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The three plans were selected because their membership (with their fan ilies) comprised more or less a cross section of an employed population. See The Experimental Health Plans of the United States Department of Agriculture, Subcommittee Monograph 1, January 1946, p. 33.

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Source: The Journal of the American Medical Association, vol. 124, p. 371, 1944; vol. 128, p. 1173, 1945

The typical cost for a family of four ranges from $18 to $36 a year. This is usually purchased together with Blue Cross hospitalization. Thus, for a total of about $50 annually a family eligible to join may be assured relatively complete medical service for hospitalized illness during the period of hospitalization.

Data concerning some of the largest medical society plans are shown in table 7. Most medical society plans have group-enrollment and income-limit requirements.

When such plans were first started, several State medical societies. (e. g., in Michigan, California, and New Jersey) offered comprehensive medical care coverage, including home and office service. However, all have withdrawn such contracts or are doing so now. Why is it that the group-practice prepayment plans are usually able to offer comprehensive medical service, whereas the medical society plans are not?

One reason is undoubtedly the difference in cost of furnishing services under the two types of plans. All the medical society plans pay individual doctor's fees for each service rendered, and none have any but the loosest professional organization and supervision. On the other hand, the doctors in the group-practice plans are on full- or part-time salary, under more or less integrated professional organization and supervision. It is interesting to note the estimates by two experts of the costs of comprehensive medical care under conditions of group practice and individual fee-for-service practice.

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Whatever the explanation, the fact remains that almost no medical society plans offer comprehensive care. They do not cover the numerous illnesses that confine a patient to his home or take him to a doctor's office but are limited to hospitalized illness. The result is that they cannot possibly offer the member all needed preventive, diagnostic, and therapeutic services, i. e., complete high-quality medical care.

COMMERCIAL PLANS

Commercial health and accident insurance policies are of two main types-those with group and those with individual enrollment. According to estimates of the companies, group commercial insurance covered about 8,000,000 people in 1944.5 Of these, over six million had hospitalization policies. Five of the eight million had surgical policies as well. Members are paid specified amounts of cash toward their expenses for different kinds of operations or toward their hospital bills. Some have, in addition, policies which pay specified amounts of cash during disabling illness. An illustration of the group type of plan is given in table 9.

No accurate information is available concerning the number of people covered by individual commercial health and accident policies. They vary widely, and generalizations are difficult to make concerning

The Washington and Oregon plans do not fit this and certain other generalizations true of other medical society plans. With the exception of maternity care, plans in these two States do provide comprehensive doctor and hospital service. See E. Milliman, Social Security in the United States. Proceedings of United States Chamber of Commerce Conference on Health Insurance, January 1945.

According to a national health and accident underwriters organization, 40,000,000 people were covered under group and individual policies for "substantial health benefits" in 1944. The validity of this is open to serious question. If the 8,000,000 people with group disability insurance are subtracted, this would leave 32,000,000 people with individual health and accident policies. Such policyholders received, in the aggregate, $104,000,000 as benefits in 1944. Thus, the average benefit received by the policyholder could not have exceeded $3.25. Of this the lion's share went to pay wage loss from disability; less than a fifth was paid as indemnity for any kind of medical service. This can certainly not have provided very "substantial health benefits"; the average individual's costs for sickness and wage loss comes to around $60 annually. The benefits usually cover only a relatively small percent of the insured person's sickness costs.

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NOTE.-Information relates to middle of 1945. Source: Same as fig. 9.

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