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the record-but I believe at one time we had over 900 bills for study. I would like to correct the figure, if it is wrong.

Senator HILL. Mr. Chairman, I imagine that Mrs. Secretary will want to give us some testimony sometime or some estimates sometime on the Humphrey bill because Senator Humphrey will be here tomor- “ row on that bill.

Senator PURTELL. I am advised that we have not been advised that he will be here tomorrow.

Senator HILL. Has he been advised to be here tomorrow?

Senator PURTELL. Yes.

Senator HILL. That means that if he does not come tomorrow, he will come in at a later time.

Senator PURTELL. That is correct.

Senator HILL. Of course we will have the bill before us and we will have to see it.

I would like to put in the record, Mr. Chairman, the budget estimates we have been talking about on health. I would like to put them in the record.

Senator PURTELL. So ordered.

Senator HILL. Thank you.

(The budget estimates referred to are as follows:)



1. The Department of Health, Education, and Welfare: A cut of $57 million 1954, $1,863,000,000; 1955, $1,806,000,000 (budget, pp. A9 or 644).

2. Social security, welfare, and health: A cut of $62 million. 000,000; 1955, $1,857,000,000 (budget, p. M60).

1954, $1,919,

3. Office of Education: A cut of $381⁄2 million. $121,601,500 (budget, p. 646).

1954, $160,295,611; 1955,

And as regards health:

4. Total funds for Public Health Service: A cut of $41 million. 1954, $232.830,950; 1955, $191,463,000 (budget, p. 647).

5. Funds for venereal disease control: A cut of $2.7 million (54 percent). 1954. $5,000,000; 1955, $2,300,000 (budget, p. 646). (Of course, we're conquering V. D., but not at a rate of 54 percent a year.)


6. Funds for tuberculosis control: A cut of $211⁄2 million (42 percent). $6,000,000; 1955, $3,500,000 (budget, p. 646). (Same comment.)

7. Funds for control of communicable disease: Cut more than half a million (though I haven't heard that the common cold has been licked yet). 1954. $5,009,000; 1955, $4,397,000 (budget, p. 646).

8. Funds for the going vocational-rehabilitation program: Cut $3.5 million 1954, $23,658,100; 1955, $19,825,000 (budget, p. 646). (They say they will ask $ million more if new legislation is passed.)

9 Funds for hospital construction: Cut $15 million. 1954, $65,000,000; 1955, $50,000,000 cbudget, p. 646), (Here again they say they will ask 60 million more if legislation is passed. But since 150 million is already authorized, the Prostdent could have asked for 110 million instead of 30 million without new łezislation)

10. Funds for Medical Research: At first glance, the budget would seem to indicate that the administration is adding some $30,000 to funds for medical research under the National Institutes of Health. Upon examination, however, it becomes apparent that grants made by the Institute for general medical research. for detection and for special cancer control projects have actually been cut by more than $2 million. This does not show up readily in the budget because $2,365,000 have been added for direct operations at the new clinical center out in Bethesda. The fact is that when the Congress authorized the building of that center we knew it would cost over $2 million to operate after it was built. We intended that that $2 million be added to the funds being spent for research. We expected that the administration instead of cutting research grants by $2 million

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Since they did

wald come before the Congress to ask for $2 million additional.
not we should have it clearly understood that a good deal of the money which at
tre glance would seem to be going for research is in fact going for housekeeping
er at Bethesda. Specifically, almost half a million dollars of the $2 million I
bae referred to is charged to the housekeeping section of the National Institutes
of Health. Over $400,000 is charged to service operations, and over $100,000 is
Do be spent for laundry. Now, I know that all of these services are essential to
The operation of the fine new center we have built. But I don't want anyone to
the impression that funds for cleaning approximately 1 million square feet
for space out there, or for washing 1,900 windows (and I don't know how
ften they wash them) are funds for medical research.

Conclusion: What on radio and television may sound like a "dynamic, progres-
gve, forward-looking program" in the field of health, education, and welfare
rts out, when we look at the hard facts as set forth in the budget, to be a
4amically, progressively, backward-moving program.

Senator PURTELL. Have you other questions, Senator?

Senator HILL. No, I want to thank you again, Senator, and I want to thank you, Mrs. Secretary, and all of those who have been very paent this morning.

Senator PURTELL. I want to thank you for helping us because the questions developed much what we will need in this record and I know it is going to be helpful to our colleagues on the committee and I want to thank you for the way in which information has been developed. Mrs. Secretary, I want to thank you and your associates for coming up here and helping us and you have been a very great help to us and I want to compliment you again on the way in which your facts were presented. I want to tell you that your whole statement including the change made today and including the charts, and I would like to have that clear, the charts will become part of the record.

Mrs. HOBBY. Sir, may I ask that this chart that we introduced at the last minute which we did not use as a part of the chart talk be included in the record?

Senator PURTELL. Is it not in your prepared statement?

Mrs. HOBBY. No, sir.

Senator PURTELL. It will be included if you will supply us with Something for the record.

(The statement and new chart referred to are as follows:)



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 chairmas of your committee to implement one of President Eisenhower'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. 8149, 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 18. The schedule 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 broadPied is the first of these proposals which you have selected for discussion. The

pital 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 belongs to your committee, which played such a prominent role it 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 its 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 Terri tory, 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, chronic disease, and tuberculosis— as well as for public health centers.

Progress 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 a billion and a quarter dollars of State and local moneys. 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 chronically 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 acceptable 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 information in graphic form.


Chart A-Results of program to date; 1947-53

Chart A shows the accomplishment of the hospital survey and construction program from its beginning in 1947 to 1953. A total of 106,000 hospital beds have been built or are under construction with Federal support. These are divided among 4 categories as follows: General medical and surgical, 86,000 beds; mental, 11,000; chronic disease, 3,000; tuberculosis, 6,000.

In addition, 446 public health centers have been constructed, as well as many other supporting facilities such as diagnostic centers, State health department laboratories, premature nurseries, outpatient departments, and nurse-training facilities.

Chart B-Acceptable hospital beds, 1954

Chart B shows the actual number of acceptable beds in the United States today, as determined by State surveys, in the four categories. The chart also shows (by the light segment in the middle of each bar) the number of beds that have been added under the hospital survey and construction program: i. e., the same data as shown on chart A. The upper part of each bar shows the unmet need in each category. Overall needs in each category are based on formulae contained in the original Hospital Survey and Construction Act.

This chart shows that the greatest degree of unmet need for hospital beds is for patients with chronic illness.

Chart C—Eristing and needed hospital facilities

Chart C is similar to chart B, but is in terms of percent of total needs rather than absolute number of beds. Taking the total number of beds needed in each of the 4 categories as 100 percent (the top of each bar), it shows, by percent, (1) the additional beds provided under the Hospital Survey and Construction Act, and (2) the remaining unmet need.

While there is a large remaining element of need in each of the four fields, the relative need in the area of chronic disease hospitals is by far the greatest88 percent.

Chart D-Increasing aged population

The need for more chronic beds is intensified by the aging character of our population. Chart D shows that in 1900, when the population of the United States was 76 million, the number of persons over 64 was only 3 million. In

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1961 the population of the country had doubled to 151 million, while the number d people over 65 had quadrupled to 12 million.

Chart D also shows that life expectancy over the same period has increased from 49 years in 1900 to 68 years in 1950.

Chart E-Chronic disease rise; infectious diseases decline

The aging character of our population is contributing to a change in the incidence of a number of common diseases. Chart E shows that, since 1900, the acidence of communicable diseases, such as tuberculosis, influenza, and pneuDenia have shown a gradual decline. On the other hand, certain chronic diseases, such as cancer and heart disease, have shown a steady increase since 1900. This chart illustrates the need for more emphasis on facilities for the care of ong-term illness.

Chart F-Days of hospital care for aged persons, 1951

Chart F shows the greater need for hospital care in the older age group. For the population under 65 years of age the requirement for hospital care in 1951 ras 1,045 patient days per 1,000 persons, or slightly more than 1 hospital day per person per year. In the age group over 65 the requirement was more than able that number, namely, 2,051 patient days per 1,000 population, or slightly than 2 hospital days per person per year.

hart G-Operating costs

Chart G shows the marked differential in operating cost between short-term Les general hospitals on the one hand, and long-term chronic hospitals and cursing homes on the other hand.

In the short-term general hospital the average operating cost is $18.35 per atent day; in the chronic disease hospitals, the cost drops to $6.63 per patient day, and in nursing homes the cost, while varying widely among individual Lomes, ranges from $2 to $8 per patient day.




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