. About 80 percent of the membership was represented by delegates at these meetings. (g) The general annual meeting, also of delegates from the local groups. Here the educational media are reports of officers, discussions by the delegates, and addresses usually by two nationally important speakers. At least one of the addresses is directly concerned with health matters. More than 500 members and delegates attended the 1953 annual meeting. One hundred and twenty-three local groups, comprising well over 50 percent of the membership, were represented. (h) Personal contact through the field staff, the home-office staff, and more than 400 local volunteer collectors. 2. Membership growth.-Group Health reached the highest point in its history in membership and business volume during 1953, in spite of competition of the most aggressive kind, and in spite of the necessity to convert all of our old con tracts to new ones in order to meet changing needs and changing conditions. We closed the year with a membership of 38,000 family units or 125,000 persons. Growth is reflected also in the expansion of our insurance lines. We are offering a wider variety of protections, including life, accidental death and dismem berment, and catastrophic sickness insurance, and the average member is making greater use of these protections. Another area of growth-relatively small, as yet, is the Group Health Federal Credit Union. We passed the $50,000 mark in 1952, doubling the previous year's figure, and we will at least double again in 1953. Many of our creamery health groups now sponsor local units of the credit union and handle deposits and loans. This phase of the work is beginning to snowball. 3. Utilization.-We paid out $1,750,000 in 1952 for hospital, medical, and related expenses, an average of $7,000 every working day. Roughly 1 family in 2 had occasion to use hospital services during the year, and members used in benefits during the year 72 cents of every premium dollar paid in. 4. Financial status.-Group Health did more than $2 million worth of business in 1952, and finished the year with a surplus of $135,000. Because of our policy of paying out a maximum of benefits with relation to income, and because of rapid growth in recent years, our surplus is not as large as it should be with relation to the volume of insurance we are providing. We are remedying this by (1) an increase in the surplus out of premiums, and (2) a new issue of guaranty-fund certificates which will be offered to all members with the plan of getting as many as possible to become investors. 5. Community relations.—(a) We sponsored a regional health conference this year to explore the recommendations of the President's Commission on the Health Needs of the Nation, and our secretary-treasurer and general manager was local chairman of the regional hearing which the President's Commission held in Minneapolis last fall. At our regional conference, we involved all of the major farm organizations in the area with the exception of the Farm Bureau, the major labor organizations, and the cooperative organizations. Our efforts got top-level attention from the metropolitan press. (b) We provide medical and nursing scholarships to 9 students, at the rate of $500 a year each. This program gets a great deal of attention from the high schools, universities, and colleges in our area, and from the local press. Our scholarship screening committee is made up of professors in the medical and nursing schools in the University of Minnesota, practicing physicians, educators in the liberal-arts field, etc. (c) Every local or district meeting is the subject of news releases provided by the home office and usually placed by local officials of the organization. We also encourage delegates to the annual meeting to place stories with their local papers about their attendance. (d) Through Group Health Association we have contributed both in cash and in other forms of assistance to hospital-fund drives in our area. (e) We have taken part in such campaigns as that of the Multiple Sclerosis Society, and we have aided such drives in our publication. 6. Plans for 1953–54.—(a) To achieve a premium income of $2,750,000 annually. (b) To increase our surplus substantially, with an eventual goal of $1 million. (c) To consolidate Group Health Mutual, Inc., of Minnesota, with Group Health Mutual Life, of Washington, and expand our life-insurance program in Minnesota and Wisconsin. (d) To develop our direct medical service program in the Twin Cities on a greatly accelerated scale, through agreements with medical practice groups to serve our members and through development of new membership for this type of service. (e) To develop home-care programs for chronically sick persons in our rural areas. (f) To step up our education work to the end of a better understanding of the program by our members and stronger bonds of loyalty to the program. (g) To prepare our members for transition to the direct-service type of prepayment through education, stimulation of local committees, and encouragement of the local groups to identify themselves with the direct-service program by (1) participation in the regional health conferences; and (2) by direct affiliation as associate members, with the Cooperative Health Federation. (h) To expand the credit union by at least doubling its assets and membership, and to develop much more fully those phases of credit union service directly related to the problems of financing the costs of illness and security. Presented by Louis E. Lerman, Group Health Association, St. Paul, Minn. GROUP HEALTH ASSOCIATION, ST. LOUIS, MO., 1. Membership education. The program of membership education within Group Health Association of St. Louis, Mo., has been conducted largely through the medium of a publication, compiled and edited by our board of directors and titled "Your Health News," In addition to personal items about our members or some unusual incidents that may occur in connection with any member of the association or the medical staff, we also try to include in each issue, an article about some happening or new development in group medical practice, on a national scale. The current schedule of hours for doctors and clinic at the Labor Health Institute Medical. Center, is also a part of each issue. This keeps the membership informed as to the day and hour when any certain doctor on the medical staff is available at the medical center. At each of our annual membership meetings, the members are given a full account of any actions taken by the board of directors during the preceding fiscal year. We have had addresses at these annual meetings by prominent doctors, as well as panel discussions between lay members and doctors on our medical staff. Some years ago, the board initiated a series of group meetings. Our entire membership area was divided in four major sections, with a board member. heading each of these sections. Each major unit was then further subdivided into a number of smaller groups, consisting of approximately 15 to 20 members, with a director or a member appointed as group leader. The objective was to arrange meetings of the group, generally at the home of one of the members and have the group leader act as moderator of the meeting. Membership plans, rules, and regulations procedures at the medical center and other items of general interest were presented and discussed. The idea was not only to educate our present, members in all phases of our operations, but to create an active enthusiasm on their part, so they in turn, would actively seek to interest their friends, neighbors, and acquaintances in becoming members of Group Health. This group plan got off to a very good start, but unfortunately the supervising and the operation of the plan required too much time on the part of the board members and we had to abondon it, at least temporarily. 2. Growth.-Membership in Group Health has increased approximaely 25 percent, during the past 2 years. We attribute this high percentage of growth to the very efficient and comprehensive medical, services available to Group Health members at the Labor Health Institute Medical Center and also to the fact that for perhaps the first time in our years of operation, we have been able to go along on a fixed and definite membership plan, without the necessity of making major changes both in coverage and extra charges. 3. Utilization.-Exact data as to the degree of utilization by Group Health members is not available at this time. However, as a result of our continuing educational program and the fact that quite a few of our members have been in the association for a number of years and are, therefore, fully cognizant of the advantages of preventive medicine, we believe our group is making the maximum use of the services and facilities available to them. 4. Financial status.-Due to our arrangement with LHI in the matter of medical services for Group Health members, our financial statement has not changed appreciably during these past 2 or 3 years. 5. Community relations. When the LHI facilities were originally established, it was felt by Dr. Elmer Richman, who was then our medical director as well as occupying that position with Labor Health, that the best way to offer comprehensive service to those outside of the union, was by providing group health service sthrough LHI. Early in its history, Group Health based its operations on the tenets that now guide. voluntary prepayment plans. They include: group practice, preventive medicine, health budgeting, strict professional control of medical problems and laymen control of the co-op's business affairs. Through its union sponsorship, LHI brings modern, comprehensive health service to large numbers and Group Health makes similar service available generally in the community. The two organizations feel they provide an example of how labor and the rest of the community can work together for the betterment of the entire group. Today the small pioneering body of Group Health Association and the nationally recognized model health center of LHI, continue to work hand in hand and toward better health care for all the people. 6. Board-staff relations.-Dr. John O. McNeel, medical director of LHI, is also medical director of Group Health Association. Since assuming his post here in St. Louis, Dr. McNeel has taken a very active and personal interest in Group Health and its continued growth. In spite of the unusual demands on his time, he has attended every business meeting of our board of directors. His wise counsel and advice have been very helpful and this cooperation on his part is greatly appreciated by every member on our board. As a result of this close cooperation between the medical director and the board of directors, the relationships between the board and the entire medical staff have also been very pleasant and cooperative. 7. Plans for 1953-54.-The board is planning a continuance of the series of educational articles in our newsletter. Our membership program will be con tinued and we hope, will be intensified. If it is possible, we may attempt to revive the group meeting plan. GROUP HEALTH COOPERATIVE OF PUGET SOUND, SEATTLE, WASH. During the year of 1952 Group Health has continued its rapid expansion, taxing its facilities and personnel to the limit, and showing in general the first tendency for utilization figures and costs to level off as the fundamental size of the organization becomes stable enough to absorb the new members without a resultant statistical variation. 1. Membership education. In the field of membership education, we continue to edit our News and Information bulletin which appears at about 6 weeks' intervals, carrying articles of medical care, administrative announcements, and reports, health education and community news as well as cooperative news. This organ appears to have fairly generalized reader acceptance, and a moderately good penetration throughout the membership. It is mailed to every member, and copies of it are distributed to other interested organizations. Also developed during the past year were monthly meetings of expectant mothers, at which obstetricians and pediatricians talked to expectant mothers and answered questions. Usually an educational film having to do with childbirth or early postnatal care was shown. The attendance at these sessions has embraced about 50 percent of the expectant mothers, and has been remarkable in the high percentage of fathers which have been present for these sessions. It is contemplated at the present time to add a full-time health educator to the staff to further this program, and an allotment has been made in the present budget for the addition of such a person as early in the fall as a suitable candidate can be obtained. 2. Growth. In the field of growth, the organization had reached by January 1953, 8,430 families, representing 24.203 people. In addition to this, there were some 7,634 other people being serviced on industrial and individual contracts, and an additional 2,500 who use the services of the clinic but do not pay dues. This represents a total load of some 33,000 individuals covered as of the 1st of January 1953. 3. Utilization.--The utilization figures which will come out of our annual audit have not yet been fully developed, but preliminary estimates show utilization to be on the order of 4.7 services per year, including the services of the pathologist and radiologist. This is a very slight increase over the previous year. One other figure of utilization which is interesting is that for the past 2 years the total number of people serviced exclusive of those dealt with over the telephone has been on the order of approximately 15 people per day per 1,000 covered. 1.9 person per 1,000 per day has been actually hospitalized, which is comparatively a very low ratio as judged by current community standards. Our gross utilization curve is quite similar to that developed by the Health Insurance Plan of Greater New York statistics for annual fluctuation. A detailed comparison is being made of the utilization rates of co-op members who are selected on an individual basis as compared to the utilization rates of group contracts, and presently it would appear to show that the utilization is about 20 percent greater in the individually assigned group. Further studies along these lines will be reported as soon as they are completed, since this is one of the critical problems to an organization which is organized around an individual subscription basis rather than a group. 4. Financial development.-In 1952 we again came in a very close second on the profit versus loss race, showing a net loss at the end of the year of $27,000 cut of a gross operation of $1,700,000. This had been foreseen in the early fall, and a 10 percent dues raise had been put into effect in November which was reflected in the final figure but was not put into effect early enough to overcome the accrued deficit of the prior 10 months. It is anticipated that this should be reasonably sufficient to carry us through the year of 1953, although rising prices and the heavier use experience of a prolonged respiratory epidemic have produced a series of increased costs during the early part of 1953 which may or may not be offset by the experience of the summer. The current dues rate is for males, $4.25 a month; females, $4.75; unmarried females, $5; first child, $2.25; second child, $1.75; third child, $1, with no charge for other children. 5. Community relations.-In July of 1952 all eligible members of the medical staff were admitted to the medical society, and since that time as other members have become eligible, all of them have been approved without any apparent contest. Our physicians have been admitted to the staffs of four local hospitals, which gives us a cushion of hospitalization which was not available to us previously. Additionally, two of our staff members have been appointed to important committees in the medical society, and while the reception we get is still cool and several of our members have been turned down by local professional organizations, it is our feeling that patience and straightforwardness will result in eventual complete acceptance of the program. 6. Plans for 1953-54.-Because of extremely rapid growth and the necessity for keeping our heads above water, the board of directors of this organization decided in April to limit expansion and growth to a total load of approximately 35,000 people for a period of 1 year, or at least until the spring of 1954. There are numerous reasons which impelled this move, among which were overloading of facilities and lack of immediately available expansion space. Expansion is also limited by the fact that we have had to plow back into our current plant so much of our current assets that there is no ready money available for expansion into a branch clinic program which is on the planning boards at the moment. During this period of a year of consolidation, a number of projects have been undertaken. The first of these is a complete administrative shakedown and study of our entire operation from the point of view of effectiveness and efficiency. Secondly, the medical service program and its relationship to the dues structure is scheduled for going over. Thirdly, the entire problem of capitalization as it is related to our expansion has been assigned to a committee for study. It is a commentary on our present situation that for each individual person who joins the organization some $22.50 is contributed to capital, with which we must supply approximately $45 worth of capital space, including clinic and hospital. Consequently it would look as though either some drastic revision of operation or some drastic revision of capital structure was in order. This problem is under study in connection with a renovation and expansion of our present 86-bed hospital, which is overcrowded and poorly arranged for the amount of service demanded from it. The previously mentioned difficulties arising in the field of board-staff relationship seem to be in the process of being ironed out and a new contract with the doctors is underway which is a far more streamlined organ, and represents a change in two particular points: first, the increased autonomy of the medical staff, and second, the determination of a capitation plus percentage of cash business basis is being developed. Numerous other productive programs are under study which will be reported as they become completed. One interesting development is in the field of labor relationship, in which our present contract with one large union includes a provision that any surplus of dues over cost will be assigned to a capital fund. Should that fund reach a proportion of $100 for each member of the union represented, they will be presented with permanent life memberships in the cooperative, and at that time will acquire a voice in the management of the cooperative' affairs. Prior to that time officials of the union have been invited to sit with some of the advisory committees of the board so that they will be fully acquainted with the problems we face, as well as the fate of the money which they contribute. It is recognized that there are certain inherent difficulties and dangers in this program within a democratic organization such as a cooperative, but the organization accepts the challenge of education as one of its community duties. Administratively during the latter part of 1952, the organizational structure of Group Health was altered to provide for an executive director, who is responsible to the board and under whom work an administrative director, a chief of staff, and a hospital director. Within this framework all functions of the |