away from the area. Some study is now being made of the problem to see whether reasonably adequate protection can be provided for members when away from home.

The cost of prepaid comprehensive medical care and hospitalization services is such that a large segment of the population feel they cannot afford such coverage. An intensive study is now being made of our records to develop some actuarial figures on cost of services to various types of participants. These actuarial figures will be useful in reviewing our dues structure and other charges.

We are also hopeful that a practical method can be worked out in cooperation with groups of employees and their employers for providing services to groups on contract or develop plans whereby payments may be based upon a percentage of the payroll so that the total amount will provide comprehensive service to all members of the group and their dependents without imposing a hardship on the lower paid members of the group.

Mr. Chairman, I have presented this statement as a short and rather simple statement of the basic services provided and the limitations of service, with the expectation that if there were any questions about details, they would be raised in question form, and I did not provide any of the detail as regarding costs and other factors that may interest the group. I am available for questioning, if you wish.

The CHAIRMAN. Any questions, gentlemen?

Mr. HARRIS. Mr. Chairman, I would like to ask a question. First I would like to say, Mr. Myer, that we are glad to have you come before the committee.

Mr. MYER. Thank you, sir.

Mr. HARRIS. I have had occasion to have your association in the past. I remember the job you did in various positions in the Federal Government. Now, to have you come before the committee and explain the program and its interest to the public in this area is of interest to me. Where is your clinic?

Mr. MYER. Our clinic is at 1025 Vermont Avenue NW., just between K and L Streets on Vermont Avenue.

Mr. HARRIS. Do you have a medical center there?

Mr. MYER. We do have; yes, sir.

Mr. HARRIS. How many hospital beds do you have?

Mr. MYER. We have no hospital beds other than emergency beds at the clinic. We utilize the local hospitals for the services provided where it does require hospitalization.

Mr. HARRIS. Local hospitals?

Mr. MYER. Local hospitals, yes, sir. We have access to the hospitals within the District, and we do utilize those hospitals and pay them for the services which are providing for hospitalization.

Mr. HARRIS. I knew in connection with our efforts on this committee, of which I am a member, when we had the hospital center program, that we did not have any information as to this group having a hospital here in the District.

Mr. MYER. NO; we have none.

Mr. HARRIS. I wondered about your hospital facilities. I noticed that you said in your statement that you charge your members, or your members' cost was $11 per day for hospital.

Mr. MYER. Outside of the area. We provide a minimum up to $11 a day if a person happens to be away from home, in some other part of the country. We guarantee that his costs will be paid up to $11 a day for a semiprivate room and operating and anesthetist services.

Mr. HARRIS. What about in the District?

Mr. MYER. In the District, we provide the hospitalization through arrangement with the hospital, and pay the bills ourselves.

Mr. HARRIS. Without limitation of costs?

Mr. MYER. No limitation of costs, other than it is limited to the charge for a semiprivate room. If a patient would wish to have a private room, they would have to pay the extra charge.

Mr. HARRIS. You say you have 7,500 members. I suppose those are the members who have signed up and are paying dues?

Mr. MYER. That is right.

Mr. HARRIS. Now, 19,600 participants, does that mean that those others are their dependents?

Mr. MEYER. Family dependents; yes, sir.

Mr. HARRIS. What is your per-month charge?

Mr. MYER. For adults it is $4 and for children it is $2.75.

Mr. HARRIS. Per month?

Mr. MYER. That is right. I might add, Mr. Harris, that in addition to that, there is an application fee of $5 and a membership fee of $20, which is to be paid during the first 10 months. But that is out of the way at the end of the first year.

Mr. HARRIS. You gave a list, in your statement, of services which are not furnished by the association.

Mr. MYER. That is right. It is a rather limited list, but it is set forth here.

Mr. HARRIS. Are those usually termed the catastrophic illness group?

Mr. MYER. No, I would say for the most part those are services that are provided in institutions generally or under industrial insurance laws by governmental agencies. The first one I gave had to do with it not providing for industrial accident cases to the extent that they were already provided for. We would take care of the bills over and above what they do not provide for.

The next one has to do with congenital items, such as birthmarks and deformities and so on; unless they are malignant, and plastic surgery, which we do not provide.

The third one has to do with hospitalization for those diseases which are normally institutionalized, such as tuberculosis, alcoholism, and drug addiction, and similar diseases.

Mr. HARRIS. Thank you very much, Mr. Myer. I am very glad to know of your operations here in the District of Columbia.

(The following information was submitted for the record :)

Group Health Association, Washington, D. C.: Summary of medical services provided

Other office visits with doctors (outside office referrals with GHA staff physicians and other GHA consulting specialists

395

Number per 1,000 persons eligible..

OTHER SERVICES BY DOCTORS

Group Health Association, Washington, D. C.: Average income per capita per month by source for the years 1947-53

Group Health Association, Washington, D. C.: Selected medical services, per

Group Health Association, Washington, D. C.: Hospital utilization

Group Health Association, Washington, D. C.: Family composition of membership, members and participants in given types of families as percent of total number of GHA members or participants, respectively

SAMPLE LETTER OF AGREEMENT WITH PHYSICIAN ON FULL-TIME BASIS

DEAR DR.___ : In order to verify your employment agreement with Group Health Association, I am submitting for your review and approval the following outline of this agreement. In addition to the specific items outlined below, as a full-time physician, your employment relationship to the association is set forth in the personnel policy of the association.

Your classification is "practitioner of general and internal medicine." This position is included in the department of general and internal medicine and comes under the supervision of the chief of that department. The base salary for this position is $____ --- per year. Provision is made for automatic salary increases of $_____ per year for this position until a maximum salary of $-------- per year is reached. Any change in this pattern requires a special recommendation and approval by the board of trustees. Your current salary is $‒‒‒‒‒‒‒‒

The duties for which you are responsible include consultations with patients in the clinic, making home calls on patients as required, making calls on the hospitalized patients, and performing such medical practice as comes within the scope of your position and within the limits of your qualifications. In the performance of these duties you are expected to work in close cooperation with the physicians in your department and in all other departments insofar as applicable. You are privileged, on approval from the medical director, to call into consultation when necessary, physicians not on the Group Health Association staff.

You are employed as a full-time physician on a 44-hour-week basis exclusive of night-call duty. You are privilege to take 4 hours per week of this schedule for study leave. Home-call service, both during scheduled clinic hours and after clinic hours, will be rotated among the physicians in your department in accordance with a schedule set up by the chief of your department and approved by the medical director.

You are granted 26 working days, or 188.5 hours, per year of annual leave. Annual leave may be accumulated to a maximum of 60 days, or 435 hours. You are also granted 15 days, or 108.8 hours, per year for sick leave, as required, and