Dr. ELIOT. I would like to point out first, as Miss Lenroot did last, that I have not been advised whether this bill to which we are addressing ourselves today is in accord with the program of the President and therefore I am not speaking for the administration, but for myself. I am not proposing to present before this committee a full statement in support of titles I and II of S 1318 because, on May 1, 1946, I presented such a statement in support of the maternal and child-health section of the National Health Act, S. 1606, title I, part B, and at that time described the need to expand the State maternal and child-health and crippled-children's programs. I have also recently presented testimony before the subcommittee of the physically handicapped of the House Committee on Labor describing the need of children and mothers in this country for better medical service. Senator PEPPER. May I interrupt just a moment? Since we are dealing with delinquency of children, I have been handed a newspaper clipping from New York, dated June 21, United Press: A natural for any age. Moirshe Byrone was found guilty in police court tonight of disorderly conduct. Police said he was shooting craps. Byrone is 104. Now, go right ahead. Senator DONNELL. Now do you want to change the definition of a child to an age of 104? Senator PEPPER. 104. Dr. ELIOT. However, I do want to emphasize today, as I did then, that I believe that the maternal and child-health services provided under this bill should ultimately be a part of the national health program and should be coordinated with and fitted into such a broad program when enacted. The preamble to this bill S. 1318, which Senator Pepper has proposed as an amendment, states this position, and I want to make clear my support of it. If Reorganization Plan No. 2 becomes effective, the various grants-in-aid programs will be more fully coordinated and the way will be opened for effective implementation of the purpose of Senator Pepper's preamble when the national health program becomes law. In the meantime, if S. 1318 is enacted, health services to children and maternity-care programs can be developed further in all States. The basis for such expansion exists in each of the States and Territories and in the District of Columbia through State programs developed with Federal aid under title V of the Social Security Act. I would like to submit at this point for the record a summary of the provisions of titles I and II of S. 1318, covering maternal and child-health and crippled-children's service. Senator PEPPER. It will be received. Dr. ELIOT. I think it will make the record complete if it goes in at this point. (The document referred to is as follows:) PROVISIONS OF TITLES I AND II OF THE MATERNAL AND CHILD WELFARE ACT TITLE I. MATERNAL AND CHILD HEALTH SERVICES Purpose. The purpose of this title is to enable States to provide services and facilities for (1) maternity care; (2) preventive maternal and child-health work, including mental health; (3) school health services; (4) diagnostic serv ices and care of sick children; (5) dental care of mothers and children; and (6) correction of defects and conditions likely to interfere with the normal growth and development and the educational progress of children. Each State will develop its own plan for expanding services over a 10-year period, including demonstrations and the training of personnel (sec. 101). Conditions for approval of State plans.-The Chief of the Children's Bureau is required to approve any State plan which meets the conditions specified in the act. These include: 1. The State health agency shall administer or supervise the administration of the State plan. The plan must be coordinated with the agency's general public-health and medical-care program. 2. The services and facilities provided shall be available to all mothers and children who elect to use them. There must be no discrimination because of race, creed, color, or national origin, and no residence requirements. 3. There shall be such methods of administration as are necessary for the proper and efficient operation of the State plan, including-(a) personnel standards on a merit basis; (b) standards for professional personnel rendering service, and for hospital and other institutional care and services, to be developed by the State agency in consultation with professional advisory committees; (c) free choice of physician, hospital, clinic, or health service agency meeting such standards, and the right of physicians, hospitals, or clinics to refuse to accept cases; (d) maintenance of high quality of care by providing for adequate compensation for persons and institutions giving care, providing opportunity for postgraduate training for professional and technical personnel, and by the satisfactory distribution and coordination of preventive, diagnostic, consultative, and curative services; (e) payment to physicians on a per capita salary, per case or per session basis, or in the case of consultations or emergency visits on a fee-for-service basis, and purchase of care from public or voluntary hospitals or other health-service agencies included in the State plan on a basis related to the cost of providing such care. 4. There shall be opportunity for fair hearing before the State health agency for beneficiaries of the program, as well as those furnishing services, on matters affecting their interests. 5. There shall be financial participation by the State, provision for dissemination of information regarding the services and facilities available under this title, and cooperation with medical, health, hospital, nursing, education, and welfare groups and organizations in the State. There shall also be provision for State general and technical advisory groups (sec. 103). 6. A State plan adequate to carry out these purposes must be in effect in all political subdivisions of the State by July 1, 1955. Financing.-$50,000,000 is authorized to be appropriated for the fiscal year ending June 30, 1946, and for each year thereafter a sum sufficient to carry out the purposes of the title. Such part of $5,000,000 is to be allotted to each State as the number of children under 21 years of age in such State bears to the total number of children under 21 years of age in the United States. This amount is to be matched dollar for dollar by the State. The remaining amount of the sum appropriated each year is to be allotted taking into consideration such factors as (1) the number of mothers and children under 21 years of age in the State for whom the service and care are to be made available and the cost of furnishing such services and care to them, (2) the special problems of maternal and child health, and (3) the financial need of the State for assistance in carrying out the State plan (secs. 101, 102, 104). Federal advisory committee. In formulating the general policies for administration, the Chief of the Children's Bureau is directed to consult with (1) a conference of State health officials, and (2) an advisory committee composed of professional and public members, and, as necessary, technical advisory committees, which he would appoint (sec. 105). TITLE II. SERVICES FOR CRIPPLED CHILDREN Purpose. The purpose of this title is to enable States to provide services and facilities for the care and treatment of children who are crippled, otherwise physically handicapped, or suffering from conditions which lead to crippling or physical handicaps. Each State will develop its own plan for expanding services over a 10-year period, including demonstrations and the training of personnel (sec. 101). Conditions for approval of State plans.-These are in general the same as those under title I, except that prior to July 1, 1951, administration or supervision may be by whatever State agency now has a plan of services to crippled children operating under title V of the Social Security Act. After July 1, 1951, administration or supervision of administration must be in the State health agency in all States (sec. 203). Financing.-$25,000,000 is authorized for the fiscal year ending June 30, 1946, and for each year thereafter a sum sufficient to carry out the purposes of the title. Such portion of $2,500,000 is to be allotted to each State as the number of children under 21 in such State bears to the total number of children under 21 years of age in the United States. This amount is to be matched dollar for dollar by the State. The remaining amount of the sum appropriated each year is to be allotted taking into consideration such factors as (1) the number of children under 21 years of age in the State for whom services and care under this title are to be available; (2) special problems of crippled children; and (3) financial need of the State for assistance in carrying out the State plan (secs. 201, 202, and 204). Federal advisory committees.-Provision is made for Federal advisory com mittees and conferences of State officials as in title I (sec. 205). Studies and investigations by the Children's Bureau.-The Children's Bureau is authorized to make and aid the financing of such studies, demonstrations investigations, and research as will promote the efficient administration and oper ation of this act (sec. 402). Dr. ELIOT. I would like to point out that the purpose sections of title I and title II specify more particularly the content of the program that will be carried on than does the purpose section of title V, parts 1 and 2, of the Social Security Act. The contents of the bill to which we are addressing ourselves outline more directly the conditions under which States would be able to go forward with their programs than does title V of the Social Security Act. The question has frequently been raised how public demand for service under a program such as this can be controlled during the period of recruiting and training personnel, of extending the basic services, and of construction of needed health centers and hospitals. It is the opinion of many that without some form of control on a Stateby-State basis, the quantity of care provided under a rapidly expanding program will be increased at the expense of quality of care to be given children and mothers. To meet this fundamental criticism, it would be my belief that during the first 2 or 3 years of expansion of maternal and child-health and crippled-children's services under this bill, primary emphasis must necessarily be placed by the State agencies on planning for expansion and on the organization of health services for mothers and children. These would include: First, the recruitment and training of personnel. Second, expansion of community health services of a general character such as the placement of public-health nurses, the development of maternity clinics, infant, preschool, and school services (including dental service), nutrition programs, and certain State-wide medicalconsultation and advisory services. A fuller description of this phase of the program was submitted by me in my testimony before this committee on S. 1606 and it seems to me that it might be appropriate to make that part of this record, as well as part of the record under that earlier bill. I believe the 11 points I have outlined here are the 11 points to which one of the witnesses referred yesterday, and I will come back to that later when I am speaking of the cost of the program. I would like to have this included in the record. Senator PEPPER. It will be received. (The document referred to is as follows:) MATERNAL AND CHILD HEALTH SERVICES IN THE COMMUNITY Excerpt from testimony by Martha M. Eliot, M. D., Associate Chief of the Children's Bureau, before the Senate Committee on Education and Labor, on the National Health Act (S. 1606): "Maternal and child-health services in the community include the following types of service: "1. Fact finding necessary to determine the needs of mothers and children. "2. Setting standards for maternity care and for complete health services to infants and children, including medical and hospital service. "3. Organizing community programs to provide for health education, case finding, and health and medical services which require the coordinated work of professional personnel-physicians, dentists, nurses, nutritionists, medical-social workers of hospitals and other institutions, and of agencies outside the health field, such as education and welfare. "4. Developing special programs such as school health services, child-guidance clinics, maternity and pediatric clinics, and coordinating them with general programs. "5. Setting up demonstrations, special projects, and research activities, local or State-wide, to test methods of providing services, or to serve as examples in the administration and provision of services-e. g., demonstrations of complete maternity care, including hospitalization; pediatric or obstetric consultation to local physicians and hospitals; special service to premature infants; nutrition programs; vision and hearing tests; school health projects; dental projects; special maternity or pediatric nursing projects; training nurse-midwives; maternity and pediatric hospital consultant service and inspection programs. "6. Recruiting and training administrative personnel, medical and nonmedical, to organize programs and operate maternal and child-health services in the community. "7. Providing administrative consultation through the staff of the State health agency or local health department to local professional personnel and local institutions to enable them to perform a more satisfactory service. "8. Initiating or cooperating in plans to attract professional medical, dental, and other professional and technical personnel needed by mothers and children to local areas that do not have them, or that are served inadequately. "9. Making arrangements for or providing services of medical and dental clinical consultants and specialists to assist medical practitioners in the field of maternal and child health, and other professional workers, such as nurses and medicalsocial workers, needed for medical and dental care of high quality for mothers and children. "10. Developing and promoting construction and staffing of needed facilities. "11. Arranging for, or providing, special training for doctors, dentists, and other professional personnel giving service to mothers and children." Dr. ELIOT. The third general purpose that would be served in the early years of this program is the organization of a variety of special county- or district-wide projects, limited at first in geographic scope, to serve as proving grounds for expansion of the different new and special health, medical, and dental aspects of the program. Initiation of investigations of administrative methods and other scientific matters related to the effective operation of the programs. And fourthly, there would be initiation of investigations of administrative methods. After the first few years, expansion would go forward more rapidly until at the end of the 10-year period all parts of the State will have been included in the area covered and all services will have been made available to mothers and children who wish to participate in them. A number of suggestions have been made on this method of expansion. The Association of State and Territorial Health Officers, for example, has proposed starting with a State-wide maternity and infant-care program and expanding it year by year to older age groups. That proposal was submitted by Dr. Getting to you when he testified before this committee on S. 1606. Each State will map out its own proposals for development of its maternity and child-health and crippled-children's programs basing them on existing services and facilities and on its own particular needs. Areas with the fewest services and facilities, such as rural areas or selected urban areas, must receive early attention, but plans for such areas would have to be related to the ability of the State to expand its basic health services and its health-center and hospital-construction program, and to provide medical-consultation service and appropriately trained personnel. I believe that, under the provisions of this bill, expansion of each State's program can be organized to keep pace with the recruitment and training of personnel to do the job, with the evolution of sound administrative and technical practices and procedures, with improvement of the quality of service and care offered, and with the special needs of each State. If, during the period of expansion of this program, the national health program is enacted and new or different methods of financing are introduced to cover a large proportion of the population, the Congress would undoubtedly provide in its legislation for the coverage of many of the individuals who are provided for under this bill. Adjustments could be made so as to fully utilize the financial provisions of such a program for maternity care and for medical services for children. During the past 11 months careful study has been given to the provision of this bill by many groups and organizations, and a variety of suggestions for amendments have been made. In the fall of 1915 the Children's Bureau called a special meeting of its Maternal and Child Health and Crippled Children's Advisory Committees to discuss the provisions of this bill and sought criticism to assist the Bureau in formulating proposals for amendments. I submit herewith a copy of the report of these advisory committees for the information of this committee, and I would like to point out at this point that the committee requested when they prepared this report as submitted to the Children's Bureau, that this report be submitted to any congressional committee that is considering the provisions of this bill, and so I would like to make this available to you. Senator PEPPER. Would you like to offer it for the record? Dr. ELIOT. It may go in the record, however the committee desires it. Senator PEPPER. Is it the same one I put in the record earlier today? Dr. ELIOT. I do not believe so. I am not sure. Senator PEPPER. All right. It will be received. (The document referred to is as follows:) REPORT OF ANNUAL MEETING OF THE CHILDREN'S BUREAU ADVISORY COMMITTEES ON MATERNAL AND CHILD HEALTH SERVICES AND ON SERVICES FOR CRIPPLED CHILDREN, CHILDREN'S BUREAU, UNITED STATES DEPARTMENT OF LABOR, NOVEMBER 8 AND 9, 19451 The meeting was called by the Associate Chief of the Children's Bureau particularly to obtain advice on Senate bill 1318 (H. R. 3922, H. R. 3994, H. R. 4059) known as the "Maternal and Child Welfare Act of 1945." To this end six com 1 Report prepared by Dr. Allan C. Butler at the direction of the Advisory Committee. |