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STATEMENT OF MRS. OVETA CULP HOBBY. SECRETARY, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, ACCOMPANIED BY NELSON A. ROCKFELLER UNDER SECRETARY. AND ROSWELL B. PERKINS, ASSISTANT SECRETARY, DEPARTMENT OF HEALTH, EDUCATION. AND WELFARE: DR. LEONARD SCHEELE, SURGEON GENERAL, PUBLIC HEALTH SERVICE: ARTHUR KIMBALL, ACTING DEPUTY DIRECTOR, OFFICE OF VOCATIONAL REHABILITATION; DR. JOHN W. CRONIN, CHIEF, DIVISION OF HOSPITAL FACILITIES, PUBLIC HEALTH SERVICE: AND MISS MARY SWITZER, DIRECTOR, OFFICE OF VOCATIONAL REHABILITATION

Mrs. HOBBY. Mr. Chairman and members of the committee, I appreciate the privilege of appearing before you today in support of S. 2758, which was introduced by the chairman of your committee to implement one of President Elenie wer's principal recommendations for progressive health legislation. This bill relates to the construction of hospitals and related health facilities. Our testimony will also encompass the provisions of H. R. 149, a bill passed by the House last week which is identical in most respects.

As your subcommittee chairman has indicated, the legislation you are considering this morning is part of an integrated health program proposed by the President in his special message to the Congress of January 1. The schedule of hearings arranged by your subcommittee will provide an excellent opportunity for thorough consideration of each proposal contained in the President's program.

The recommendation that the Hospital Survey and Construction Act be broadened is the first of these proposals which you have selected for discussion. The hospital survey and construction program, generally known as the Hill-Burton program, is one of the most successful health programs ever undertaken by the Federal Government in cooperation with the States. A large measure of credit for its success belong to your committee, which played such a prominent role in the enactment of the original Hospital Survey and Construction Act in 1946. The soundness of the program was reaffirmed by the Congress in 1949 when it expanded the program and in 1953 when it extended it- duration through the fiscal year 1957.

The essential features of the Hospital Survey and Construction Act are well known to your committee. Briefly, the law provides that each State and Territory, as a prerequisite to obtaining Federal aid, shall prepare and keep current a survey of its existing hospitals and public health centers and of its needs for additional facilities. On the basis of this survey, the State develops a plan, or program, for additional construction where it is most urgently needed.

Out of such sums as are appropriated annually by the Congress, allotments are made to the States and Territories to assist in the construction of hospitals in four major categories--general, mental, chronie di ease, and tuberculosis-as well as for public health centers. Progres under the program to date has indeed been very satisfying. We can now report that 2.200 projects have been approved, utilizing $600 million of Federal funds and $11, billion of State and local money. A total of 106,000 hospital beds, 446 public health centers, and many related health projects, such as nurses' training facilities

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

Our greatest need today lies in the area of facilities for the chronially 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 ptable 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 art 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 information 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 healing 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?

Mrs. HOBBY. This one works today, Senator.

Dr. SCHEELE. Mr. Chairman, members of the committee, Mrs. Secretary: 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 addition, the act authorized, and there have been constructed, many facilities 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 beds. Total need is measured by the State in its survey, and these needs are based on formulas which are in the act, for example, 41⁄2 to 3 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 acceptable-that is, if they are in reasonably fireproof buildings; if they

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have the at least minimum facilities that would entitle them to be called useful hospital beds. If they meet those qualifications, then they are considered acceptable.

So we have 516,000 beds in acceptable general hospitals, 86,000 of which have been aided by this program; and an unmet need of approximately 200,000.

In the field of mental beds, 438,000 acceptable beds and an unmet need of approximately 350,000.

Chronic beds, 48.000 acceptable: 240,000 unmet needs.

Tuberculosis beds, 6 acceptable beds, and 40,000 unmet need. Senator GOLDWATER. Why is the ratio so much better in the tuberculosis beds than it is in the rest! Is there something happening to that picture that has caused that to come about in the last several years!

Dr. SCHEELE. We have had a very intensive campaign in our States and communities to find cases of tuberculosis and then to hospitalize those cases: so there has been a great amount of community planning to find cases, and since we are finding cases, to produce the facilities in which to house them.

Serator GOLDWATER. I was wondering if the new theory of treatment, that is, rest in the home, might change that picture some!

Dr. SCHEELE. It has not as yet. We still do not have sufficient knowledge on the value of home care, and treatment with the newer drugs, to put us in a position to say that we want to move away from continue i construction of tuberculosis beds.

Senator GOLDWATER. I am surprised to find that picture, frankly, because you know my State of Arizona probably has the highest tuberculosis death rate in the country. We are not in that good shape out there. We are way short.

Dr. SCHFFLE. This is, of course, the national aggregate. The State of Connecticut. I understand, has now arrived at the point in its tuberculosis control program where they have no backlog of patients awaiting admission. There are many communities in your State, I believe, in which there is a long waiting list of people waiting for hospitalization.

Serator GOLDWATER. I am sure that no Arizonian in his right mind would want to move out of that State but if the State of Connecticut is in that good a condition

Senator PURTVIL. If he ever wants to settle in Connecticut and ever move out of there, even as a TB patient————

Senator LEHMAN. May I ask a question there, Doctor? Referring to your secord chart, you show 516,000 acceptable beds in general hospris. Does that include the 86,00 that were built under the Hosptal Construction Act!

Dr. SCHELLE. Yes, sir.

Serator LERMAN. Oristat exclusive

Dr. SCHEFLE. That is inclusive of the $6,000 which were aided with funds under this program.

Senator HuL That leaves how many now needed!

Dr. ScHFFLE. Approximately 200,000,

Senator HHL. How mary rental!

Dr. SCHEFLE. Approximately 350,000,

Senator LEHMAN. Do those 11,000 mental beds refer to private hos

pitals or State hospitals!

Dr. SCHEELE. These are primarily State hospitals, although I believe the overall planning private beds are accounted for, but actually 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 rojected mental health bed need is based on a concept of putting most al health patients in a mental health institution of the ordinary pe. Actually, the program that Mrs. Hobby is describing to you morning would, I am sure, take some of the pressure off for some these beds. Among these older people, there are some who have ening of the arteries of their brain, who are senile, and a bit disnted. Because of these conditions they are often committed by Nate courts or by voluntary commitment, family commitment, to regular mental institutions. Many of them could probably be cared for in less elaborate facilities, even in nursing homes if there were an ate number. So that the projected need is, in a sense, a variable nding on the total spread of facilities that exists in any period of

Nezator PURTELL. Does the number of acceptable beds that you have So there, Doctor, make any allowance for the large number of sting beds for civilians in Federal hospitals including some 50,000 In the Veterans' Administration establishments?

T. SCHEELE. That is not included. One could lower these bars on hart if one took the Veterans' Administration beds into account. Senator PURTELL. Ought we not to take that into consideration you are using that as a base for determining the number of beds thousand of population and they are part of the population? Dr. SCHEELE. We could probably reduce the ratios that we are using a small fraction and have a more accurate picture. I might point however, that we still have a need, and we would only take off a all portion of this bar if we dropped the VA beds.

Senator HILL. Doctor, you say about 200,000 general hospital beds areeeded: 350,000 mental. How many now in chronic?

Dr. SCHEELE. Two hundred and forty thousand, approximately. Senator HILL. Two hundred and forty thousand, approximately, c. And how many tuberculosis?

Dr.SCHEELE. In the tuberculosis field, approximately 40,000.
Senator HILL. Forty thousand.

Dr. SCHEELE. In this next chart (D) we have projected these shortand accomplishments in percentages as contrasted with numbers housands of beds in the former chart. Here we see the greatest et need, 88 percent, is in this field of chronic beds; 31 percent het in general beds; 48 percent mental, and 26 percent tuberculosis. Snator PURTELL. Are there any other questions the committee shes to ask before those charts are taken down?

Proceed with the rest of the charts, if you will, Doctor.

Dr. SCHELLE. It is interesting to project this shortage of chronic el against some of the changes which are occurring in our ulation.

For example (chart D), in 1900, when our national population was oximately 76 million, we had 3 million people (shown here in le). 65 years of age and over. By 1950, our population had abled to approximately 151 million. But our population age 65 Wars of age and over had quadrupled to 12 million. During the 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 hospital 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 burden. Major, long-term illness can become a financial catastrophe for a norma! American family. Ten percent of American families are spending today more than $500 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 medical and dental care. The total private medical bill of the Nation now exceeds 89| billion a year-an average of nearly $200 a family-and it is rising. This illus trates the seriousness of the problem of medical costs.

We must, therefore, take further action on the problems of distribution of medical facilities and the costs of medical care, but we must be careful and farsighted in the action that we take. Freedom, consent, and individual responsibility 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 access.

Second, the results of our vast scientific research, which is constantly advancing our knowledge of better health protection and better care in illness. should be broad'y applied for the benefit of every citizen. There must be the fullest cooperation among the individual citizen, his personal physician, the research scientists, the schools of professional education, and our private and public institutions and services-local, State, and Federal.

The specific recommendations which follow are designed to bring us closer to these goals.

Continuation of present Federal programs

In my budget 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, Education, and Welfare.

These programs should be continued because of their past success and their present and future usefulness, The Public Health Service, for example, has had a conspicuous share in the prevention of disease through its efforts to control health hazards on the farm, in industry, and in the home. Thirty years ago the Public Health Service first recommended a standard milk sanitation ordinance: by last year this ordinance had been voluntarily adopted by 1,558 municipalities with a total population of 70 million people. Almost 20 years ago the Public Health Service first recommended restaurant sanitation ordinances; today 685 municipalities and 347 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 epidemics and saved thousands of lives. These and similar field projects of the Public Health Serv ice, such as technical assistance to the States, and industrial hygiene work, have great public valve and should be maintained.

In addition, the Public Health Service should be strengthened in its research activities. Through its National Institutes of Health, it maintains a steady attack against cancer, mental illness, heart diseases, dental problems, arthritis and metabolic diseases blindness, and problems in microbiology and neurology. The new sanitary engineering laboratory at Cincinnati, to be dedicated in April, will make possible a vigorous attack on health problems associated with the rapid technological advances in industry and agriculture. In such direct research programs and in Public Health Service research grants to State and local governments and to private research institutions lies the hope of solving many of today's perplexing health problems.

The activities of the Children's Bureau and its assistance to the States for maternal and child health services are also of vital importance. The programs for children with such crippling diseases as epilepsy, cerebral palsy, cong nital heart disease, and rheumatic fever should receive continued support.

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