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. HOBBY. 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 PURTELL. Just for Senator Goldwater's information? 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. (The information requested follows:) 1 Average per bed project cost (adjusted to March 1954 cost index) under the hospital survey and construction program Location Representative building construction costs-Hospital facilities approved for construction 593, 200 GENERAL HOSPITALS-NEW BUILDINGS $1.52 $708,400 $22.00 $14, 168 .do.. 982, 000 18.62 1.45 1, 177, 000 22.55 11,770 December 1952 1, 320, 121 24.74 2. 22 1,560, 000 29.20 19, 024 cast stone, terra cotta, reinforced con- 138, 500 1 story-no basement. Fireproof, Part basement, 1 story. Fireproof, 2 stories. Bar joists, brick-faced terra 2 stories, Reinforced concrete block 4 stories. Reinforced concrete frame; Mar. 1953. 786, 194 18.74 1.65 869,387 20.73 14,490 355, 000 GENERAL HOSPITALS-EXTENSIONS 22.50 1.89 26. 17 16,478 Basement and 3 stories. Fireproof, 5 stories-no basement, fireproof, con- 2 and 6 stories. Fireproof construction, do. 1,411, 868 do. 145, 896 19.45 1.48 172,500 23.00 9, 100 2 stories. Fire-resistive construction. 67, 600 2 stories. Brick walls, stone-faced, re- Tryon, N. C. 19 7,500 395 98,700 February 1953. 112, 100 24.91 2.04 138,000 30.67 5,750 Senator LEHMAN. In these diagnostic and treatment centers, is it proposed to provide psychiatric treatment in the event that somebody 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 psychiatric treatment in many cases, and in the ideal diagnostic and treatment clinic or center such service would probably be available. Senator PURTELL. Are 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. HOBBY. 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 peoplewith lower unit costs for construction, and with lower daily costs for patient care I would like to pause for a few minutes while the charts are changed before I proceed to 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. 2578, 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 rehabilitation through Federal income taxes. In the area of vocational rehabilitation, the President's health message calls for a vastly expanded program-a goal of 200,000 rehabilitants annually by 1959 as compared with the present 60,000. If these |