What HIF does In carrying out its purposes, HIF: Studies health problems and needs and, aided by the expert opinions of its technical and advisory committees, determines those areas in which it will develop research projects. Collects information through research projects, through staff field investigations, and study of health literature. Disseminates the information through all available media--newspapers, magazines, speeches, radio, television, motion pictures, and its own published material HIF RESEARCH PROJECTS The following research projects have been completed, or are under way as indicated. An Analysis of the Multitest Clinic, Richmond, Va.-A report on findings of a clinic which screened 40,000 people for 8 health conditions, how it was conducted, and reactions of doctors and the public. Completed in 1951 by the HIF research staff under appropriations totaling $14,000. An Inventory of Social and Economic Research in Health.-A compilation of research projects being conducted in the United States, or completed since 1945. Two editions, 1952 and 1953, have been issued and a third will be published in 1954. Medical Public Relations.-This is a study of the efforts of the Toledo and Lucas County, Ohio, Academy of Medicine to improve medical services in the community. Conducted by Wayne University under an $11,700 HIF grant, it was completed in 1952. Three Studies of Community Self-Surveys on Health.-Through HIF grants totalling $115,330, these projects studied the operation of community self-surveys in which local groups, with a minimum of outside assistance, attempted to evaluate the adequacy of their existing health facilities, services, and personnel. The three projects were undertaken in communities of different sizes and in various parts of the country and conducted independently by Michigan State College, the University of Alabama, and the University of North Carolina. The research department of HIF will assess the self-survey method as a device for community health improvement. School Child Health Study.--A project designed to develop an experimental program to increase the correction of remediable defects found in school health examinations. The project was conducted by Pennsylvania State College under an HIF grant of $33.400. Study of Rural Negro Health Habits.-A study of cultural, economic, and educational barriers to positive health action, conducted by Tuskegee Institute under an HIF grant of $16,500. The report will be published in 1954. Paying for Medical Care in the United States.-Under an HIF grant of $92.000 Columbia University has completed a 2-year study which documents the various ways Americans pay for medical care. Published by the Columbia University Press in December 1953, the report contains information on the latest developments in voluntary hospital, surgical, and medical insurance. The following three projects on medical costs and voluntary health insurance were sponsored by HIF under grants totaling $330,000. 1. A survey of family medical costs and voluntary health insurance.This survey was conducted by the National Opinion Research Center, University of Chicago. (Results of the survey are summarized in this preliminary report.) 2. A study of the services rendered by health insurance in selected areas. This project, also conducted by the National Opinion Research Center of the University of Chicago, is based on a sample of Blue Cross, Blue Shield, and private insurance company contract holders in two cities. The purpose was to study the economic impact of uninsured illness, the effect of insurance on the use of health services and facilities, and the subscribers' desire for additional coverage. The final report will be published in 1954. 3. A study of the extension of health insurance coverage.—A series of projects supervised by HIF's research staff to determine how health insurance can be made available to people not now widely protected. The first project is a study of an experiment in "saturation" coverage conducted by Mississippi State College. The second, undertaken by the HIF research department, will study problems in nongroup enrollment. A study of the operation of a selected comprehensive physicians' service plan.—Directed by the Bureau of Public Health Economics, University of Michigan, an intensive study will be made in Windsor, Canada, of a comprehensive, physiciansponsored, medical service program operating on a fee-for-service basis. Under an HIF grant of $54,000 the project will be completed in 1955. Medical care problems of low-income families.-An exploratory project in a selected number of families to make an intensive case analysis of family expendi ture patterns, budgets, levels of living, etc., with primary emphasis on er penditures for health services. Initial grants amounting to $12,000 have been made by HIF for field studies by New York University and Tuskegee Institute. HEALTH INFORMATION FOUNDATION CITIZENS ADVISORY COMMITTEE Hon. Herbert Hoover, chairman Dr. Karl T. Compton, chairman of the corporation, Massachusetts Institute of Technology Donald Douglas, president, Douglas Aircraft Co., Inc. Dr. L. A. DuBridge, president, California Institute of Technology Mrs. Oscar A. Ahlgren, president, General Federation of Women's Clubs Dr. Franklyn B. Snyder, president emeritus, Northwestern University. OFFICERS Chairman of the board: John G. Searle, president, G. D. Searle & Co. Executive vice president: Kenneth Williamson Vice presidents: E. N. Beesley, president, Eli Lilly & Co. W. L. Dempsey, president, Sharp & Dohme, Division of Merck & Co., Inc. James Hill, Jr., president and chairman of board, Sterling Drug, Inc. George F. Smith, president, Johnson & Johnson Vice president and chairman of finance committee: George Van Gorder, preside Treasurer: S. Barksdale Penick, Jr., president, S. B. Penick & Co. THE LIBRARY OF CONGRESS, LEGISLATIVE REFERENCE SERVICE, Washington 25, D. C. SELECTED PREPAYMENT HEALTH CARE PLAN: A REVIEW OF THEIR PREPAYMENT PATTERNS FOR MEETING THE COSTS OF MEDICAL CARE The health-care plans outlined in the attached charts were selected to RES the variety of methods used by employers, consumers, unions, and doctors a furnishing prepaid medical care on a voluntary basis. They are sample plats chosen from the vast complexity of methods developing in this country to! to reflect new approaches as well as well-established patterns. They ircle therefore, plans which are experimenting with new types of prepayment prites tion--such as catastrophic illness insurance and preventive care-as well a plans which are more widespread and more typical. The selected plans reflect the fact that the most common prepayment meth is for the insuring agent to make cash payments directly to the medical personnel or facilities furnishing prescribed (fee-to-vendor) service up to certz maximum amounts. Beyond these maximums, the subscriber or employee bas the full cost of any additional charges which may be made. They also illustr the fact that such services are being financed through commercial insurer through nonprofit corporations or groups, and through mutual benefit or sumer cooperative organizations. Although the method of furnishing serv directly on a prepayment basis through group medical practice is less wide used, certain representative plans of this kind are shown on one chart (char III) because they now usually offer the most complete form of medical care. Employer-sponsored plans (chart I).-Plans sponsored by employers are us ally of the cash-payment type described above and they range in the scope of their protection from insurance against hospital costs only, up to certain maxi mums, through plans covering costs for surgery, medical care in the hospital and sometimes home calls as well. Chart I illustrates some of the variations which have appeared around this pattern. Plan 1, for example, shows a hospital-service plan financed jointly by employers and employees which is financed by employer-employee contributions. It is operated under the direction of the employees' benefit board of the employees retirement system, and unlike most plans, permits retired employees to participate. Plan 4 covers similar hospital costs and includes a catastrophic rider, while in plan 5 a chain department store acts as agent for its employees in providing insurance against catastrophic illness at group rates. In plan 6 the employers in one community (Akron), representing two of its major industries-rubber and aircraft-combined in a plan to furnish hospitalization insurance to their workers as a fringe benefit. In recent years employer-sponsored plans have tended to show an increase in the scope of services covered as well as higher maximums for covered costs. For example, a study of plans in 67 corporations in 1953 showed increased maximums for surgical benefits over 1949 and more plans provided for the cost of medical care given in the hospital during the same period. Although coverage of dependents was still quite rare, it had increased in amount since 1949, and 4 of the plans had the relatively new form of insurance against the costs of catastrophic illness. In 40 of the 67 plans employees make a contribution, 20 are financed entirely by employers, and in the other 6 plans employees pay only for insurance covering dependents while the employer pays the rest. Seven of the corporation plans provided comprehensive medical care, including home calls and office calls, for employees but not for dependents. Another 3 included dependents in their full medical program, while 55 provided surgical benefits for dependents. The rest provided medical care in hospitals only for employees. Seven of the 67 plans allowed retired employees to participate and, as noted, 4 plans had added a catastrophic illness rider.1 The group medical practice plan of the Endicott-Johnson Co. (plan 3) is, of course, an exception to the cash-to-vendor plan described above which is characteristic of most employer-sponsored plans, in that it provides complete medical service directly to employees, through doctors and staff hired by the company for this purpose. Plan 7 uses the same group-medical-care plan of giving clinic services directly, but only in the field of preventive medicine or in connection with industrial accidents. In this case employers representing several small manufacturing plants in one community combined to set up a single clinic for this purpose. Union plans (chart II).-Health-care plans sponsored by unions or developed through collective-bargaining agreements have appeared for members of one union in one locality, through joint action of several unions in one community, on an industrywide basis, and through regional and national arrangements. Here again the most widely used form of prepayment protection is the fee-to-vendor plan which covers hospital, surgical or medical costs up to a maximum and uses a commercial insurance company or a nonprofit organization as the insuring agent. For example, a survey of health-care plans covering 187,000 union members of unions in the San Francisco Labor Council, showed that 76 percent were commercially insured, 12 percent used group-medical-practice plans, and 12 percent were financed by nonprofit organizations.' The most common methods of financing these plans are on a percentage of payroll basis, through prepayment arrangements in which union members and employers share costs, or through a health and welfare fund established to cover a broader range of benefits (including also wage loss caused by disability or illness, life insurance, retirement, etc.). The administrative setup in most union plans conforms with that part of the Taft-Hartley law which requires that a welfare fund obtained through collective bargaining must have a board of trustees representing management, labor, and the public. The plans included in chart II suggest the variety of patterns which are, at the same time, appearing in union prepayment plans. Plan 3 is a somewhat typical Blue Cross-Blue Shield system in which employers and employees share the cost. Plan 1 is the complete hospital-care plan of the United Mine Workers financed by a share of the royalty on each ton of coal mined from which the total health and welfare fund is derived. In additoin to the fee-to-vendor Group Health Insurance Today, in Management Record (April 1953), pp. 127–128 ff. E. Richard Weinerman, Labor Plans for Health (San Francisco Labor Council, 1952), pp. 3-4. system used for meeting the cost of prescribed care for most miners, this fund is now building its own hospitals in mining areas, thus combining the direct service and cash-benefit methods of paying for medical services for members within one plan. In plan 2, a clinic operated by a union in one city serves as the nucleus ?? medical services which also incude a cash-to-vendor arrangement covering to pitalization and surgery, and certain medical care provided outside the da In plan 5, 21 affiliated uninos in one community have combined in a single par giving clinical care, including free examinations and other preventive treatmer's In plan 4, the clinical care has been greatly expanded, again with a plan ow£»! clinic at the base, to provide practically complete medical services incid home calls, office calls, and preventive care, The plan uses other hospitals fees are paid from an insurance fund operated by this institute for this purse Here the principle of financing the plan through a percentage of payroll spe-rà is used. Another development in the financing of union plans, illustrated by plat ℗ s the practice of working out a series of package plans at the national headq; res giving a choice of prescribed benefits at set benefit rates for each package pat Individual unions can then choose the particular package plan which meets Pet needs, and the national headquarters acts as the agent in purchasing that p at reduced costs from a commercial carrier or through nonprofit organizat de Group practice plans (chart III).—The combination of group-medical prac ́) ► with the prepayment principle has received considerable discussion recrz" f because most evidence indicates that in this form of so-called superbe medicine a larger proportion of the prepayment funds go directly into lues, services than with most other plans. It is for this reason that health pits developed by consumer cooperatives have usually used this method of prov... health care. The major objection to such plans advanced by members of e medical profession are that doctors are usually on a salary rather than a fee** service basis, and that the services are provided by a "closed panel" of doctors, thus limiting the freedom of choice of the patient. Of the 368 group-practice plans studied in 1946, only 56, or 15 percent, uses" the prepayment method of financing. From the standpoint of organization: of these plans were operated by doctor partners, plus employed physicia's in plan 3 of the chart), and in 19 the doctors were employed by a sponsorla organization (as in the other 6 plans). Of the other 17 plans in the 1946 stag 6 were un by doctor partners only, and 2 by corporations. The plans listed in chart III also suggest the variety of sponsorship in exist": group medical-practice pians. Plan 1- which is a prepayment plan only in 12sense that costs are assumed by the employer-is not only financed but dres by the employer and is available only to employees in his own plant. P originally sponsored by an employer for his own employees, has expanded it' separate organization which provides medical services for a variety of it pendent groups in three Western States. Plan 3 is a doctor-sponsored operated in one community (Los Angeles) on a partnership basis, which is a profit-making venture; while plan 4 is a doctor-sponsored plan which uses De method of consumer cooperatives to finance medical care in a rural commu (E'k City, Okla.). Plan 5, which also uses the structure of consumer cooperatives, deve` ** through the combined action of public officials and consumer groups in New Y ́ ́* City. Since it included employees of State and local government, and cailed f employer contributions, special legislation was required as part of its organi tional development. Plan 6, on the other hand, was organized and is ada tered entirely by one union in St. Louis, and again uses the consumer-coopera" re method in its administrative and program features. In plan 7 a variety employed groups-the Washington State Grange, the Pacific Supply Cooperie the Aeronautical District Workers Lodge 751, and the Student Cooperative a' the University of Washington-joined together in organizing a cooperative gr practice plan which would serve them all. Statewide and State plans (chart IV).-Statewide health-care plans are the Blue Cross Bue-Shield" type and are customarily formed under 'be auspices of or with the cooperation of the State medical society. Usually these plans are more protective of the subscriber than of his dependents and prov G. Halsey Hunt and Marcus I. Goldstein, Medical Group Practice in the United Stat Public Health Service Publication No. 77 (Washington, 1951), pp. 24 25. |