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STATE GOVERNMENTAL HOSPITAL

The Eugene Talmadge Memorial Hospital is designed primarily to meet the needs of the indigent, and such costs are financed from State tax funds. Its facilities comprise some 25 percent (500) of the hospital beds available in Richmond County, and it is estimated that some 15 to 20 percent of the patients are 65 years of age and over. Outpatient clinic facilities are also available.

The average census of the clinic is 30,839, of which 3,670 is the census of the medical service clinic and of which 4,690 is the census of the surgical service clinic. These services are provided for the indigent and the near-indigent citizens of the State of Georgia and Richmond County.

LOCAL GOVERNMENTAL HOSPITAL

The University Hospital is a county-city hospital and makes charges for services to paying patients. Its facilities also provide comprehensive clinic, medical, hospital, and domiciliary care for the indigent and near-indigent citizens of Richmond County regardless of the patient's or his family's resources, although some attempt is made to determine how much the person or his family can pay. The University Hospital provides approximately 25 percent (454) of the hospital beds in Richmond County, and it is estimated that some 15 to 20 percent of the patients are 65 years of age and over. The average census of the outpatient clinic is 36,585; medical service clinic, 11,385; and the surgery clinic, 2,523 census.

VOCATIONAL REHABILITATION The Office of Vocational Rehabilitation of the Department of Health, Education, and Welfare provides grants to Georgia for a local agency program in Richmond County to enable physically and emotionally handicapped persons to obtain suitable employment. Diagnosis, counseling and guidance, job placement, and followup services are provided free, and training is generally furnished without cost. Medical services, prosthetic devices, and maintenance, and transportation during treatment are covered by public funds to the extent that the individual cannot pay for these services.

LOCAL PUBLIC HEALTH AGENCY

The Richmond County Public Health Department assists private and clinic practitioners in early detection and treatment of communicable diseases, offers advice on problems of diagnosis, and provides some drugs and laboratory seryices. It conducts an active chest disease and tuberculosis program and maintains an active case register. It also conducts certain chronic disease programs, including pursing, nutrition, and medical social services to the chronically ill. The Richmond County Public Health Department in cooperation with several voluntary health agencies provides free diagnostic services. Essentially all of the direct care of individuals provided by the Richmond County Health Department is furnished to the indigent or medically indigent citizens.

MEDICARE PROGRAM

Enactment of Public Law 569, 84th Congress, which became effective December 7, 1956, was the culmination of efforts by the uniformed services to obtain a comprehensive statutory authority providing medical and dental treatment, at Government expense, for eligible dependents of their members. For the first time, dependents could obtain medical care and certain dental care from civilian sources at Government expense, as well as from uniformed services medical and dental facilities. Heretofore, treatment had been available only in uniformed services medical and dental facilities and, then, only if space and staff were available. Consequently, care was virtually denied to dependents residing at some distance from uniformed services installations. The benefits of this program have been realized with the wholehearted support and cooperation of the physicians, dentists, and hospitals in Richmond County.

STATE GOVERNMENTAL HOSPITAL (TUBERCULOSIS) The State of Georgia has assumed the responsibility for tuberculosis care for her citizens, although charges may be made for this care in accordance with the patient's or his family's ability to pay. Patients admitted to Battey State Hospital, Rome, Ga., from Richmond County frequently are elderly, indigent, or medically indigent.

STATE GOVERNMENTAL HOSPITAL (MENTAL)

The greater part of all prolonged hospital care for those persons in Richmond County suffering from mental illness is provided by the State of Georgia at Milledgeville State Hospital. Care is customarily provided regardless of the patient's or his family's resources, although some attempt may be made to determine how much the person or his family can pay. Generally, the great majority of these patients are cared for without cost to the patient or his family. Almost 25 percent of the patients in such a publicly financed mental hospital are 65 years of age and over.

VOLUNTARY HEALTH INSURANCE

A recent study by the National Health Survey gives the most recent compre hensive data on hospital insurance. This study reveals that 6623 percent of all persons discharged from short-stay hospital visits met at least some portion of the hospital charges through insurance. Over 50 percent of the elderly discharged patients had some portion of their bills covered by insurance. In Richmond County, Ga., some 12 to 15 percent of the elderly citizens are covered by Blue Cross-Blue Shield insurance programs alone. Some 25 percent of all Blue Cross subscribers are persons who have left employment where they were covered on a group basis, or who enrolled as individuals. A large segment of this group are persons 65 years of age and over. Among all persons discharged from short-stay hospital admissions who received insurance benefits, over 75 percent at least three-fourths of their bill paid by insurance. Of the elderly who received insurance benefits, 60 percent had at least three-fourths of their hospital charges covered by voluntary health insurance plans.

PUBLIC ASSISTANCE PROGRAMS

Federal matching funds are available which provides for grants to the State for assistance and services for the aid to dependent children, aid to the blind and aid to the permanently and totally disabled.

Mr. Chairman, the physicians of Richmond County, Ga., feel that this current proposal to finance health care for the aged as a benefit for all persons eligible for social security is an extension of the historical welfare practice established in the midthirties. At the same time, recognizing that there are perhaps some elderly persons who cannot adequately provide for their own medical care, the medical profession of Richmond County continues to work steadily and actively to improve health care program at our community level for those unable to pay for their medical needs. The members of the Richmond County Medical Society have always been seriously concerned with the maintaining of a high quality of medical care. For more than a half century, this society has been actively and effectively engaged in the improvement of medical care. It can now be said, without reservation, that medical care in the United States is superior to that found anywhere else in the world. The physicians of Richmond County, Ga., believe in the free enterprise system, in individuality, recognizes the dangers of dependency, centralized planning, and management of medical services.

On behalf of the members of the Richmond County Medical Society, I would like to thank you for the opportunity to present these views of the physicians in Augusta, Ga., on this most important legislation. · We shall be pleased to be of further service should this committee require from this society any additional comment or information. Sincerely,

PRESTON D. ELLINGTON, M.D.,

Chairman, Board of Trustees,

President, Richmond County Medical Society. Dated November 19, 1963, at Augusta, Ga.

STATEMENT OF THE ST. LOUIS COUNTY (Mo.) MEDICAL SOCIETY RE HEALTH CARE

OF THE AGED; H.R. 3920 AND RELATED QUESTIONS

PAST 65 PLAN

Physicians are taking steps to make certain that no one needing medical care goes without it because of inability to pay. Through an organized voluntary plan St. Louis County doctors are only doing what doctors have always done but now they are doing it a little more systematically.

A SIMPLE CARD

A small card is the heart of a simple system designed to keep medical care of the aged in the hands of the doctors. It adjusts fees to the patient's ability to pay, maintains the traditional doctor-patient relationship, eliminates third parties, and helps cut drug costs—all with a minimum of administrative apparatus.

This potent device is a discount card. Issued to over-65 patients by the St. Louis County (Mo.) Medical Society, it specifies a reduction, ranging from 1 to 100 percent, to be given by the county's participating physicians. More than 400 of the county society's 450 members honor the cards. Most of the nonpartici pants are obstetricians or pediatricians.

APPLY TO DOCTOR

Patients can obtain a discount card in one of two ways:

1. Their regular doctor sends a simple application form to the county society, recommending issuance of a card and the appropriate reduction. He indicates how long he's been treating the patient and how long he's treated him at reduced fees. If the doctor is familiar with the financial circumstances, he may indicate that no investigation of the patient is necessary. If not, the medical society conducts an investigation to determine the amount of the reduction.

APPLY TO COUNTY MEDICAL SOCIETY

2. Alternatively, any over-65 resident of St. Louis County may go directly to the society's offices and apply for a card.

DRUGGISTS' SUPPORT

The county druggists themselves have been quick to support the program. Many of them volunteer discounts for card-carrying patients. These druggists dispense drugs at cost-plus, with the markup reduced by the reduction percentage specified on the card.

SERVICE ADVERTISED

This service has been widely advertised in newspapers and on radio and TV. And through the society speakers' bureau, the plan has been outlined to service organizations, PTA's, other civic groups, social and welfare workers.

Inaugurated 3 years ago, the plan has had a gratifying reception by patients and the general public, and the doctors themselves are enthusiastic.

We've shown the public that the medical profession can give over-65 patients the same standard of medical care that everybody else in the community gets and at prices they can afford to pay. And we've shown doctors that they can offer this without subsidy or intervention by third parties of any kind. Actually, we're doing what we doctors have always done with little public recognition. People who need medical care get it; if they can't afford the customary charges, they pay what they can.

NO EMBARRASSMENT TO PATIENT

Establishing the discount rates to patients is the responsibility of Mrs. Robert Opel, who was trained by the St. Louis Medical Credit Bureau to check records and determine, through interviews with the patients, their ability to pay. There is no embarrassment or uneasy moments. Actually, Mrs. Opel completes an interview in little more than half an hour, but many applicants feel so relaxed they turn the sessions into reminiscences of their histories.

“I had dreaded coming to see you," one elderly woman told Mrs. Opel as her interview neared an end. “But, my gracious, in the short time I've en here I feel like you are an old family friend.”

FREEDOM OF CHOICE OF DOCTOR

Sometimes a patient is referred to the society by member doctors. The county society includes physicians in both the county and city of St. Louis. Some patients are referred by their pastors or friends, or have read about the work in their local newspaper. When referrals are made by those other than physicians, the applicant is given his choice of doctors. If he has none, Mrs. Opel refers him to a physician in his own neighborhood.

ELIGIBILITY REQUIREMENTS NOT RIGID

Unlike rigid government programs this is flexible. It demonstrates what free people can do when not pushed around by government coercion. Many cases involve a certain amount of seat-of-the-pants judgment. William Hovins, 72, who owns his $8,000 home free and clear, has nevertheless been given a 90-percent reduction. That's because his income is barely enough to live on. If he lost his house because of his high medical bills, St. Louis doctors feel, he'd be on the county.

“But the plan isn't intended as mere charity,” says its founder, Dr. Miller. "Patients pay what they can afford. They like it better that way; it helps them keep their dignity. Some patients pay only 50 cents for a house call—but that 50 cents means as much to them as a $10 fee does to a middle-income patient.

“In one way, these people are probably now getting better medical care than before the plan started. The doctor knows that a patient who can't afford a $5 prescription will probably stick it in his pocket-and do without medication he needs. When the doctor is reminded of the patient's circumstances by a discount card, he'll try to find a cheaper way of getting the desired results-or perhaps he'll rummage around in the sample drawer."

PLAN STARTED IN 1960

The plan was put into effect in the latter part of 1960 after Dr. Charles Miller headed a committee which originated the procedure. The program came as a result of a preponderance of the doctors in the society desiring to offer those past 65 low-cost medical care while preserving the right of the patient to choose his own doctor.

PARTICIPATION

“We thought we would be swamped with requests for rate reduction cards," said Edgar J. Mothershead, executive secretary of the St. Louis County Medical Society, “but surprisingly only 108 cards were issued during 1961, the plan's first full year of operation.”

In 1962 another 93 cards were issued. To the middle of November 1963, a period of 3 years, 317 cards have been issued, of which 227 cards have been renewed. This doesn't indicate a need for a massive Federal program costing billions of dollars to increase power and control in Washington.

RENEWALS ANNUALLY

A card is issued for 12 months, after which the case is reviewed by Mrs. Opel. If the financial status of the patient has remained unchanged, the card is renewed for another year. If there has been a change, the percentage of reduction is lowered or increased as the change dictates. Sometimes the patient's situation is so improved that renewal of the card is not requested.

EXTENDED TO ALL REGARDLESS OF AGE

One afternoon last July a man walked into the offices of the St. Louis County Medical Society in Clayton, Mo., a St. Louis suburb. His voice and his manner denoted extreme nervousness as he explained he was in need of immediate medical attention but could not afford it.

"I know you have a plan to help those 65 and over,” said the man. "I thought maybe there was some way you could help me even though I'm not half of 65.”

Mothershead explained that the “past 65 plan” did not hold rigidly to age limitations.

“Our purpose,” said Mothershead, “is to make certain that no one needing medical care goes without it because of inability to pay. I'm sure we can help you.”

“We find our plan is proof that the medical profession does not knowingly permit anyone needing medical care to go without it,” emphasized Mothershead.

PLAN SPREADING

Seventy-six medical societies have inquired about the plan and one society, King County (Seattle, Wash.), has adopted it without modification.

A survey by AMA indicates that well over 70 percent of the local medical societies have a specific program to assure medical services to all. Some are formal and some informal.

27-166—64— pt. 5-19

“We have always handled this problem individually," wrote one society chairman. “It is handled quietly. We do not feel a need to do it otherwise. No individual in this county has been denied medical care because of his inability to pay.”

Another society chairman wrote: "Every one of us sees patients every day for whom we know we will not receive pay. We don't talk about it—we just do it. That is and always will be part of the doctor's job.”.

Finally, this terse reply: "In small communities this is no problem, except to the doctor. We take care of people who are sick whether they can pay or not."

Results of the survey emphasized that doctors are reticent to publicize guar. antees of service, fearing they will be flooded with requests from freeloaders. However, societies with formal programs report requests were about the same as expected, and more often less than expected.

PUBLIC LIKES PROGRAM

The St. Louis Globe Democrat in an editorial after summarizing the plan had this to say:

“The St. Louis County Medical Society deserves warm commendation for embarking on this almost revolutionary method of tailoring medical costs to the patient's pocketbook. It is revolutionary, in the sense that it is an organized attempt to establish a patient's ability to pay, and to persuade all members of a local medical society, to accept this yardstick.

"Traditionally, physicians have tailored their bill to meet the patient's economic circumstances. But physicians are too busy to inquire into each patient's background to determine what his circumstances are.

“Thus, the physician's effort to charge what the patient could afford must have been done in somewhat of a hit-or-miss fashion. In many cases, the need for medical care at less than regular cost must not have been known to the physician.

“The County Medical Society's approach is the kind that will kill quicker than anything the rising demand for a socialized program of medical care run by Washington."

NO NEED FOR FEDERAL INTERFERENCE

Where are all the applicants? Does the means test put them off? Those familiar with the operation of the plan think not. They report that applicants talk openly about finances—except occasionally in the presence of sons, daughters, or in-laws.

The doctors have two explanations for the low response. Some feel it shows that the economic plight and medical care requirements of the Nation's over-65 group have been exaggerated. A widely held view is: “People aren't going to rush in to apply for a reduction in fees until they're faced with medical bills. This plan meets the need as it arises. And many elderly people don't need our plan simply because their physicians are already giving them reduced fees.”

The St. Louis County Medical Society now does not know of any person needing medical care who is not getting it. We invite anyone to bring any case of need to our attention, and if after checking it is found the request is bona fide we can assure you the patient will be given medical care regardless of ability,

to pay.

STATEMENT OPPOSING KING-ANDERSON BILL, H.R. 3920, FROM TOMPKINS COUNTY

(N.Y.) MEDICAL SOCIETY The following statement is submitted in opposition to the King-Anderson bill, H.R. 3920, on behalf of the Tompkins County Medical Society at Ithaca, N.Y., a component part of the New York State Medical Society.

To avoid repetition we first wish to state that we wholeheartedly endorse the position the American Medical Association has taken in opposition to this bill. We also endorse the statement made by the AMA in opposition to H.R. 4222 in August 1961. Much stated in that testimony is still most pertinent and applies equally well to H.R. 3920.

We wish to submit evidence to support in greater detail some points insufficiently stressed in the hearings on either one of these two King-Anderson bills, namely

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