Mr. COATES. I am quite sure that is correct, although Dr. Morgan can tell you more about that.

Senator MURRAY. Ninety-percent utilization would be considered an efficient operation of a hospital, would it not?

Mr. COATES. I believe that comes pretty close to the maximum.
Mr. Backlund, do you want to take that question?

Mr. BACKLUND. I understand 85 percent is usually considered good. Senator MURRAY. In view of the fact that the Public Health Service and Veterans' Administration hospitals are operating on the basis of 90-percent utilization, why should we affect them because of the fact that there is a smaller percentage of utilization in the other hospitalsthe Army, Air Force, and Navy?

Mr. COATES. Senator, I think the Commission was trying to foresee situations visible to the Commission at the time or they believe the demands for Federal hospitalization might exceed all extant capacity in any two Federal medical agencies and make available the capaci ties of the others, which currently are not available.

Senator MURRAY. If you take a veterans' hospital that was 90 percent utilized and put other people in there who were not under the Veterans' Administration, it would create great confusion, would it not?

Mr. COATES. I do not think you would take one that was 90 percent occupied, Senator. That represents, I understand, except in an emergency, something pretty close to maximum utilization.

Senator MURRAY. General Gray claims that he is utilizing the full capacity of hospitals under his administration.

Mr. COATES. Yes, sir.

Senator MURRAY. And there would not be room in any of his hospitals for outside patients.

Mr. COATES. He might have a hospital well below 90 percent. It might be the exception to the rule, but it might be standing there, whereas in an emergency it might be very valuable to have that space.

Senator MURRAY. But it would be very insignificant, would it not? If he says he is operating on the whole on a 90 percent basis, it seems to me there would not be much room for finding some hospitals that were not right up to the top.

Mr. COATES. Well, if we try to visualize all situations and emergency situations particularly, we cannot be too sure that it might not be very beneficial at times to have the space available in one hospital made available to the beneficiaries of another group.

Senator MURRAY. We had emergencies in the last war, did we not, and at the same time it was not necessary to do that? Is that not true?

Mr. COATES. I could not testify as to that, Senator.

Senator MURRAY. Go ahead.

Mr. COATES. I will conclude, if I may, by saying I hope also that you will find opportunity to read appendix E, the testimony of Mr. McCormick of our staff, because he makes some of the more detailed points which the Commission itself brought out in support of the four principal assertions that I read to you today.

Some of them are extremely cogent, especially in view of recent developments.

Senator DONNELL. I assume Mr. Coates desires his entire statement as he has it written out here, and his appendixes to be incorporated in the record.

Mr. COATES. We should be most grateful if they are.

Senator DONNELL. I so move.

Senator MURRAY. It will be incorporated in the record. (The documents above referred to are as follows:)

STATEMENT OF CHARLES B. COATES, VICE CHAIRMAN AND GENERAL MANAGER, CITIZENS COMMITTEE FOR THE HOOVER REPORT

The complete preoccupation of each of the five major Federal agencies with its own medical program, together with the lack of adequate facts and figures on which to base prudent over-all planning of our costly medical programs, have led to expensive and needless duplication of medical services and hospitals.

It is, of course, basic and fundamental that effective and efficient administration of any operation in Government or business is impossible without judicious planning, based on the elemental facts and figures involved.

It is a serious indictment of the present method of administering our $2,000,000,000 annual Federal medical programs and of the laws governing those methods, that there is available to the public:

1. No single Federal source of authoritative statistics on the number and utilization of all Federal hospital beds.

2. No single source of authoritative statistics on the present need and future requirements for Federal hospital beds.

Nowhere in our $40,000,000,000 Government can a private citizen, let alone a Member of Congress or an officer of the executive branch, find definitively in print the following pertinent facts regarding our $2,000,000,000 annual Federal medical programs:

(1) How many active and inactive hospital beds the Federal Government has. (2) How many patients are in them.

(3) What patient loads are expected over the near and long term.

(4) How much money is being spent for medical research-and where-and why.

(5) Comparative operating costs, per bed, per doctor, and per patient for all hospitals.

(6) How each community of our Nation is equipped to handle present and potential hospital requirements.

(7) What manpower is and will be available to staff present and potential hospital requirements of the Government and of State and private institutions. At present the statistical measures used by each of the five agencies are sufficiently different so that to compare the published statistics of one against the other is to compare peaches to pears. That is, it is impossible to simply total the published bed capacities of each agency and get usable and reliable statistics on over-all bed capacities or other aspects of Federal medical services.

The investigating subcommittee of the Senate Expenditures Committee prepared an interim report on the utilization of Federal hospital beds, published on May 23, 1950. In assembling the data on Federal hospitals, the subcommittee staff discovered that "Most of the agencies use the terms 'authorized bed capacity' or 'operating bed capacity' to denote those beds that are set up and ready to receive patients. These figures may, and often do, vary substantially from the constructed bed capacity, since in many hospitals there exists a potential capacity greatly in excess of the present need."

The research staff of the Citizens Committee has prepared for the use of this committee summaries of statistics on both Federal and non-Federal hospital bed capacity and utilization. The Citizens Committee's statistical study is for the most part based on the findings of the Senate Expenditures Committee's Subcommittee on Investigation and the 1949 census of hospitals registered by the American Medical Association, published in the AMA Journal of May 6, 1950.

Appendix A attached summarizes the statistics on all hospitals-Federal and non-Federal. Table No. 1 shows the bed capacity and average daily utilization of all hospital beds in calendar year 1949 by type of control. Table No. 2 pictures both total and Federal hospital beds by States. Table No. 3 gives average length of patient stay in general hospitals by type of control.

Appendix B summarizes statistics on Federal hospital beds. These table picture the number, type, and use of all Federal hospital beds by the controling agency.

Appendix C is a breakdown by States of Federal hospital beds by type d hospital and by control.

The Citizens Committee prepared these statistics at its own expense, as! public service. They were prepared by the Citizens Committee for the simp reason that these facts are not publicly available in usable form. They are her presented that they may serve a useful purpose for your committee.

PROPOSED AMENDMENTS TO S. 2008

In all cases where bills were prepared by the legal staff of the Hoover Conmission, substantial amendments have been required to—

(1) take account of changed conditions since the reports were written. (2) make use of constructive suggestions brought forth in public hearings and by experts in and outside Government,

(3) provide for orderly implementation of the reforms.

The bills prepared by the Commission's staff were all intended to be skeletal in nature.

Therefore, our suggestions as to amendments to S. 2008 (H. R. 5182) and o explanations of them, are attached hereto as appendix D.

PREVIOUS TESTIMONY OF CITIZENS COMMITTEE

Robert L. L. McCormick, research director of the Citizens Committee, has test fied at great length on this measure before the House Committee on Expendi tures in the Executive Departments to avoid redundancy here. His statement is attached hereto as appendix E.

APPENDIX A

(Summary of statistics on total hospital beds in the United States in calenda year 1949. This study was prepared by the research staff of the Citizens Comittee for the Hoover Report. Basic data on non-Federal hospitals are from the 1949 census of hospitals registered by the American Medical Association published in the May 6, 1950, issue of the AMA Journal. Basic Federal hospital bed statistics are from the Report on Utilization of Federal Hospital Beds published in May 1950 by the Senate Expenditure Committee's Subcommittee on Investigations.)

TABLE NO. 1.-Summary of hospital beds in 1949 classified by control

T

TABLE No. 2.—Breakdown of total and Federal hospital beds, total and veterans
population by States for calendar 1949

TABLE NO. 3.-Average length of stay per patient in general hospitals, 1947, 198,
1949, classified by control or ownership

STATISTICS ON THE NUMBER AND UTILIZATION OF FEDERAL HOSPITAL BEDS

All the facts and figures on bed capacities and bed utilization in each Federal
hospital, by type of hospital, by operating agency, and by location, are abso-
lutely requisite to planning any and all Federal medical programs

The conspicuous absence of any single Federal source of authoritative statis
tics on the number and occupancy of Federal hospital beds points up a serious
deficiency in the present conduct of medical activities. It is a serious indictment
of the present method of administering medical services that the totals of these
statistics are not available.

The research staff of the Citizens Committee for the Hoover Report has pre
pared tables, which are attached, showing bed capacity, bed occupancy by type
of hospital, operating agency, and by area. These tables are based on informa-
tion found in the one source of such statistics-namely, the Senate Committee on
Expenditures Investigating Subcommittee's report, entitled "Utilization of Fed-
eral Hospital Beds," dated May 23, 1950.

The totals on 1949 Federal bed capacities reported in the attached tables are
compiled from figures reported by the Senate Expenditures Committee's Inves
tigating Subcommittee. The Hoover Commission's Task Force on Medical Ser-
vices made its own survey of Federal capacities for the year 1948. There was
a greater number of beds reported in the Hoover Commission task force study
in 1948 than there was in the Senate Expenditures Committee's Investigating
Subcommittee report for 1949 for two reasons:

1. The Senate committee's report only includes the bed capacities of hospitals
in the five major Federal agencies, namely, Army, Air Force, Navy, Public
Health Service, and Veterans' Administration. The task force study included
additional beds as follows:

2. The remaining difference between reported 1948 and 1949 bed capacities
may be accounted for as reflecting normal changes from one postwar year to
another. This change is reflected as follows:

(a) A reduction of 8 Army hospitals with 11,400 beds in 1949.

(b) A reduction of 4,506 beds among the 54 Air Force hospitals in 1949.
(c) A reduction of 37 Navy dispensaries and hospitals with 9,254 beds in