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figured on the total facilities in the hospital and if you had both the diagnostic X-ray and the therapeutic treatment X-ray (for skin diseases and so on), the bed cost in the latter hospital will be higher than the bed cost in the hospital without the therapeutic X-ray. So, when one discusses bed costs, one has to give a picture of comparable costs. It is very difficult to compare apples and oranges. You have to talk about the same thing. But according to all our statistics, and I can assure you there are facts, $16,000 per bed cost is the national average for general hospitals today. .

The big, university medical school hospitals that have radio-active isotope facilities and the whole gamut of the instruments of precision and their complex equipment lists will run up much higher. They will run $22,000 to $25,000 per bed. The small community hospital of 35 beds may be down as low as, in some instances, $12,000 to $13,000 a bed. But in the total computation of these figures if you lay it out on a chart, you see two clusters--there are two clumpings. There is a clumping on the upper range of figures around $20,000; that range may be $19,000 to $25,000 per bed. We get another clumping down around $12,000 to $14,000 per bed. So $16,000 is the average between the two. And it is factual for the country today.

Senator GOLDWATER. I am not being critical of that except in this sense. I think it would be wrong for your organization and this committee of the Senate to encourage communities to construct hospitals on the idea that they might do it this cheap.

There is another point to remember in this. We are taking the average of Hill-Burton. Hill-Burton started before the ravages of inflation really got going on costs. For instance, in 1947 and 1948, perfoot building costs were as low, basic costs were as low as $6 and they are up to $10 and $11 now. By the same token, your hospital construction instead of being $20 in those days was probably $14 or $15, fixturized. So if I were going to start to build a hospital in my community, I would not take $16,000 as being the amount. I recognize what you say is true, that a small hospital and a small community might' possibly be built at that figure. I doubt it, even in a 35 or 50 bed hospital today:

I do not want to be picking faults with you. I would just like to be realistic on these things when we go to the public with it. We got caught on that. I was chairman of a drive to raise $2 million to build a hospital that we have spent $5 million on that we have not finished yet.

Mrs. Horry. I got caught the same way, Senator.

Senator PURTELL. I am sure that the point you are making is a good one, Senator.

Senator GOLDWATER. I wonder if we could get that study that you made just for our own information ?

Mrs. Hobby. Make it available for the record?

Senator GOLDWATER. Show the groupings, where we are getting this money.

Senator PIRTELL. Just for Senator Goldwater's information!
Do you desire to have it in the record ?
Senator Hill. It might be a good idea to have it in the record.

Senator PURTELL. We will receive it and it is ordered to be placed in the record.

PRESIDENT'S HEALTH RECOMMENDATIONS

(The information requested follows:)

Average per ded project cost (adjusted to March 1954 cost index) ' under the

hospital survey and construction program

Fiscal year

Average project cost

Cost adjusted Adjusted cost to March as of March 1954

1954

per bed

1948 1949. 1950. 1951 1952 1953

$13, 600
12,689
13, 240
16, 676

16, 245
: 16, 726

Percent

+27 +24.3 +16.5 +9.2 +5.2 +1. 46

$17, 300 15, 800 15, 400 18, 200 17,000 17,000 16, 780

Average adjusted bed cost as of March 1954.

I Engineering News Record building cost index (1913= 100). 1 To date.

on the total facilities in the hospital and if you had both ic X-ray and the therapeutic treatment X-ray (for skin de

so on), the bed cost in the latter hospital will be higher bed cost in the hospital without the therapeutic X-ras. S discusses bed costs, one has to give a picture of compar! is very difficult to compare apples and oranges. You har sont the same thing. But according to all our statistics

. 2 uire you there are facts, $16,000 per bed cost is the nation! or general hospitals today. s, university medical school hospitals that have radio-act: cilities and the whole gamut of the instruments of preces complex equipment lists will run up much higher. The 22.000 to $25,000 per bed. The small community hospita may be down as low as, in some instances. $12,000 to Siim it in the total computation of these figures if you lay it out . you see two clusters-there are two clumpings. There : ! on the upper range of figures around $20.000; that range 2,000 to $25,000 per bed. We get another clumping down ,000 to $14,000 per bed. So $16.000 is the average between nd it is factual for the country today. FOLDWATER. I am not being critical of that except in this hink it would be wrong for your organization and this of the Senate to encourage communities to construct hos

idea that they might do it this cheap. nother point to remember in this. We are taking the averBurton. Hill-Burton started before the ravages of inflatot going on costs. For instance, in 1947 and 1948. per ? costs were as low, basic costs were as low as $6 and the () and $11 now. By the same token, your hospital conead of being $20 in those days was probably $14 or $15, So if I were going to start to build a hospital in my comulid not take $16,000 as being the amount. I recognize

is true, that a small hospital and a small community y be built at that figure. I doubt it, even in a 35 or 3 oday. nt to be picking faults with you. I would just like to be pe things when we go to the public with it. We got : I was chairman of a drive to raise $2 million to build

we have spent $5 million on that we have not finished I got caught the same way, Senator. rill. I am sure that the point you are making is a good WITER. I wonder if we could get that study that you ir own information ? Make it available for the record! WATER. Show the groupings, where we are getting this FIL. Just for Senator Goldwater's information! to have it in the record!

It might be a good idea to have it in the record.
II. We will receive it and it is ordered to be placed

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reinforced concrete and steel.
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inforced gypsum slabs, 0. I. aluminum sash. (No excavation.) (Nursing wing of beds.)

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Senator LEIMAN. In these diagnostic and treatment centers, is it proposed to provide psychiatric treatment in the event that somebodly comes to them suffering from mental illness?

Dr. SCHEELE. That would, of course, be optional with the community that built the diagnostic or treatment clinic. We would hope that these clinics would be staffed by groups of physicians who would represent a variety of specialties Modern care of patients requires psvehiatric treatment in many cases, and in the ideal diagnostic and treatment clinic or center such service would probably be available.

Senator PURIELL. Ire there any other questions, Senator Hill?

Senator Hill. Not at this point. I have some questions later, but not at this point.

Senator PURTELL. Thank you very much, Doctor.
Mrs. Secretary, if you will proceed-

Mrs. Horby. Mr. Chairman, from what you have just seen, I believe it is clear that the proposals described thus far in our presentation would provide better medical and hospital services to more people with lower unit costs for construction, and with lower daily costs for patient care

I would like to panse for a few minutes while the charts are changed before I proceed io the rehabilitation facilities.

Senator PURTELL. We will be very glad to have this rest period.

We would like to compliment you on the excellence of your presentation here. With your graphic charts, it helps us understand a very very difficult problem.

Mrs. Hobby. Thank you very much.

5. REHABILITATION FACILITIES

Having discussed the first four major proposals of S. 2378, let us turn now to the fifth proposal--the construction of rehabilitation facilities

Rehabilitation is the process of restoring a physically handicapped person to the point where he can either take care of himself in the same, or even better, assume a position in productive employment. The latter is called vocational rehabilitation.

As the President stated in his message of January 18 on the health needs of the Nation, considerations of both humanity and self-interest demand immediate measures for the expansion of our rehabilitation programs. While, as the President states, "there are no statistics to portray the full depth and meaning in human terms of the rehabilitation program," nevertheless it also has a very practical dollars-andcents meaning. Rehabilitation for self-care is an important step in relieving the economic burden on families and the patient load in hospitals and nursing homes. Rehabilitation for employment has a direct effect in reducing governmental relief expenditures in those instances where disabled persons are receiving public assistance. Furthermore, as a group, disabled persons who have returned to work will, during their remaining

work lives, more than repay the cost of their rehabili. tation through Federal income taxes,

In the area of vocational rehabilitation, the President's health message calls for a vastly expanded programma goal of 200,000 rehabilitants annually by 1939 as compared with the present 60,000. If these

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