Our nurses teach the fundamentals of nursing care to the relative, friend, or attendant of the sick person, whenever possible. In the event there is no one whom we may teach, we give necessary nursing care to the patient where limited service will adequately meet the needs. Nursing care of the sick is given under the direction of the family physician to whom we turn for specific orders and guidance.

Unit fee schedule

MEDICAL

Units

O-Office visits__

1

HD-Day home visits (7 a.m. to 9 p.m., city and suburban), plus 25 cents per mile one way on country calls-

2

HN-Night home visits (9 p.m. to 7 a.m., city and suburban), plus 25 cents per mile one way on country calls---

HP-Day hospital visits (7 a.m. to 9 p.m.), special hospital calls--.

Plastic and skin grafting (for special cases, see committee)

25

Incision for superficial abscess, as furuncle or boil, same as office or home call_ Deep abscess or infection___

10

Removal of nail, finger, or toe, including local anesthetic

10

Repair of minor wounds, not otherwise specified (sutures)

2-5

Major surgery, not otherwise specified_.

35

GYNECOLOGY AND OBSTETRICS

Deliveries, home_.

Deliveries, hospital__.

Circumcision of infant.

Vaginal hysterectomies.

Laforte operations, vulvectomy, complete 3d degree repair_.

Consultation, hospital__

Diathermy (see hospital and clinic).

Electrocardiograms and consultation, doctor's office_

Transfusion_.

35

20

5

35

35

20

20

15

10

10

5

20

20

35

15

1

5

3

5

5

5

15

35

10

35

5

10

5

35

10

20

15

1

42322221

7th half_

8th half.

After first half hour, 15 minutes or more computed as one-half hour and no allowance made for less than 15 minutes.

Unit allowance for clinic time served will be computed by the executive office from the clinic time sheets. No other report for clinic time served is required, however, it is important that all members enter time of arrival and departure on clinic time sheets and complete column, “Diagnosis and type of service."

To: Shawnee County Medical Society, Inc.

315 West Fourth Street,

Topeka, Kans.

Form Must Be Completed at Time of Admission and Returned to Medical Society Executive Office Within 24 Hours

PLEASE NOTE.-The Shawnee County Medical Society will not recognize responsibility of payment of services for this patient after 7 days unless request for additional hospitalization is made out by attending physician.

Proposed rate of payment for 1964 for total health services per person per

HOSPITAL CARE FOR THE AGED UNDER SOCIAL SECURITY-THE KING-ANDERSON BILL H.R. 3920 AND S. 880

A Background Paper Including Comparisons With S. 65 (McNamara) and S. 849 (Javits et al.) and Recommended Changes by Walter J. Lear, M.D., New York, N.Y.

The current King-Anderson bill is a great improvement over its predecessors It contains several excellent new provisions and important improvements of old provisions. However, it still disregards a few major recommendations and a number of minor ones advocated by community and professional organizations which favor the social security approach to medical care of the aged and which have studied this type of legislation carefully.

These recommendations, with one exception, would require only several moderately significant changes. A copy of H.R. 3920 with these changes is attached. These changes and several other timely issues are briefly discussed in the following pages.

A. Range and amount of benefits-Reluctant acceptance of proposed size of social security tax increase (pp. 7-17, 57-60)

The major shortcoming of this bill is the limited range and amounts of benefits, primarily, acute general hospital care. This is the result of the limited amount of money available from a social security tax of one-half of 1 percent of employee wages (total of employee and employer contributions) and an increase in the taxable wage base to $5,200. Apparently both the administration and the congressional sponsors of all the social security bills believe this is the maximum tax increase possible at this time.

In view of the well-demonstrated need of the aged for comprehensive health care benefits, it is only with great reluctance that the proposed size of the tax increase is accepted. It should be recognized, however, that the dollars thus available are insufficient to cover the cost of "basic" benefits in all major areas of health care, leaving aside the much more costly nad controversial goal of truly comprehensive health care benefits.

A very rough indication of the discrepancy is obtained by comparing the estimated cost of this bill-about $100 per person per year-and the current cost of the most comprehensive health insurance policies available in New York City— $104 per person per year for HIP and extended Blue Cross bought on a group basis. This, of course, does not cover dentistry, drugs, or care in nursing homes and chronic disease hospitals. Moreover, the cost of medical care of the aged is almost double that for younger people.

B. Definition of nursing home benefit-Elimination of prior hospitalization requirement (p. 9: 4, 5; p. 20: 15, 16; p. 31: 18–24)

The only medical reason given for the requirement that nursing home services be covered only when the patient is transferred from a hospital, is that any patient that needed to be in a nursing home should have the benefit of a complete workup in a hospital. This is a serious misconception of the proper role of the hospital and is counter to major efforts by medical and hospital leaders to cut down unnecessary hospitalization, particularly for diagnostic studies of patients who really don't need to be in a hospital. In fact, this goal is considered so desirable it is even given the special status of a separate paragraph in this bill's purposes (p. 5:24; p. 6:1-5).

Apparently, this conflicting definition was inserted as one of several means to limit the amount of nursing home care that would be paid for by this bill. Even if this were a valid reason in earlier versions, it is now unnecessary to restrict the nursing home benefit beyond the new highly restrictive definition of a skilled nursing facility in the present version.

This bill should not encourage unnecessary hospitalization of those who need only nursing home care; rather it should encourage, as stated in its purposes, the use of nursing homes as an alternative to hospitals.

C. Diagnostic studies from nonprofit and local government clinics not part of a hospital-Addition of new provisions (p. 11: 17, 20; p. 12: 15; p. 23: 20) Diagnostic studies are limited to those done by hospital out-patient departments in order to avoid the several very difficult problems presented by including those done by physicians as part of their private practices without legally or professionally required qualifications or supervision.

Until arrangements are developed for including physician services generally, this exclusion is a wise one. However, an exception could easily and properly be made for the few clinics not part of a hospital which have a public or nonprofit status. This modification is supported by the American Public Health Association, the Group Health Association of America and the Physicians Forum. In order to safeguard the quality of care provided by these clinics, this bill should include a set of standards comparable to those for other participating providers of services.

D. Medicine benefits-Addition of new provisions (p. 12: 8; p. 14: 16; p. 24: 3) The cost of medicines is one of the major segments of medical care costs accounting for about 21 percent of private expenditures for medical care of the aged. The per capita medicine expenditure for the aged is over twice that for the population as a whole, and a greater proportion is for prescribed medicines. In the 1958 HIF-NORC study, the mean per capita expenditure for those over 65 was about $33 in comparison to $13 for those of all ages. This same study showed that a substantial number of people of all ages have annual expenditures for medicines totaling $200 or more (6 percent of families in the compari