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Mrs. HBeT. Wr. Chairman armen.bers of the committee, I appreciate the privire of apierry before you today in support of 5.2, which was iliruluerbs in chartan of your committee to implement ore of Presiile!. Eerk wer's przcipal recommendations for progressive baith leg-latin. T!: s bill relates to the construction of top.tals and related health facities or testimony will also encompas the provisions of H. R. S. a bill passed by the House la-f work whii is identical in most rrepietis.

1. your suixeunimittee chairman las indikatel. tiie legi-lation you are montering this nornir.. is part of an integrated health program propried by the President in his per al Desire to the Congress of January 1". The schelule of hearing arranged by your subcommittee will provide an excellent opportunity for thorough conmidleration of each proposal contained in the President's program.

The recommendation that the Hospital Surver and Construction Art by broadened in the fint of these prepevals which you liave elected for dinuzion. The hopital survey and construction program. generally known as the Hill-Burton program, is one of the most success. fulliealth programs ever undertaken by the Federal Government in Coxiprsation with the stater. I large measure of credit for its success tulong to your committee, which plave such a pronnnent role in the enactment of the original Hospital Survey and Construction Act in 1916. Typ soundness of the program was reathirmed by the Congress in 1999 when it expaneled the program and in 1950 when it extended 1to sluration through the fiscal year 1957.

'The fastential features of the Hospital Survey and Construction et are well known to your committee. Brietiv; the law provides that Perbestate and Territory, is a prerequisite to obtaining Federal aid, shull progare and keep current a survey of its existing hospitals and problee walth centers and of its nered for additional facilities. On the bensm of the murvey, the State develops a plan, or program, for aidiflonal con-trixtion where it is most urgently needed.

Out of urbe mums are appropriated annually by the Congres, allotments are made to the States anal Territoriem to anxist in the conmit sention of boompostals in four major categories--general, mental, chronic 1101-e, ha tuberculosiswas well as for public health centers.

l'intester the program to date has indeed been very satisfying. W's now report that 2.203) projects have been approved, utilizing

million of Federal funds and sli, billion of State and local meg. A total of 106,00 hopital beris, 416 public health centers, end any related health projects, such as nurstraining facilities

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and laboratories, are being added to our health resources. Nevertheles, there still remains much to be done.

Our greatest need today lies in the area of facilities for the chroni-
ally ill. By far the greatest percentage of construction under the
program thus far has been in the general hospital category. As a
consequence there has been a national net gain in the number of
aptable general hospital beds since 1948, when construction under
the program commenced. During this same period, however, there
has been a net loss in the number of acceptable hospital beds for the
care of patients with chronic diseases, including cancer, arthritis and
heart disease. Thus, as valuable as the present program is, it has not,
to date. provided a balanced answer to our Nation's needs for hospital
and health facilities.
Before turning to the provisions of S. 2758, Mr. Chairman, I should
like to ask Dr. Scheele to present some additional background infor-
mation in graphic form.

Senator PURTELL. We will be very happy to have Dr. Scheele do so.
I think, Mrs. Secretary, that it is auspicious that we are starting
these hearings on St. Patrick's Day. If we can do as well with heal-
ing programs as St. Patrick is reported to have done with the snakes,
we will have accomplished a great deal.
Senator Hill. Do you have a magic wand?
Jirs Hokey. This one works today, Senator.
Dr. SCHEELE. Mr. Chairman, members of the committee, Mrs. Sec-
retary: Mrs. Hobby has described to you some of the accomplishments
of the program under the Hill-Burton Act to date. She has referred
to the construction or approval of projects for adding 106,000 beds to
our Nation's bed supply as a whole.

This chart A shows how these beds break down into the 4 principal
Categories provided for in the original act: 86,000 of them are general
medical and surgical beds; 11,000 are mental beds; 3,000 are chronic
beds; and 6.000 are tuberculosis beds.
The Secretary has referred to another part of the program, namely,
the assistance in construction of 446 public health centers. In addi-
tion, the act authorized, and there have been constructed, many facil-
ities related to hospitals, such as diagnostic centers, nurseries for
premature infants, and training facilities for nurses.

In addition, a number of State health department laboratories have
been aided.

Now, the next chart (B) projects the beds that have been built and will be built with assistance under this program, against the total need in the four categories mentioned. The green areas showing in these bars

, and showing in the following chart, represent the same beds that are shown here in the first chart.

Here we see that we have this projection against the total need for berls. Total need is measured by the State in its survey, and these needs are based on formulas which are in the act, for example, 41, to lo beds in the general category, 5 per thousand in the mental health category, 2 per thousand in chronic disease category, and 21/2 times the average annual deaths in the State measured over a 5-year period, 1940 to 1944, for figuring needs in the tuberculosis field. Also, the States investigate existing beds in the States to see if they are acceptall-that is, if they are in reasonably fireproof buildings; if they

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have the at least minimum facilities that word entitle them to be caliai useful hospital kels. If they meet these qual.fications, then they are considerri aceptable.

we bare 516,0 beds in acceptable general hospitals, 56000) of which have kmen aided by this program; ard an urimet need of approximately).

in the fied of mental bels. AS acceptable bels and an unmet need of approximately 3.71

(hronie beis. 15.11acceptable: 2:0. urmet Deels.
Tuberrulos berts, i acceptable beds, and an unmet need.

Senator GOLDWATER. Why is the ratio so much letter in the tuberculis beds than it is in the rest! Is there whething happening to that picture that has caused that to con.e about in the last several rears!

Dr. SCHEFLE. We have had a rery intensive campaign in our States and comin:unities to tind camps of tulereuknis and then to hospitalize those cases; so there has been a treat amount of community planning to tind caps, and since we are finding cases, to produce the facilities in which to honse them.

senator GOLDWATER. I was wondering if the new theory of treatment, that is niet in the home, might change that picture some?

Dr. SCHEILE. It has not as bei. We stiil do Tut have sufficient kresleriye on the value of home care, and treatment with the newer drugu, to put 11- in a position to say that we want to move away from continue constrution of tuberculosis bends

Senator GOLDWATER. I am surprised to tired that picture, frankly. ***1/1-e you know my state of Arizona probably has the higheat tuberculori obrath rate in the country. We are not in that gooi shape out there. We are will short,

Dr. SHFELE. This in, of coure, the national aggregate. The State of Conratkut, I undertand, has now arrive at the point in its tulerruloomin inntrol program where they have no ba klog of patients anttiru admi-on. There are many communities in your State, I {m:pte, in which there is a long waiurg line of people waiting for hrepitalizita).

Senator G IDWATIR. I am sure that no Irizonian in his right mind would want to move out of that state but if the state of Connecticut in in that go a condition

stor Purul. If he ever wants to settle in Connecticut and pips me out of there, even as a TB patient

Spintor LFHMX. May I ask a question there, Dextor? Referring to pulir perhart, you show 510) geceptable bees in general berpres Dram that include the steht that were built under the H

pal (ot-trution lit! Dr.MF. Visi r.

itor LHMEN. Orisalterunive! Ir. HFF. That is inslusve of the wick) which were aislari with fund- under this pretien. Stor HmL. That leave how many now needed! Dr. UHF. Upprunately

nator HI Ilowa! I'r. SCHEE Appropriately shem)

Senator LIMAX. It: 11. mental beds refer to private hospitals or State hopitai!

DE SCHEELE. These are primarily State hospitals, although I believe
a the overall planning private beds are accounted for, but actually
De ratios are very much on the side of public beds in this field.
I might say at this point-and this is a bit of digression that this

a mojated mental health bed need is based on a concept of putting most recital health patients in a mental health institution of the ordinary pleActually, the program that Mrs. Hobby is describing to you

morning would, I am sure, take some of the pressure off for some it these beds. Among these older people, there are some who have

ening of the arteries of their brain, who are senile, and a bit disTanted. Because of these conditions they are often committed by Site courts or by voluntary commitment, family commitment, to rezolar mental institutions. Many of them could probably be cared bir n less elaborate facilities, even in nursing homes if there were an wie wste number. So that the projected need is, in a sense, a variable ding on the total spread of facilities that exists in any period of

Autor PURTELL. Does the number of acceptable beds that you have coat, there, Doctor, make any allowance for the large number of Ating beds for civilians in Federal hospitals including some 50,000 son the Veterans Administration establishments?

Ir. SCHIELE. That is not included. One could lower these bars on "xshare if one took the Veterans' Administration beds into account. wator PURTELL. Ought we not to take that into consideration

* vou are using that as a base for determining the number of beds po thousand of population and they are part of the population?

Ür. SCHEELE. We could probably reduce the ratios that we are using kasuall fraction and have a more accurate picture. I might point $it, however, that we still have a need, and we would only take off a :.!! portion of this bar if we dropped the VA beds.

Senator Jill. Doctor, you say about 200,000 general hospital beds
Freeled ; 350,000 mental. How many now in chronic?
Dr. Scurele. Two hundred and forty thousand, approximately.
Senator Hill. Two hundred and forty thousand, approximately,
mic. And how many tuberculosis?
Dr. SCHEELE. In the tuberculosis field, approximately 40,000.
Senator Mill. Forty thousand.
Dr. SCHEELE. In this next chart (D) we have projected these short-

and accomplishments in percentages as contrasted with numbers honsands of beds in the former chart. Here we see the greatest 12't need, 88 percent, is in this field of chronic beds; 31 percent altre in general beds; 18 percent mental, and 26 percent tuberculosis. nator PURTELL, Are there any other questions the committee Tules to ask before those charts are taken down? Proceed with the rest of the charts, if you will, Doctor. DR. SCHLELE. It is interesting to project this shortage of chronic lorida against some of the changes which are occurring in our

For example (chart D), in 1900, when our national population was priimately 76 million, we had 3 million people (shown here in mole). 65 years of age and over. By 1950, our population had duliled to approximately 151 million. But our population age 65 frars of age and over had quadrupled to 12 million. During the same period of time, life expectancy had increased from 49 years to

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are, for example, 159 practicing physicians for every 100,000 of the civilian population in the Northeast United States. This is to be contrasted with 126 physicians in the West, 116 in the North Central area, and 92 in the South. There are, for another example, only 4 or 5 hosp.tal beds for each 1,000 people in some States, as compared with 10 or 11 in others,

Even where the best in medical care is available, its costs are often a serious burslen. Major, long-term illness can become a fiancial catastrophe for a normal American family. Ten percent of American families are spending today more than $300 a year for medical care. Of our people reporting incomes under $3,000), about 6 percent spend almost a fifth of their gross income for and dental care. The total private medical bill of the Nation how 'eeds $9 billion a year-an average of nearly $200 a family--and it is rising. This illustrates the seriousness of the problem of medical costs.

We must, therefore, take further action on the problems of distribution of mertical facilities and the costs of medical care, but we must b) careful and farsig ited in the action that we take. Freedom, consent, and individual respon. sibility are fundamental to our system. In the field of medical care, th's means that the traditional relationship of the physician and his patient, and the right of the individual to elect freely the manner of his care in illness, must be preserved.

In adhering to this principle, and rejecting the socialization of medicine, we can still confidently commit ourselves to certain national health goals.

One such goal is that the means for achieving good health should be accessible to all. A person's location, occupation, age, race, creed, or financial status should not bar him from enjoying this accpes.

Second, the results of our last scient fie research, which is constantir ad. vancing our knowledge of bitter health protection and better care in illness. should be broad'y applied for the benefit of every citizin. There must be the fullest cooperation among the individual citizen, his personal physirian, the resach scientists, the schools of professional education, and our private and public institutions and services-local, State, and Federal.

The speritie recommendations which follow are designed to bring us closer to these goals. Continuation of present Federal programs

In my bulga't message, appropriations will be requested to carry on during the coming fiscal year the health and related programs of the newly established Department of Health, Eluation, and Welfare.

These programs should be continued because of their past success and their present and future 11pfulness. The Public Health Service, for example, has had a conspicuous share in the prevention of disease through its efforts to control health hazırds on the farm, in industry, and in the home. Thirty years ago the Public Health Service first recommended a standard milk sanitaisiin ordinance; hy last year this ordinance had been voluntarily adopted by 1,118 municipalities with a total population of 70 million people. Almost 20 years ago the Public Health Service first recommended restaurant sanitation onil. dance: foday 655 municipalities and 317 counties, with a total population of 90 million people have such ordinances. The purification of drinking water and the pasteurization of milk have prevented countless epidemies and enred thousan is of liver. These and similar field projects of the Public Health Serv. ice. much as fechanical assistance to the States, and industrial hygiene work, have great public value and should be maintained.

In addition the l'ubble Health Service should be strengthened in its research activities. Through its National Institutes of Health, it maintains a steady attack againnt cancer, mental illness, heart diseases, dental problems, arthritie and metabolic climate bilindness, and problems in microbiology and peurology. The new sanitarv en’ineering laboratory at ('incinnati, to he indicated in April, will make possible a vigorous attack on health problems asiated with the rapid technological advaners in industry and agriculture. In such direct research programs and in Public Health service research grants to state ani local povernments and to private researh institutions lies the hope of solving many of toutin's porplering halth problems,

The activities in the Children's Bureau and its assistance to the States for maternal and ched health services are also of vital importance. The protams for children with such crijptus diseases as epilepsy, cerebral palsy, congruital heart disease, and rheute lever should receive continued support,

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