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 history. (Children under 16, of course, are cared for separately in the pediatrics department.) Your family physician may recommend that other staff physicians examine and treat you. This freedom of consultation may at first seem unusual to you, but such "double checking" of diagnosis and treatment provides added health security for you and is one of the major advantages of group practice. A patientdoctor relationship based on trust and confidence can contribute toward good health. Members and staff therefore are encouraged to cooperate in its development. Specialists' services Whenever necessary, your family physician will refer you to an appropriate specialist for examination and treatment. Doctors in many of the specialties of medicine are full-time members of the GHA staff. Other specialists are on a regular part-time basis. Also available when needed, as determined by the medical director are the services of the most competent men in additional special fields. Obstetrics and gynecology Obstetricians provide prenatal care, delivery, and postnatal care, when both parents have been members of GHA for 10 months prior to delivery. The expectant mother is examined frequently during the prenatal period and given careful laboratory tests. Each obstetrician on the staff familiarizes himself with her case; her medical history is recorded and this record is available to the doctor who performs the delivery, at any time, day or night. Both husband and wife are carefully briefed on symptoms and procedures during the preg nancy period. Planned meetings for expectant parents are held every other month. Pediatrics A newborn child of a member or of a listed dependent automatically becomes a member of GHA, as provided in the bylaws. For children of GHA members, comprehensive medical care starts early. Shortly after delivery a GHA pediatrician will visit the hospital to give the infant a thorough examination. You are urged to bring the child to the medical center for the frequent examinations your pediatrician will recommend. From birth to 16 years of age, your child will be under the care of your pediatrician. Thus, through all the critical periods of childhood, including puberty, the child is under the supervision of a specialist. In addition, authoritative guidance in child psychology is available for a moderate charge. A pediatric telephone period is set aside from 9: 20 to 10 a. m. (Monday through Friday), at which time you may discuss with your pediatrician matters pertaining to your child's health needs. CHARGE FOR SERVICES TO PERSONS ENTERING WITH RESTRICTED CONDITIONS In case a person has accepted membership with restrictions, the association, as provided in the bylaws, may be able to provide on a cost basis the services which are required for the restricted conditions. If such services are provided in the clinic or by GHA staff, they are charged for in accordance with a schedule of costs which is set up by the board of trustees, and is subject to change by the board without notice. GHA SPECIAL SERVICES The following services are available to members at the medical center. Injections Medications needed for injections (you will usually have a prescription written in advance by your doctor) may be purchased in the injection room. There is a charge of 75 cents, exclusive of the cost of materials, to be paid at the time and for each injection given, except for persons receiving allergy injections. There is only one charge of 75 cents for an allergy injection visit regardless of the number of injections given on that visit. This is an addition to the regular charge for the cost of materials. Patients receiving allergy injections may pay in advance for materials for a 6 months' or a year's course of injections. Thus the member may avoid the larger expense of purchasing injection materials in small quantities. X-ray Materials used in making X-rays are to be paid for at the time service is provided. A charge of $3 is made for each X-ray plate. Laboratory examinations A minimum charge of 75 cents will be made for routine laboratory procedures, to be paid at the time of service. If special tests are ordered (for example, at an outside laboratory), the member will be responsible for extra charges involved. (Conditions under which this would happen will be explained to the patient by the physician on the case.) Physical therapy For physical-therapy treatment, diathermy, ultraviolet, short wave, hydrotherapy, etc., recommended by the doctor, a charge of $1.50 is made for each of the first 20 physical-therapy treatments received during a calendar year. There is no charge for treatments in excess of that number in unrestricted cases. Basal metabolism test There is a charge of $3 for each BMR (basal methabolism) test, to be paid at the time of the test. Electrocardiogram There is a charge of $3 for each EKG (electrocardiogram) test, to be paid at the time of the test. Optical services The optical department will fill your prescriptions for glasses at a saving. Many styles of frames are available both simple and decorated, as well as a wide variety of optically correct sunglasses. Repairs or replacement of frames or lenses also are made. Pharmacy The GHA pharmacy offers savings to members. Every effort is made to provide minimum prices. Drugs will be delivered in the downtown area every weekday (Monday through Friday). There is a delivery fee of 10 cents for orders totaling less than $3 and no charge for orders of $3 or more. HOW GHA HOSPITALIZATION SERVICE IS PROVIDED (Not applicable to persons holding nonhospitalization memberships) Your GHA physician arranges for hospitalization. The hospital services which GHA procures, when necessary, for eligible members are outlined below: Ambulance service as ordered by the GHA physician. Hospital care not to exceed 90 days in any calendar year, or in any 1 illness or condition, or continuous period of hospitalization for each member and listed dependent. This care is provided for members except in restricted cases (preexisting conditions), in which event the member pays the hospital charges. Semiprivate (two-bedroom) accommodations. If a private room is occupied, the member pays the difference between the cost of a semiprivate room in that hospital and cost of the private room. In maternity cases, when both parents have been in membership for 10 months prior to expected delivery, the member pays the first $125 of the hospital bill, GHA pays the balance for those items normally covered by the association. In general illnesses, the member pays the first $15 of the hospital bill normally covered, and GHA pays the rest. Meals (as furnished on the hospital's regular bill of fare). Medications (except serums, oxygen, penicillin, streptomycin, and other antibiotics). Transfusion service (does not include the cost of blood, if charged, or any costs charged by donor or blood tests in connection with transfusion). It does include services of nurses and doctor performing the transfusion. General nursing care Use of operating room Use of recovery room Anesthetist's services and materials Routine laboratory examinations EXAMPLE OF SERVICES NOT COVERED BY GHA Blood, special foods, including babies' formulas; special nurses and their meals; X-ray and fluoroscopic examinations and treatments; special medications; special laboratory tests; and other special services. These are paid for by the member. If you need hospitalization when away from the 15-mile service area, GHA will reimburse you, as provided in the bylaws, up to $7 per day for room and board up to $10 for anesthesia, and up to $15 for operating or delivery room. Other GHA services, of course, cannot be provided outside the service area, for it is only through efficient use of our own local staff and facilities that GHA can provide comprehensive medical care on the present dues basis. THE DENTAL PLAN The GHA dental plan is designed to keep members in good oral health with emphasis on preventive care. Members enrolling in the dental plan, therefore, agree to have all work performed which the dentist recommends. Thus, following a planned program, members are also able to obtain complete mouth care. Group Health Association's modern and completely equipped dental center is staffed by highly qualified dentists, dental hygienists, and dental technicians, As in the medical department, your dentist may recommend that other staff dentists examine and treat you when you require the attention of a specialist. Saturdays, 9 a. m. to 1 p. m. Services The following services are provided for adults and children enrolled in the dental plan, at a fee for service based on cost. Prophylaxis (cleaning of teeth) Full mouth X-ray Examination and diagnosis by the dentist Dental treatment: Fillings; prosthetics (bridges, dentures, etc.); treatment of diseases of the soft tissue; oral surgery The following services are available on a fee-for-service basis to all GHA men bers and their families whether or not they are enrolled in the dental plan: Emergency dental treatment (care necessary to relieve pain) Orthodontic treatment (correction of irregular teeth) Full denture services Flouride treatments for children The CHAIRMAN. Are there any further questions, gentlemen. If not, that will conclude the hearing this morning. Now, with reference to the appearance of Mr. Hansen, I would like to know whether it would be agreeable to him and to the members of the committee if he should consider with the chairman as to the statement to be made in the record to eliminate the necessity of him appearing as a witness this afternoon, and the holding of a hearing. Would that be satisfactory to the committee? Will that be satisfactory to you, Mr. Hansen? Mr. VOORHIS. It will be, Mr. Chairman. He had to go, but I am certain that I can speak for him and say that it will be satisfactory. The CHAIRMAN. Very well. Then the hearings will adjourn until to morrow morning at 10 o'clock, at which time we expect to have some witnesses here from the CIO organization. (Thereupon at 11:57 a. m., a recess was taken until Tuesday, January 19, 1954, at 10 a. m.) HEALTH INQUIRY (VOLUNTARY HEALTH INSURANCE) TUESDAY, JANUARY 19, 1954 HOUSE OF REPRESENTATIVES, COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE, Washington, D. C. The committee met at 10 a. m., pursuant to recess, in room 1334 of the New House Office Building, Hon. Charles A. Wolverton (chairman) presiding. The CHAIRMAN. The committee will come to order. Our first witness this morning is Mr. John W. Edelman. Associated with him are other witnesses of the CIO who will speak on behalf of their respective organizations. Mr. Edelman will be the first witness. He was born in my State of New Jersey in 1893. As a boy and young man, Mr. Edelman lived in England. Mr. Edelman's first union membership was in the Agricultural Laborers Union of Great Britain and later in the British Union of Journalists. Returning to this country prior to World War I, Mr. Edelman served in the United States Army and returned to newspaper work upon his discharge from the Army. In 1924 Mr. Edelman worked on newspapers in my home city of Camden, N. J. From there he went to Pennsylvania where he became research director of the American Federation of Hosiery Workers. In that capacity, Mr. Edelman had years of experience in framing social and labor legislation, both State and Federal. In 1934, Mr. Edelman was instrumental in setting up the Labor Housing Conference, which drafted the first public housing legislation, and worked for its enactment. In 1937, Mr. Edelman became CIO regional director in eastern Pennsylvania, continuing in that capacity until he was called to Washington to serve with the United States Housing Authority. During the war years, Mr. Edelman worked with the National Defense Advisory Commission and the Labor Office of the Office of Price Stabilization. In 1945, he became Washington representative of the Textile Workers Union of Amica, CIO, and continues in that post today. For the past 25 years, Mr. Edelman has been a close student of labor and social legislation. For the past 5 years he has been a member of the executive board of the Committee for the Nation's Health, a national organization which in addition to advocating national health insurance, has closely followed major developments in the field of voluntary effort to solve the health problems of our people. On behalf of the committee I wish to express our appreciation at the attendance of Mr. Edelman and his associates who will testify 39087-54-pt. 6- -31 |