The Health bulletin [serial] - University of North Carolina at Chapel Hill

March, 1951The Health Bulletinconducive to emotional and physicalhealth.2. The immunizations and healthsupervision each individual should have,the kinds of ill health which maythreaten him, and symptoms whichshould warn him to seek medical attention.3. The elements involved in the provisionof complete health care to thecommunity, how he can use these mosteffectively, and the coop>eration he mustgive if they are to function economically,and to the greatest satisfaction of theindividual and the community.You can see that the provision of thiskind of information and understandingis a major and continuing task in whichmany groups and agencies have a heavyresponsibility. If it is not provided nodegree of adequacy in available serviceswill suffice to give us that "state of completephysical, mental and social wellbeing"which we call health.The fifth and final element in theright to health is a method or combinationof methods which makes it possiblefor each individual to secure adequatehealth and medical services at a costwhich he can afford, and under a systemwhich preserves his dignity andself-respect.Let us consider briefly some of thefacts of this problem of financing medicalcosts. There are two facts whichImmediately stand out:1. The greatly increased expensivenessof medical and hospital care in recentyears.2. The irregular and unpredictable incidenceof medical costs.There is no question about the expensivenessof medical and hospitalcare today. The new techniques ofexamination and treatment and thenew therapeutic agents, which havemultiplied the effectiveness of medicaldiagnosis and treatment, cost a lot ofmoney. These costs can be tempered ina measure by more economical administration,better coordination among thevarious individuals, groups, and facilitiesproviding care, by expansion ofgroup practice and by less demand onthe part of patients for luxury care andfacilities, but even with all possibleeconomy the costs of good care are stillhigh.The distribution of the medical caredollar among the various items of expenditureis interesting, and perhaps notquite what most of us would expect.Around 25 cents goes for physicians'services, 21 cents for hospitalization, 14cents for dental care, 21 cents for drugs,and 19 cents for nursing and all othercare.The population can be divided intotliree groups so far as their ability topay the costs of medical care is concerned:1. The indigent and medically indigentwho can pay for none or only asmall part of their care.2. The great middle income group whocould pay their medical costs if theywere spread out uniformly, but whosefinancial competence is jeopardized byprolonged and major illness.3. The relatively small percent ableto meet any eventuality.$2000 a year would appear to be theminimum income on which a familycould be expected to pay for even normalroutine medical costs without assistance.In 1946 twenty eight percent of individualsand families had an income ofless than this figiore. Government clearlyhas the major responsibility forfinancing medical care for this groupthrough some plan which assures themof adequate care, and which does notpauperize them or offend their self respect.This is a responsibility which isbeing met very unevenly and inadequatelyin the country as a whole. Andit is worth noting that the compulsoryhealth insurance plans which have beenproposed would not take care of thisgroup.It is around the needs of the secondgroup, who can meet their medical costsif they can be spread out through somekind of prepayment or insurance plan,that the greater part of current discussionhas centered. There is generalagreement that the principle of contributoryhealth insurance should be thebasic plan of financing medical care fora large majority of the American people,but there is wide divergence as towhether this can be accomplished by