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The costs of medical care have been the object of study for several years by a research staff engaged by the Committee on the Costs of Medical Care. The Committee is composed of fifty members, including physicians, dentists, nurses, educators, social workers, social scientists, labor leaders, and industrialists. The purpose of the study has been to determine the amount and distribution of the present costs of medical care, with a view to suggesting methods by which costs of production could be reduced, or by which the financial burden of sickness could be more equitably distributed. Many other individuals and agencies also have been concerned with studying the costs of medical care during the last several years, and the committee has drawn upon their research in the attempt to deal with the problem. Monographs on special subjects have been presented from time to time, and the publication schedule of the committee includes twenty-six titles. Sometime during the year 1932 there will be issued a final report composed of an analysis and interpretation of the findings, with recommendations for the correction of undesirable conditions.

A physician is the crucial factor in the organization and functioning of social institutions for health maintenance. The availability to the population of his skilled services, as well as his counsel and leadership in community organization, are antecedent to the achievement of desirable goals in the matters of health. While hospitals, clinical and other facilities are vitally important, it is needless to point out that they are secondary in importance to the professional personnel which mans them. With the maintenance of the public health assuming such major importance in the present national crisis, some knowledge of general trends in the distribution and characteristics of medical personnel in peace time should be of value. The distribution of physicians is shown to be inversely related to the fertility of the population; that is, the regions with the higher fertility ratios had the fewest doctors in proportion to the population, while the areas with lower fertility had relatively more doctors. The departure of physician from rural areas is undoubtedly related to economic factors. If medical care is to be regarded as of equal social importance to education, social action to make rural service more attractive to the professional personnel seems highly justified.

The article presents information on ways to develop better rural health. The tragic need of security against illness has been revealed in many studies of the problem. On an average day of the year four million persons are disabled by illness. During one year-1935-approximately twenty-two million cases of disabling illness, lasting seven days or more, occurred with a loss of one billion, two hundred and fifty million days from work, home or school, as reported by the U.S. Public Health Service. Through reports on the physical examinations for selectees and through reported studies on the family health situation in many areas, the need for improved health and increased availability of health service facilities has come to the attention of the public and has become increasingly more important. Modern medical science is far in advance of medical practice available to and accepted by rural people. Doctors generally recognize this fact and are usually ready and willing to plan with lay people to improve the health situation. So much depends on good health-life, happiness, work, success, even the survival of a nation.

Two opinion research organizations, the National Opinion Research Center (NORC) and Opinion Research Corporation (ORC), have made comprehensive studies of the public attitude toward social medicine. Both organizations used adequate national cross sections in surveys which came to the following widely published conclusions--ORC: Only 16 percent of the U.S. people approve of a six per cent payroll deduction from wages for the Federal government to provide medical care and hospitalization. NORC: 68% think it would be a good idea for Social Security to cover doctor and hospital care. NORC in the same report mentions that only 41% of all respondents can be fairly counted as advocates of the Wagner-Murray-Dingell Bill, arriving at this by eliminating from the 68% both those respondents who think it a bad idea to increase to 21/2% the amount taken from pay checks and those who say they would rather have the insurance handled through some private insurance plan. The ORC report, on the other hand, states that 32% of its respondents approve of a plan to increase Social Security taxes and have the Federal Government use the money for a medical and hospital insurance program. ORC, desirous of discovering the technical reasons for the difference between the 32% it reported and the 68% reported by NORC, has recently polled the general public on six different ballots experimenting with question order, word choice, personalization of approach, multiple vs. dichotomous choice, order of alternatives, elimination of confusion of means and ends, and measures of intensity.

The article focuses on the public health insurance in the U.S. This article is a study of the economic and social hazards of ill health and accidents and of the ways in which health insurance can lessen these hazards. This method of payment also operates on the insurance principle. Under this arrangement medical and hospital expenses would be paid from a government created insurance fund supported by employer-employee contributions through pay roll deductions. The Catholic Church's attitude toward the sick is best indicated by her practice. For almost two thousand years, the Church has founded and encouraged hospitals, institutions, and charitable agencies to aid the sick, infirm, lame, and blind. Religious communities dedicate their lives to serve the sick in the name of Christ. A health insurance program should provide all the basic medical and hospital needs. In the home there should he provision for medical care by a general practitioner and specialist, visiting nurse service, and ambulance service. In the doctor's office the patient should be allowed eye examinations, psychiatric advice, medical attention by general physicians and specialists, vaccinations, diagnostic and laboratory tests, periodic check-ups, physiotherapy, etc.

The article presents a discussion on medical care programs in United States. Authors point out problems related to medical care. These problems have been need of more knowledge of causes of various illnesses and need for adequate local public health services for low income groups. Requirement for additional health personnel physicians, dentists and nurses in order to provide adequate health care to all. Moreover other health facilities are needed, many people cannot pay or have difficulty in paying for the health services. There is need for adequate prepayment coverage available to all at costs which they can afford. The growth of medical knowledge and specialization, coordination among specialists, and the arrangements are required, whereby a patient in a single illness consults several specialists each practicing solo has many disadvantages. More group practice among physicians in and out of hospital, closer co-ordination between physicians and hospitals, and more co-ordination among hospitals is also a need.

The article focuses on voluntary and compulsory medical care insurance in the United States. The compulsory medical insurance should be for all, covering all citizens or at least all employed and self-employed people. In social insurance, benefits should be set at a level below that requires to cover full loss. The horizontal limit on benefit may be applied as an upper limit in dollars per week. In cash benefit insurance paying for lost wages amount per week. Benefits should be exclusively in the form of provision of medical care, which would eliminate the problem of fee-setting and the possibility of fee-padding inevitable in a program providing cash reimbursement of medical bills. Social insurance abroad has taken for its function in protection of the working classes, leaving to private insurance the rest of the population. In planning a medical care program in the United States, construction of hospitals and related physical facilities, a more efficient and equitable allocation of these facilities, and the education and training of much additional medical and related personnel are all more important than medical care insurance.

The article focuses on welfare implications of alternative methods of financing medical care in the United States. A welfare analysis of medical care should be integrated with welfare analysis of the economy as a whole. According to the author the criteria for welfare within the economy are, optimum allocation of resources in terms of medical and non-medical employments, maximum efficiency in the utilization of medical resources and minimizing the financial burden on consumers, subject to the first two criteria. The money sums which consumers pay for the receipt of medical care do not represent consistent individual or group valuations of benefits to them. These benefits are not strictly allocable to those required to pay and because the total emergency nature of these benefits and the expensiveness of rendering them, substantial segments of the industry are organized on a nonprofit basis. As far as allocating resources to medical and non-medical employments, guarantees at least enough resources to medicine to give good care to all those suffering serious illness promises greater total consumer satisfaction than any alternative allocation. Consumers would pay medical resources directly for all services with nontransferable, dated, signed and addressed coupons.

The article focuses on the paper on the research on sociological aspects of health. The report will describe these experiments and, in addition, will present in some detail the major steps of the study that are important to an understanding of the methodological aspects. The methodology of the current statewide health survey is actually a part of an extensive and varied research effort which is now being made in the sociology of health and health care throughout the U.S. The major purpose of the survey was to ascertain the extent of unmet need for medical attention by use of the symptoms approach among a representative sample of the population in Michigan. Other purposes were to obtain information about the availability and use of medical services, methods of paying for health care, attitudes regarding physicians and medical care, and the attributes and characteristics of people which might be related to all three of these areas.

In the course of a study of the medical profession in Soviet society undertaken as part of a larger project on the Soviet Social System by the Russian Research Center, it was decided to tap former Soviet citizens' attitudes as patients toward the Soviet system of medical care and the Soviet physician. Refugees were asked to fill in a medical questionnaire in Russian. Two-thirds of these were administered in Munich and the rest, in New York. There can be no question but that the use of refugees as informants presents methodological problems. Disaffected people are hardly the type to give the West an objective picture of Soviet society. Moreover, there is often a suspicion that refugees tend to flatter Western inquirers by telling them what they think will please them, rather than the truth about the Soviet system. The present paper is limited to delineating certain meaningful patterns within the sample at hand. Finally, as will be seen below, if it is assumed that the refugee sample was strongly and consistently biased against the Soviet Union and its institutions, or that it consistently tended to flatter the U.S. and its institutions. then this assumption is certainly not borne out by the evidence.

An informed view of the controversy now taking place in social work circles concerning the role of organized religion in probationary, rehabilitative, and child welfare services must necessarily include reference to certain features of the contemporary religious scene in the U.S. Difficulty attends the interpretation of the U.S.'s postwar religious revival because in a secular society there is no necessary correlation between a rise in the fortunes of organized religion and an increase in religious thought and motivation. Many courts record the religious affiliation of the children and families coming within their jurisdiction, this information is customarily used as a guide for sectarian referral or for foster-home placement, particularly if religious identity between child and foster care is required by statute. Important questions arise, however, when courts go beyond this usage and impute diagnostic significance to the presence or absence of church affiliation on the part of the child or his family.

This study tests the hypothesis that the acceptance of an innovation in a medical care practice follows the same patterns as the acceptance of approved farm practices. The health practice used in testing the hypothesis is the acceptance of the Salk polio vaccine. The data for the study were secured from a representative sample of 701 households in Greene and Hancock counties located in the Piedmont section of Georgia. Contrary to expectations there were not the relationships between individuals receiving polio vaccine and the sociocultural factors previous studies had indicated were associated with the acceptance of approved farm practices. One unexpected result was the significantly higher percentage of Negro children receiving the Salk vaccine than whites--a result that could account for most of the other unexpected associations. A more intensive analysis of data and special interviews were made to find an explanation for the greater acceptance of polio vaccine among nonwhites than whites. [ABSTRACT FROM AUTHOR]

The article presents information on the paper "Principles of Management of Allergic Disorders With Prednisone and Prednisolone," by S.C. Bukantz, published in July 1958 issue of the Journal of American Medical Association. After a detailed account of the management of allergic disorders with prednisone or prednisolone, in which indications, dosage and complications are fully described, the authors conclude that these drugs can be safely employed even in long-term treatment provided the patients remain under close clinical and laboratory supervision.

Some remarkably difficult problems are being posed by chronically ill psychiatric patients who when treated with pharmacotherapy attain a tenuous remission which makes their return to the community at lest theoretically feasible. A study made throughout the mental hospital system in New York State finds that in a group of patients hospitalized the mental hospital system in New York finds that in a group of patients hospitalized three years or more the outlook for release after treatment with tranquilizing drugs improved 52 percent. Social workers who are as alert to resources within the hospital itself as they have traditionally been to resources within the community can do quite a lot to further the re-education of the chronic patients assigned to them. Work programs both within and without the hospital can be constructive or stultifying depending on whether they are fully exploited to give patients practice in making choices and in using initiative.

As this note is being written, a proposal to provide health insurance to retired workers under Social Security—the Forand bill—is being vigorously debated. Although health care for such workers involves some special considerations, the arguments of the proponents of this bill and the massive support being marshalled for its passage are symptomatic of general concern over voluntary health insurance. The dilemma threatening the survival of many of these voluntary programs is that costs tend to outstrip their ability to provide the quantity and quality of health care demanded by the groups they serve. In this discussion, the authors attempt to identify the major problems currently at issue in voluntary health insurance and to describe and appraise some administrative innovations that have been made in a few instances to control costs and improve the quality of medical and hospital care. [ABSTRACT FROM AUTHOR]

The article presents information on effectiveness of social work in meeting mental health needs. Psychiatric social workers in large numbers work closely with psychiatrists, psychologists, nurses, and others in the treatment of the ill. With regard to detection of those becoming ill and community activities to promote mental health, the total social work profession is focally and extensively involved. The concern of this paper, after noting the size and nature of the problem, is to suggest some ways of increasing social work's effectiveness in dealing with it. A few nationwide statistics will serve to indicate the size of the problem of treating the mentally ill. Figures for 1958 show that of the 6,786 hospitals of all types in the United States, 518 are psychiatric. In any year, the mental hospitals care for about 1,070,000 different persons, there are also upward of 60,000 patients in institutions for the mentally retarded. Social workers can extend the social dimensions in mental health work by discreetly extending their own roles to include those of consultant and educator. Even concepts of mental illness and mental health are changing, with accentuation of social factors. The ill or maladjusted person is seen as a product of social and societal forces as well as of organic pathology or intrapsychic conflicts.

Several years ago the Practice Committee of the Medical Social Work Section in the newly formed the U.S. National Association of Social Workers arrived at the conclusion that a comprehensive view of social work in the health field was essential. The first step was taken in social work education through development of the basic curriculum. The second step was the establishment of a unified professional organization, which included a new Commission on Social Work Practice, charged with clarifying and defining practice. This commission formulated an initial "Working Definition of Social Work Practice" to provide a base for its own program. The Working Definition focuses on the operating social worker. The Working Definition is now in an early stage, it will be continually tested and revised as the profession grows. Already its dynamic nature and value far beyond the commission's program are being clearly demonstrated. In starting to analyze any segment of social work practice one must always begin with these basic elements, keeping them firmly at the center as one continues the analysis.

The article presents information on various activities of the American College Health Association (ACHA) in the U.S. The first general session of the Forty-first Annual Meeting of the ACHA was started with the presentation of the paper "Modern Problems in Medical Ethics." A joint meeting of the ACHA's Committee on Tuberculosis, Section on Clinical Medicine and Section on Nursing Service was conducted on April 24, 1963. The second council meeting of the ACHA was held on April 25, 1963.