Of the total of 16,000,000 Blue Cross members in 1944, 13,400,000 d only their hospital bill covered. Some 2,000,000 also had their geon's and obstetrician's fees provided. About 100,000 had phyjan's care in hospitalized illness covered. Only 50,000 were entitled physician's care in home and office as well as in the hospital. (See .6.) It should be noted that these plans usually cover only the hospital l and do not cover doctor's or dentist's bills, home nursing, or other pes of medical service. Hospital expenses comprise about onerenth of all medical care costs, while physicians' and surgeons' FIGURE 6. ALL BLUE CROSS MEMBERS GET HOSPITALIZATION Source: Letter from director, Hospital Service Plan Commission, American Hospital Association, Janu. F, 1945. ervices account for about three times as much. Important as these lans are to those having hospital expenses, which tend to be large Then they are incurred, they do not cover most medical care, preentive or therapeutic. MEDICAL CARE PREPAYMENT PLANS A much smaller number of people have insurance for doctors' ervices. Physicians' and surgeons' services take 40 percent of the verage medical dollar and are the most important single item in all nedical care. It is early, high-quality doctor's care in home and office that the average person needs most, but current prepayment plans handle such service most inadequately. The various types of medical care prepayment plans differ wide in the services they offer. (See fig. 7, pp. 14-15.) GROUP PRACTICE PLANS Most of the plans offering comprehensive prepaid medical c are group practice plans, sponsored by industrial firms, consume or physicians. In general, they offer services to groups of employ individuals and sometimes to their families. The doctors are usual on salary, full-time or part-time, and the service is given mainly clinics rather than in the individual doctor's office or in the patien home. The cost ranges from $12 to $36 a year per person and fre $36 to $100 or more for a family of four. A typical cost is $24 a ye per person. Certain data concerning a few of these plans are shown in table TABLE 5.-Examples of group practice prepayment medical care plans which prom comprehensive service 1 Reduced fees for individual services to dependents; 73,000 dependents covered. Initial membership fee of $20. Initial membership fee of $50. Initial membership fee of $12. Special assessments up to $9 in any one year. Extra charges; e. g., for home calls and hospitalization. Company pays all. Figures refer to cost to company in 1941. Includes sickness disability payment of $12 per week for employee. Principal source: Klem, Margaret, Prepayment Medical Care Organizations, Social Security Board Memorandum No. 55, third edition, June 1945; information as of 1945. Forty percent of all members of prepayment medical care organiza tions obtain care through group practice. Over half of these, or 1.3 million people, are members of industrial type plans; the others are members of private group clinics or consumer sponsored plans. In order to illustrate concretely what such plans offer, a summary description of one of the best-known plans is shown in table 6. TABLE 6.-Ross-Loos medical group (Los Angeles, Calif.)—Private group clinic Age and physical examination requirements if not in group. (No income requirements.) IBLE 6.-Ross-Loos medical group (Los Angeles, Calif.)—Private group clinic Continued General practitioner and specialist in clinic, home, hospital. Surgery. Maternity. Hospitalization, up to 90 days in any one year except for maternity. SERVICES NOT INCLUDED OR INVOLVING EXTRA CHARGES Dental care. Services obtainable from public programs (tuberculosis, mental, workmen's compensation). Home nursing. . Drugs and appliances. 3 The number and membership of group practice prepayment plans re increasing gradually. Their popularity is rising among doctors, specially younger ones, as well as among the public. A poll of medical fficers in the armed forces, sponsored by the American Medical Assoiation showed that 53 percent of the doctors replying wanted to enter rivate group practice after their discharge. This popularity is indoubtedly based on sound reasons. There is evidence, both qualitative and quantitative, that well-organized group practice can offer better medical care than individual practice. The best utilization of specialists' knowledge and skills, of auxiliary personnel, and of complex modern laboratory facilities can be achieved through group practice. The cost of high-quality care under group practice seems to be considerably less than under individual practice. (See p. 13.) Study of the amount of medical care received by members of group practice plans indicates that they receive more service, on the average, than recipients of individual, fee-for-service care. A comparison of the services received by subscribers to three typical group practice plans having a total membership of 150,000 with a control group of simllar size who received care on an individual practice basis appears to illustrate this point well. The control group lived in communities of similar geographic location, pop ulation, and per capita income. (See fig. 8.) MEDICAL SOCIETY-SPONSORED PLANS A more recent type of medical care prepayment plan is that sponsored by State or county medical societies. Until about 1939 almost all medical societies opposed prepayment plans, actively or passively. Many have now begun to offer plans covering certain limited types of services, which are usually confined to surgical care during so-called catastrophic (i. e., hospitalized) illness and to maternity service after a waiting period of about 9 months. • Based on data in Journal of the American Medical Association, vol. 125, p. 558, 1944. TABLE 7.-Examples of medical society plans-Descriptions in terms of family of 4 NOTE.-Information relates to middle of 1945. Source: Same as fig. 9. Surgery in office, home, and hospital; maternity Surgical care; includes Caesarean sections and Surgical care in home, office, hospital; mater- Surgery and 2 weeks aftercare up to $150 in any Care for hospitalized illness; surgical benefits Name |