During the 30-year period since 1930 the medical bill has grown with respect to other costs. The rate of hospitalization per capita has more than doubled; the demand for physicians' services has nearly doubled; and the expense for medication has increased proportionately. As a result the share of the national income going to medical care has risen from 3.5 to 5.2 percent in this period. This compares with 4.7 percent in both Sweden and Great Britain. The extensive investigations of the Health Information Foundation have shown that a "large bill"-in excess of $200-may be due to such varied causes as the purchase of drugs, physician services, and hospitalization. It seems likely, however, that the truly major problems of paying for medical care are most often those related to episodes of hospitalization that, in addition to hospital bills, also involve larger fees paid to the doctor.

MODERN HOSPITAL, controversial in some respects, was built by the Kaiser Foundation at Panorama City in San Fernando Valley in California. It has 133 beds and is a medical center as well, providing care for 60,000 members of prepaid, group-practice medical-care plan. Rectangular three-story base has medical offices and diagnostic facilities. Twin seven-floor, circular columns above hold the hospital. Stair wells are at the ends of the columns. Several other circular hospitals have been built previously in various parts of the country.

Americans today receive a large amount of hospital care.

About 125 persons

per 1,000 are hospitalized each year. This is not only twice the rate of 30 years ago but also is substantially higher than the rate of 86 per 1,000 in England and Wales. The availability of insurance funds to pay for hospitalization has undoubtedly played a part in this development. Among the uninsured the rate of admission is 90 per 1,000 per year, compared with 140 among the insured.

The part that is also played by the organization of medical practice is illustrated by a study of the much-studied Health Insurance Plan of Greater New York. Enrollees in this plan have a lower rate of hospitalization than other New Yorkers with the same hospitalization insurance provided by the Blue Cross. The implication is that the group-practice units caring for the enrollees in the health insurance plan are able to care for their patients more effectively outside the hospital or that they are more selective in prescribing admission of their patients to the hospital. It is also worth observing that the group-practice units are paid a flat annual capitation for rendering comprehensive care to their subscribers and do not receive a fee for the service that happens to involve sending the patient to a hospital. A parallel study shows that steelworkers cared for in California by the Kaiser Foundation medical care program-a prepaid medical care plan that also provides comprehensive services through group-practice units paid through a combination of capitations and salaries-show a correspondingly lower rate of hospitalization than steelworkers elsewhere in the country who are covered by Blue Cross hospitalization insurance and a variety of insurance plans that pay the doctors on a fee-for-service basis.

The differing rates of hospitalization may be due to many factors other than those cited. But one thing is clear: there can be great latitude in the rate of hospitalization without danger to health. European experts cite the U.S. experience as evidence of the need for control of admissions by well-paid, well-trained, full-time specialists on hospital staffs.

The growth of health insurance in the United States evidently reflects the consumer's prudence in the face of his exposed position in relation to the costs of illness. Several investigations have shown the popularity of comprehensive insurance. In the State of Washington physicians provide a remarkably allinclusive insurance plan to cover doctors' bills. George A. Shipman and his colleagues at the University of Washington have found that the purchasers' satisfaction is tempered only by their desire for still more comprehensive prepayment. The most intriguing unanswered question is why physicians, who are so concerned about Government intervention in health insurance, have not tried to forestall it by imitating more widely the successful precedents established by their colleagues and by nongovernmental lay institutions. Even though all the costs of illness probably should not be insured, the fact is that only about a fifth of personal medical care expenditures are now covered. Because the best of medical care, such as heart surgery, is often expensive, our present rather limited provision for insuring medical care must be much improved if the best of medical care is to be available.

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NURSING STATION at center of hospital floor is in area closed to the public. The typical patient floor contains 23 beds in each circular unit, with every bed only a few steps from the nurse. Visitors' lobby is in another service area between circular patient units.

ORBITING ASTRONOMICAL OBSERVATORY is shown under construction at the Grumman Aircraft Engineering Corp. in Bethpage, N.Y. A prototype is visible in the background. The 3,300-pound craft, scheduled for launching next year, will carry into orbit one 16-inch and four 8-inch reflecting telescopes. They will provide the first view of the sky from above the atmosphere.