3. Cost of hospital care.“

Seventeen and three-tenths percent of the women interviewed could not provide information regarding the amount which they would be required to pay for their hospital care. It must be remembered that the women were interviewed while still hospitalized and some of them did not know what they would be charged for the in-patient service. Of the 81 for whom information regarding this item was available, the cost for hospital care for 19.8 percent of the cases was between 0 and $50; the cost for 7.4 percent was between $51 and $75; the cost of 22.2 percent was between $76 and $100; the cost for 18.5 percent was between $101 and $125; the cost for another 19.8 percent was between $126 and $150; the cost for 7.4 percent was between $151 and $175, while the cost for 4.9 percent was $176 or above. Two of the cases included in the $51 to $75 were "package deals" which included payment for the prenatal and delivery care as well as for the hospital care. One of the cases in the $101-$125 interval was a "package deal"; two of the cases in the interval $126-$150 were “package deals," and three of the cases in the $151-$175 interval were "package deals." 4. Method of payment for hospital care

The method of payment for hospital care was analyzed in a similar manner to that used for analyzing the method of payment for prenatal care, with the exception that a major insurance category was included in this analysis; 12.8 percent of the cases received agency subsidization (care less than cost) in whole or in part; 11.6 percent of the cases received total subsidization, and the remaining 1.2 percent received partial subsidization. Fifty-seven percent of the women had paid or were planning to pay lump sums for their hospital care. Of this group, 24.3 percent of the women paid lump sums prior to delivery, 22.2 percent were planning to or had paid lump sums subsequent to delivery, and 10.5 percent were planning to or had paid lump sums both prior to or subsequent to delivery. The method of payment for hospital care for 19.8 percent of the cases was installment payments. Of this group, 2.3 percent of the cases paid on an installment basis prior to delivery; 16.2 percent planned to pay on an installment basis subsequent to delivery, and 1.1 percent of the cases planned to utilize the method of installment payment both prior to and subsequent to delivery.

Four and eight-tenths percent of all the study cases were covered by insurance, 3.6 percent of the cases had partial coverage, and 1.2 percent of the cases had total coverage.

In addition to the above, 8.1 percent of the women had not made any arrangements for hospital payments and did not know at time of interview what method they would utilize for doing so. Although five cases did not know how much the hospital costs would be, they were able to give us information as to the methods they intended to use in paying their hospital bills.

5. Method of payment for private hospital care

The methods of payment for private hospital care were analyzed in addition to the methods used for all hospital care so that special attention could be given that group which had managed to arrange for private hospital services. Fiftynine of the servicemen's wives interviewed utilized private hospitals resources for delivery. Of the 56 wives for whom this information was obtained regarding method of payment for the hospital service, 92.9 percent stated that they paid lump sums either prior to, subsequent to, or both prior and subsequent to delivery; 16.1 percent stated that they paid their hospital bill through installinent payments, again either prior to, subsequent to, or both prior and subsequent to delivery; 7.2 percent indicated that they had partial or total insurance coverage; and 3.6 percent indicated that they had no plan as to method for meeting this cost. The percentage distribution adds up to more than 100 percent because some of the women utilized more than one method for payment.

6. Sources of payment for hospital care

As can be seen in table XXII, the five major sources of income for payment for hospital care were "husband's pay and/or allotment," which was cited by 43.5 percent of the women; "the wife's wages for employment during pregnancy,' which was cited by 15.2 percent of the women; savings from "husband's earnings prior to enlistment," which was cited by 14.1 percent of the women; and "savings from current income" and "friendly loan," which were each cited by 13 percent of the women.

14 The total medical costs for prenatal care, delivery, and hospital services combined are analyzed in the following chapter and will be presented in greater detail in the final report.

TABLE XXII.-Frequency of response and percentage of 92 women, citing each

The servicemen's wives were interviewed within a few days following delivery. They, therefore, of course, had not as yet had any experience in using pediatrie care services for their new child. However, they were questioned regarding projected plans for this service: 15.7 percent of the women planned to secure the services of a pediatrician for their child; 18 percent planned to utilize the services of a general practitioner for this purpose; an additional 19.1 percent planned to utilize the services offered dependents at military hospitals; 4.5 percent planned to use private hospital clinics; and 22.9 percent planned to use clinics operated by local public health departments. This last group was influenced somewhat by the interview itself, which served to make known the resources available. An additional 10.1 percent didn't know at the time of the interviews what plan they would follow, and a like percentage definitely had no plans.

IV. HOSPITAL OR HEALTH INSURANCE

In the course of the study, information was obtained regarding hospital or health insurance for obstetrical care, and hospitalization in connection with obstetrical care carried by the women interviewed. As can be seen in table XXIII, 85.7 percent of the women were not covered by either hospital or health insurance. Of the 14 women who did have some kind of coverage, 7 were insured under the Blue Cross plan, 1 was insured by the Angeles Hospital Beneficiary Society, 1 by the Paul Revere group insurance, and 1 by the Permanente plan. One of the women covered by Blue Cross was also covered by Blue Shield. In additional to the 10 above, 4 women stated that they were covered by some insurance but did not specify the name of the particular insurance plan. As pointed out in the next chapter, insurance protection is definitely related to pay grade.

TABLE XXIII.—Frequency and percentage distributions of coverage by hospital or health insurance of the 98 women in the sample

Certain of the data obtained in the course of the study were cross-tabulated so that patterns of medical services as related to a number of other factors could be identified. The pressures of time made completion of all of the pertinent cross-tabulations impossible. The tables following were developed after a careful weighing of priorities. It is sincerely hoped that the relationships examined in this chapter are those with greatest importance to the immediate purposes of this study."

15 Relationships which appeared to be interesting, but which were believed to be of less importance than those herein presented, will be more fully explored prior to completion of the final report of this study.

When preparing and presenting the material contained in this chapter, two procedural policies were followed which need to be known by the reader so that proper interpretation will be assured:

1. Because tables are difficult to read when frequencies and percentages are both indicated in each cell, the tables following contain percentages only. It was originally planned to present the source tables in an appendix attached to this report. Stringent time pressures, however, require that this report be completed prior to compilation of the appendix.

2. Where necessary, the relationships analyzed were restricted to "pure cases.” This means that in those instances where resources utilized for a particular kind of medical care are related to other factors in the text, the women utilizing a combination of resources were excluded from the analysis because they were impossible to classify. Those cases for which no information was available in respect to a particular item were also excluded when that particular item was being subjected to analysis. Whenever an analysis was based on less than the total number of cases, this fact is stated in the title accompanying each table or in the text.

I. PRENATAL CARE

1. Resource used for prenatal care related to time of first care

As shown in table XXIV, the women who utilized the services of a private physician or the services provided by a clinic operated by a private hospital sought prenatal care at an earlier time in pregnancy than was the case with women utilizing facilities operated by the military or by the local public health departments.

Eighty-one and nine-tenths percent of the women utilizing the services of a private physician and 80 percent of the women using the private hospital clinics received service during or prior to the third month of pregnancy, as against 61.1 percent of the women utilizing the military facilities and 54.5 percent of the women utilizing public health department facilities.

TABLE XXIV.-Percentage distribution of time of first prenatal care by resource used for prenatal care by 67 women in the sample

2. Resources used for prenatal care related to reasons for selecting resources When the kinds of resources utilized for prenatal care were related to the reasons offered by the servicemen's wives for their choices, some interesting comparisons were found.

Seventy-two and seven-tenths percent of the women utilizing military resources and 63.6 percent of the women utilizing local public health department clinics gave economic considerations as at least one of their reasons for this choice as against 2.5 percent of the women utilizing the services of a private physician and 28.6 percent utilizing clinics operated by private hospitals. The reason which stressed the inconvenience of location of alternative resources was cited by 37.5 percent of the women utilizing the services of a private physician, 85.7 percent of the women utilizing private hospital clinics and 63.6 percent of the women utilizing local public health department clinics, as compared with 4.5 percent of the women utilizing military clinics. Fifty-two and five-tenths percent of the women utilizing the services of a private physician and 42.8 percent utilizing clinics operated by private hospitals cited previous satisfactory experiences as the reason for their choice as against 9.1 percent of the women utilizing military clinics and 18.2 percent of the women using public health department clinics.

It is important to note that none of the women using military, private hospital or public health department clinics indicated that they anticipated unsatisfactory experience with alternative, i. e., services of a private physician.

For the women utilizing the services of private physicians for prenatal care, the reasons were: "Previous satisfactory experience," "anticipated unsatisfactory experience with alternative," "inconvenience of location of alternative," "status considerations,” and “lack of knowledge of alternatives." For the women utilizing military clinics for prenatal care, "economy" was the important reason. For the women utilizing public health department clinics for prenatal care, the primary reasons were "economy," "inconvenience of location of alternative," and "convenience of location" of resource selected. For the women utilizing private hospital clinics for prenatal care, the reasons were "inconvenience of location of alternatives," "status," and "previous satisfactory experience."

3. Resource used for prenatal care related to cost for prenatal care and delivery The resource used for prenatal care was related to the cost for prenatal care and delivery. As could be expected, the average cost for specialized private care proved to be greater than the average cost for nonspecialized private

care.

Forty-four and four-tenths percent of the women utilizing the services of a general practitioner paid $100 or less as against 15 percent of the women utilizing the services of an obstetrician. Fifty percent of the women utilizing the services of a general practitioner paid between $101 and $150 as compared to 40 percent of the women utilizing the services of an obstetrician. Five and six-tenths percent of the women utilizing the services of a general practitioner paid more than $150 for prenatal care and delivery as compared to 45 percent of the women using services of an obstetrician for these purposes; and whereas none of the women utilizing the services of a general practitioner paid more than $175, 20 percent of the women utilizing the services of an obstetrician paid between $176 and $200. Most of the women, 95.5 percent, utilizing military facilities for their prenatal care and delivery paid $50 or less.

The two significant groupings for the women utilizing private hospital clinics for their prenatal care were in the $151 to $175 category and the none to $50 category.

The explanation for the substantial difference in the amount paid by these women is that some of the women were delivered in hospitals operated by a public agency, either county or military, which meant that there was no cost for delivery, while some of the women, 42.8 percent, were delivered in private hospitals.

All of the women utilizing resources operated by local public health departments for the prenatal care paid $50 or less for their prenatal care and delivery service.

4. Cost of prenatal care and delivery related to method of payment

No relationship was found between amount paid for prenatal care and delivery and method of payment.

5. Serviceman's pay grade related to resources used for prenatal care

As can be seen in table XXV, wives of servicemen in the first two pay grades distribute fairly evenly into the various types of resources available for prenatal care. At the third and fourth pay grade level the servicemen's wives cluster in the category in which prenatal care was received through arrangements with a private physician. At the fifth and sixth pay grade level the servicemen's wives cluster in the category in which military clinics were utilized. The wives of all the servicemen in the seventh pay grade utilized the services of private physicians.

It is important to note a significant shift in the kinds of free facilities utilized by the wives of men in the first three pay grades when compared to the wives of men in the fourth and fifth pay grades. The wives of the men in the lower pay grades sought out the services offered by public health departments whereas the wives of men in the fourth and fifth pay grades sought out the services offered by military clinics for prenatal care. This latter may be associated with strong Navy or military identification of the wives of men who have been in service longer. The seventh pay grade offers a distinct change in type of serv ices utilized for prenatal as well as other care.

TABLE XXV.-Percentage distribution of type of prenatal care utilized by wives of servicemen in each of the pay grades for 81 women in the sample

6. Serviceman's pay grade related to reasons for selection of resource used for prenatal care

The serviceman's rank or pay grade was related to the reasons given by his wife for the selection of the resource used for prenatal care. As can be seen in table XXVI, the reasons given by the wives with husbands in the first and second pay grades cluster in the categories indicating economic considerations and inconvenience of location of resource alternative to the one used.

Sixty percent of these women gave economy as at least one of their reasons for their choice, and seventy percent gave inconvenience of location of alternatives as at least one of their reasons for their choice.

The reasons given by the wives of the men at the third pay-grade level clustered in the two categories indicating previous satisfactory experience with the resource used and inconvenience of location of alternative resources. Forty-four and four-tenths percent of these women mentioned previous satisfactory experiences as at least one of the reasons for their choice and forty-eight and one-tenth percent of these women gave inconvenience of location of alternatives as at least one of the reasons for their choice.

The wives of the servicemen at the fourth pay-grade level clustered in the two categories indicating previous satisfactory experience and economy.

Forty-one percent of these women gave previous satisfactory experience as at least one of their reasons and thirty-five and three-tenths percent gave economy as at least one of their reasons for their choice.

The only significant clustering of reasons associated with the wives of the men at the fifth and sixth pay-grade levels was in the economy category. Forty-one and two-tenths percent of these women indicated economy as at least one of the reasons for their choice.

The wives of the servicemen at the seventh pay-grade level gave reasons which clustered in three categories. Sixty percent of the wives gave previous satisfactory experience as at least one of the reasons for their choice; forty percent gave anticipated unsatisfactory experience with alternatives as the reason for their choice, and forty percent indicated status considerations as influencing their choice.

TABLE XXVI.—Percentage distribution of reasons for selection of prenatal care by husband's pay grade for 76 women in the sample