increased coverage. eral reinsurance system. There are certain groups in our population, as Dr. Allman pointed out, that cannot be reached by any health insurance program: the well-to-do, who prefer to pay directly for their own medical and hospital expenses, on the one hand, and the indigent, who cannot afford health insurance, on the other. As Dr Allman stated, the American Medical Association has for many years been studying and promulgating indigent care plans, and working toward solution of this problem. There are enclosed herewith certain publications which show what the association has done to reach this segment of the population. These are submitted for the record. These things are being done privately, without any Fed The American Medical Association has, in addition, worked for many years toward greater participation by the public in hospitalization and medical and surgical plans. An example, with regard to rural coverage, is found in the last two national conferences on rural health, sponsored by the association's Coun cil on Rural Health, at which times the subject of health insurance was covered by many different experts for the primary purpose of encouraging further un lization of existing and proposed health plans by persons in rural areas. We enclose herewith certain literature which, summarizes the activities of the Coyn cil on Rural Health at its 4th, 5th, 6th, 7th, and 8th conferences. The Ameri can Medical Association likewise has, as part of its organization, a Council on Industrial Health, which has long been active with respect to the health of ot dwellers and to the special health problems created by our industrial socie'y The second matter under consideration deals with the extension of the Ho pital Survey and Construction Act, familiarly known as the Hill-Burton Ac You will recall that in our statement we raised a number of questions in con nection with the pending bill, particularly with regard to certain definitions and concept of the “diagnostic and treatment centers." You appreciate, I am sure, the difficulties involved in arriving at a proper definition of "diagnostic and treatment centers," within the framework of the theory of the original Hill-Burton Act. Comparable difficulties also exist with respect to facilities for the chronically ill, rehabilitation centers and nursing homes. The establishment of a formula which will not place the Federal Government in com petition with individual physicians and private hospital and allied health facilties, but which at the same time will accomplish the stated purpose of making more facilities available in areas where they are not now available, is most difficult and requires a cautious and considered approach. We would reiterate the point made by Dr. Allman in his prepared statement that the purpose of the bill with respect to the matter of priorities be made clear, and we further recommend that approval of the other types of facilities specified in the bill be limited to those which are a part of or operated in connection with an established hospital. We view the proposal to build diagnostic and treatment centers and then lense them to physicians in private practice as being contrary to the theory of the Hill-Burton Act. The American Medical Association has encouraged, through all means at its disposal, the proper distribution of physicians throughout the country. Its vari ous councils, particularly the council on medical service and the council on rural health, have conducted a number of studies of methods of encouraging young physicians to settle in rural areas. Third, with regard to the proposed changes in the system of grants-in-aid ta the States for public health activities: We find on reading the prepared statement of Dr. Allman that the majority of questions on this bill were answered by him in the statement or in response to questions at the hearing. We consider " inappropriate for us to submit proposed language at this time since we do not now know to what extent, if any, our recommendations will be accepted. Fourth, with respect to the proposed amendments to the Vocational Rehabilita tion Act: In his prepared statement, Dr. Allman indicated that the America” Medical Association was not prepared to take a definite position on the bill to amend the Vocational Rehabilitation Act, but that the bill was under study The association will not be able to take a definite position on this bill until the next meeting of its committee on legislation. It is not anticipated that the com mittee will meet for the next several weeks. However, after the bill has been further considered by our committee on legislation and board of trustees, a statement with respect to the measure will be forwarded to your committee. Sincerely yours, GEORGE F. LULL Secretary and General Manager A Report on Medical Care for the Indigent In Ten Selected Communities 1952-1953 COUNCIL ON MEDICAL SERVICE COMMITTEE ON INDIGENT CARE of the COUNCIL ON MEDICAL SERVICE H. B. MULHOLLAND, M.D., Chairman.........Charlottesville, Va. Preface The Committee on Indigent Care has made considerable progress in its study of the various types of programs through which medical care is made available to public assistance beneficiaries and to the borderline group often referred to as the medically indigent. Fifteen field trips have been made to review and compile data concerning the operation of local and state-wide indigent medical care plans. Five additional plans are scheduled for review before the study will be considered complete. Ten individual reports on the study have appeared in The J. A. M. A. and reprints have been made available to medical societies and others interested in this particular subject. Because interest has increased and requests continue, these ten reports are being published together in this pamphlet. During the study the Committee has been concerned with the problem of how to assist medical societies in evaluating indigent medical care plans. After many conferences and meetings, it has developed the following set of "Guides" which were submitted to and approved by the House of Delegates at its session in December, 1953. Guides for Evaluating Indigent Medical Care Plans These guides represent working data of the Committee on Indigent Care and are not statements of policy of the A. M. A. They are presented with full recognition that every community will have local problems which may necessitate variations from the suggestions made here. Nevertheless, it is the opinion of the Committee that a reasonable evaluation may well rest upon the characteristics listed below: TO SERVE BEST ITS PURPOSE AN INDIGENT MEDICAL CARE PLAN SHOULD: 1. Make provision for those necessary services normally available locally to others; 2. Make equal services and facilities available to all indigent groups in any given local area; 3. Utilize existing facilities and avoid duplication wherever possible; 4. Wherever feasible, offer free choice of physician in home and office care so as to have continuity of medical supervision for each patient. A patient should have the opportunity to select a physician of his choice or, where available, a teaching facility. (Facility here refers to teaching hospitals approved by the Council on Medical Education and Hospitals for residency and/or internship or outpatient department of medical schools approved by the Council.) Such facilities should accept only such load as is sufficient to meet their needs for clinical material; 5. Develop and use outpatient clinics not affiliated with teaching hospitals and medical schools only when mutually agreeable to the medical profession and the administrative agency involved. Participation in clinics established by agencies responsible for the care of the indigent, other than in hospitals and medical schools, should be open to all physicians in the community qualified to serve in the particular types of clinics; 6. Provide for medical supervision of all medical aspects; 7. Provide reasonable payment to physicians on a basis agreed to by the medical society. The organization of all programs and the method or methods of payment should be approved and reviewed at regular intervals by the local medical societies. Suggested are: a. Fee for service in the home, office, and hospital; 8. Provide for local administration of the medical program for all indigent groups (such as Old Age Assistance, Aid to the Blind, Aid to Dependent Children, and General Welfare Cases) by a single agency; 9. Provide for continuous liaison between medical society and administering agency; 10. Give additional consideration to: a. Special diagnostic aids, b. Preventive medical services, c. Health education, d. Rehabilitation, e. Home nursing as substitute for prolonged hospital care, f. Adequate social service coverage. The principles embodied in these guides are neither new nor are they a departure from past practices; rather they emphasize medicine's continuing interest in the quality of |