International Journal ofOrthodontia and Oral SurgeryPUBLISHED THE FIFTEENTH OF EVERY MONTH BY

THE C. V. M OSBY CO., 3523-25 P ine Blvd., St. Louis, Mo.

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Editorial

A Health Service Plan Successfully Directed by Physicians andDentists Themselves

" There is a growing belief that the proponents of compulsory sicknessinsu ran ce are preparing to enter upon a campaign ag ain at the coming sessionof Congress. Senator Wagner, a close ad herent of the administ rat ion andfri end of the president, has so stated."?"

Some form of regimented practice to provid e adequate health service f orth e low-income gro ups of the people is an urgent necessity i lik ewise it is im­portant that the direction, the policy and the operation of s nch service be left

*A .D. A. Com mittee on E co n omic, Quo t in g, J ohn T. H a nks.

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1294 Editorial

in the hands and control of the health professions. The world is rapidlybecoming conscious of the wreckage of derelict health service plans startedin various countries, controlled by politicians and operated by laymen who donot know good health service from the incompetent and inefficient variety.Excavations of these experimental plans and posthumous debris in variouscountries reveal indifferent and lethargic attention and interest on the partof the doctor in the operation of these health plans. The most convincingevidence, that gleaned from experience, now points to the obvious conclusionthat for health service to be successful and efficient the doctor's spirit, driveand enthusiasm must not be snuffed out of existence by a system of politicalpatronage, but that his ambitious cooperation should be preserved if any planis to be successful for the people.

This question still remains entirely unanswered. What are the physiciansand the dentists going to do about it themselves in guiding and directing thenext big move? What are the health professions going to do to offset the pos­sibility of the mistakes being made in America which have been made in for­eign lands? The time for the professions to shrug shoulders and assume thatthe problem belongs to the future generation is past; some kind of regimen­

tation is now on its way.

Ail American method is now being tried, which is quite successful inWashington, D. C., and in St. Louis, Missouri. The organization is called theMedical Economic Security Administration, and consists of three parts:

1. The medical-dental service bureau.2. The group hospitalization service.3. The central admitting bureau.

They are all incorporated as nonprofit bearing organizations. The impor­tant points of the plan are based on the fact that each individual in any com­munity is a separate economic unit.

By the operation of this organization, the dentists and the physicians,through their respective societies, are prepared for any changes which mightbe recommended by either the federal or the state government with regard tothe delivery of health service. Unselfishly, the allied professions have estab­lished a well-coordinated program which utilizes existing machinery and doesnot subject the community or the taxpayers to any additional expense. Inmaking possible to every class, free choice of dentist, physician and hospital,the professions have not disturbed the patient-doctor relationship which isso vital to the recovery of the individual. The dentists and the physicians ofMissouri have not sacrificed their individualism nor have they established anew experiment at the expense of the public.

The dentists and the physicians operating this plan are the first in thiscountry actually to inaugurate group hospital service plans. Other societieshave approved them after establishment, but professional leadership was evi­dent in the societies taking the initiative. In the establishment of the Medical­Dental Service Bureau and Group Hospital Service and the eventual establish-

Editorial 1295

767$67,000

23053764

224 or 22.4%31.7 %82%

9414%

$70.00$47.00$64.00

ment of a central admit ting bureau for clinics, the professions doing t his aregiving to the community th e leadership in mat ter s of heal th that is expec tedof th em. Th e field secretaries and the director of this economic project haveaddress ed educational t alks t o approximately 100,000 people in employedg roups, and t o each of them has been brought the message that they shouldsee the ir family dentist and ph ysician with out further dela y . Th e imp ortan ceof prevention has been stressed because the economic qu estion has not beenone that requires the utm ost cons ideration any longer . In this educatio nalwork among th e laity it has been pointed out that the services of th e Medi cal ­Dental Service Bureau wer e offered to them, making it possible for them t oreq uest of their family dentist and their family ph ysician the privilege ofusin g the society 's bureau to budget needed health care over a period ofmonths without additional cost .

In educational work f or the plan, the direct or and the field secretaries ofthe Medical Economic Security Administration have addressed other gTOUpS,such as parent-teacher assoc iat ions, civi c organizations and the entire t each­ing staff of the public schools . In addition t o the direct meth od, printed in­serts car rying the same message have been delivered in pay envelopes t oalmost 200,000 worke rs.

In setting up a plan of coord inat ion which makes it possibl e for t he in­dividua l with low income to budget for dental or medical care and to enro llin a prepaymen t plan for hospitalization, th e worke r has been relieved offinancial worry to a considerable ext ent.

Since th e establishmen t of the Medi cal E conomic Secur ity program anumber of unethical cont ract health plans have been re moved from certaininstituti ons. The professions must be alert to the danger which lies in theseveral prepayment plans whi ch have been sp onsored by several govern mentage ncies. Th e mechanism of the Medical Service Bureau makes it possibl e tooffset th e subst it ute pl ans as a stop-g ap service.

The Resettlement Administration has endeavored to secure a foothold ,and the Farm Credit Administr ation has attempted the same thing; neverthe­less it is now obvious that the professions have established a service to fillthis requirement of govern ment employees.

Some figures assembl ed by Dr. Virgil Loeb and the number of patientshandled by the Medi cal-Dental Service Bureau in eleven months are interest.ing in connection with a survey of this plan.

Number of patients handl ed by Medi cal -Dent al Service Bureau( in 11 months)

Amount of payments (over)Nu mber of pat ients budgeting old billsNumber of patients budgeting new billsl eases pendin gNumber of city phys icians using bureauP ercentage of county physicians using bureauPercentage of hospi tal s using bureauNumber of dentist s using bureauP ercentage of dent ists using bureauAverage amount of physi cians billAverage amount of dentist 's billAverage amount of hospit al bill

1296 Editorial

There is now an opportunity for the professions to originate a plan whichwill set the pattern and which will be workable and will be satisfactory to them.The outline of the above plan, known as the Washington plan, now being oper­ated successfully in St. Louis and other cities is being watched with a greatdeal of interest.

H. C. P.