TABLE 12.-Percentage distribution, by family income, of all families according to gross medicine charges

1 Gross medicine charges refers to the costs of medicines (either prescriptions or other drugs and t cines) which the family bought from the drugstore or elsewhere rather than medicines which a bi patient received and for which he was billed on the hospital bill. Similarly, it does not include medans which the doctor administered to the patient and charged for on the doctor bill.

Less than one-half of 1 percent.

* Percentages not computed for groups of less than 50 families.

TABLE 13.-Percentage distribution, by family income, of all families according to dental charges

* Dental charges are all charges by dentists for their services and any dental laboratory work.

* Less than one-half of 1 percent.

Percentages not computed for groups of less than 50 families.

TABLE 14.-Medians, by income group, for percentage of family income paid out for hospital, medical, and dental services and goods and for voluntary health insurance for families with incomes under $10,000 with and without insurance

1 These medians are for the families' net outlay for hospital medical and dental services and goods plus any amounts paid by the family for voluntary health insurance. That is, net outlay is gross incurred costs less insurance benefits received and amounts still owed on these incurred charges plus payments on old bills incurred prior to the survey year. In some instances it was not possible to distinguish payments for hospital, surgical, or medical expense insurance from payments for disability, accident or life insurance; therefore inasmuch as total outlay figures included these latter payments, these medians slightly overstate the percent of family income spent for the purposes stated above.

TABLE 15.-Outlay for hospital, medical, and dental services and goods and for voluntary health insurance as a percentage of family income

This figure, outlay for health, includes the outlay figure plus amounts paid for voluntary health insurance. That is, net outlay is gross incurred charges less insurance benefits received and amounts still owed on these incurred charges plus payments made on old bills incurred prior to the survey year.

I. e., for half of the families with some outlay for health, this outlay for health amounted to less than 4.1 percent of family income; for the other half of the families it amounted to more than 4.1 percent of family income.

NOTE.-Median percent for total outlay for health as a percentage of family income 2-4.1 percent.

TABLE 16.-Receipt of voluntary health insurance benefits to cover gross medical charges

1 Gross charges are here defined as hospital charges, physicians' charges, charges for medicines or mest mal appliances, charges for other medical services and dental charges incurred by family members. It desti include travel costs and other costs incidental to illness but not directly for medical services or gods. 3 does not include the "cost" of free care, but it does include the estimated gross charges for hospital care un be a service plan and medical service in the case of services from comprehensive plans. Moreover, these we gross incurred charges. That is, they include unpaid bills for services received during the survey year an they, of course, exclude payments made on bills incurred prior to the survey year. They also exclude the family's medical expense for persons not currently a part of the family unit (except for family members deceased during the survey year), and they exclude premium payments for voluntary health insuran 2 In 227 of these families where no insurance benefits were received, no gross charges had been inctarted Among those who received insurance benefits, half received amounts which covered 32 percent is of charges and half received amounts which covered more than 32 percent.

NOTE.-Median percent of gross charges covered by insurance=32 percent.

TABLE 17.-Receipt of hospital insurance benefits to cover gross hospital charges

1 Gross hospital charges are the total amount of hospital bills. It includes total room-and-board chaters, laboratory fees, drugs, X-rays, and the usual extras, but it does not include special nursing, the anestoel2") fee when anesthesla was administered by an outside anesthetist, or physician's fees. These gross chanc were mainly incurred in connection with in-patient care, but in a few instances they were for emergency Cub patient care. Gross hospital charges exclude the "cost" of free care. (About 1 or 2 percent of lainaki received only free hospital service.)

11. e., among those families who received hospital insurance benefits, 30 percent had 89 percent or more d their gross hospital charges covered by hospital insurance benefits, so that their net hospital charges wert percent or less of their total hospital bills.

NOTE.-Median percent of gross hospital charges covered by hospital insurance *=89 percent.

TABLE 18.-Receipt of hospital, surgical, and medical insurance benefits to cover gross surgical charges

1 Surgical charges are physicians' charges incurred in connection with surgical procedures, a surgical procedure being defined so as to include the treatment of fractures and dislocations as well as "cutting" procedures. In general, these are the charges for the operations, but in some instances they include charges for post-operative care.

NOTE.-Median percent of gross surgical charges covered by insurance=75 percent. Half of the families who received insurance benefits to cover surgical charges received 75 percent or more to cover these charges and half received less than 75 percent.

TABLE 19.-Receipt of maternity benefits to cover gross obstetrical charges

1 Gross obstetrical charges include physicians charges for prenatal care as well as for delivery. Where currently pregnant women had not yet been billed for any part of this care, these charges were treated as not yet incurred. In the case of delivery by Caesarean the charge for the delivery was included under surgical charges.

NOTE.-Median percent of gross obstetrical charges covered by insurance-60 percent. Half of the families who received maternity benefits had 60 percent or more of gross obstetrical charges covered and half had less than 60 percent covered.

3. UTILIZATION OF PERSONAL HEALTH SERVICES AND VOLUNTARY HEALTH

INSURANCE DURING SURVEY YEAR

PART III. HIGHLIGHTS

1. The general hospital admission rate for all families was 12 per 100 persons per year. Those with insurance had a rate of 13 and those without insurance a rate of 10.

2. The average length of hospital stay for all persons hospitalized was 9.7 days with virtually no differences between those with insurance and without insurance.

3. The number of hospital days for 100 persons per year was 100 days; for those with insurance the rate was 110 per 100 persons, and for those without insurance the rate was 80.

4. The insured rural-farm population had a hospital admission rate of 17 per 100 and the insured urban population had a rate of 12. There was no difference for those not insured.

5. The number of surgical procedures per 100 persons per year for all families was 6; among insured families the rate was 7 and among the uninsured the rate was 4.

6. Among all families, 34 percent of the individuals sought dentists' services during a year, varying from 17 percent for income groups under $2,000 to 36 percent for income groups over $7,500.

There has been a great increase in the utilization of personal health services in this country since 1940. Some of this increase has been attributed to the rise of voluntary health insurance and greater availability of facilities, and some to improved economic conditions for the great bulk of families. Insurance per se is followed by an increase in utilization which is the chief reason why there is still debate as to whether personal health services are insurable or not. Fire insurance does not necessarily increase fires nor does life insurance increase the death rate, but health insurance does increase the utilization rate of personal health services, as will be revealed in data to follow, since the need for health services is not as easily determined as the fact of a fire or the finality of death. Whether or not this increase is good or bad can also be endlessly debated. There are no standards, except very gross ones, of a normal hospital rate or a normal surgical rate. The rates emerge from the patterns of practice of thousands of physicians in their treatment of hundreds and thousands of patients. What was normal utilization 25 years ago is no longer normal utilization today because so many factors have changed: buying power, new, medical discoveries, and people's attitudes toward hospitals and other health services. A hospital admission rate of 130 per thousand today may be just as normal as a rate of 50 not so many years ago. Both reflect a combination of circumstances the separate elements of which are almost impossible to disentangle Whatever the utilization rate may be, it can be assumed that the country, individually and collectively, is willing to pay the cost, otherwise insurance would not be so widespread and hospital beds and physicians would not be in such great demand. Thus, it can be said with certainty that the data to follow are a measure of effective demand.

1. The amount of hosiptal care received

On the basis of the national sample of families and individuals interviewed in this survey, the admission rate to general hospitals was 12 per 100 persons per year. Those with some insurance had a rate of 13 and those without insurance a rate of 10. On a national scale the difference between 13 and 10 is a measure of the impact of hospital insurance on hospital admissions today. (See table 1, appendix.)

Hospital admissions by income group indicates that not until the family income is $7,500 or over does the hospital admission rate for those not insured equal the rate for those insured. In income groups below $7,500 there is an appre ciable difference between those with insurance as against those without insur ance, generally 25 percent higher for the insured group. On the other hand, among families without insurance there is comparatively little difference be tween income groups until $7,500 is reached. The high admission rate of 19 in the lowest income group among the insured can be explained, at least in part, by the fact that this group contains a higher proportion of people 65 years of age and over than other income groups.

The data on the average number of hospital days per person hospitalized by family income and insurance status is difficult to interpret without more detailed knowledge underlying the facts. A high admission rate is usually associated with a short stay as measured by number of days per patient hospitalized. The average length of stay for all persons hospitalized is 9.7 days and there is vir tually no overall difference between those insured and not insured. (See table 2 appendix.) There are variations between income groups with insurance and those without insurance.

1 The usual manner in which to present hospital admission rates is by number of gömle sions per 1,000 population. In this survey the number per 100 population is used in one to avoid decimals which imply that there is, for example, a significant difference between 1 rate of 12.1 per 100 and 12.4 per 100 or 121 per 1,000 and 124 per 1,000. Instead be th rates are rounded out to 12 per 100.

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