Annual Report the Surgeon General United States Army Fiscal Year 1959
PATIENT CARE AND RELATED ACTIVITIES
Hospital Clinic Care
One of the most important of the changing concepts in the practice of medicine in the U.S. Army Medical Service in recent years has been the gradual shift from hospital care to the treatment of more and more patients on an ambulatory basis. Many medical disorders which formerly required hospital care are now being treated in outpatient clinics. In many other conditions, the period of hospitalization is being reduced by the judicious use of clinic services for prehospitalization and posthospitalization care. The result has been that for every admission to Army hospitals today there are more than 25 outpatient visits.
The increased emphasis on outpatient care is not only sound from a medical viewpoint but is also more economical in the utilization of personnel and facilities. Moreover, it maintains the patient in an effective status whether on military duty or in the home. Although the Army has operated outpatient services for many years, it has become increasingly obvious that the organization, philosophy, and concepts of the clinic services must be reoriented to meet the increased responsibilities placed upon them by modern medicine.
In recognition of this important problem, The Surgeon General has initiated an aggressive program to reorient and rehabilitate the clinic services of Army medical treatment facilities in accordance with their expanded role in the diagnosis and treatment of patients. He launched this program by sending letters to hospital commanders and army surgeons, soliciting their opinions and recommendations as to ways and means of improving clinic care. In addition, he created a special committee on clinic care to explore remedial possibilities and to make appropriate recommendations. This committee is headed by the chief of the Professional Division, OTSG (Office of The Surgeon General), and includes the professional consultants in his office, members of the Medical Plans and Operations Division, and other representatives of OTSG as well as the chiefs of the outpatient services at Walter Reed and DeWitt Army Hospitals.
Members of the committee have considered carefully the opinions and recommendations of the hospital commanders and army surgeons;
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have discussed the various administrative, organizational, logistic, and personnel changes that may be required to improve clinic care; and have visited certain military and civilian hospitals to observe operations of their clinic services. As a result, the committee has evolved the following principles which the members believe should be followed in carrying out the program for improving the clinic services:
1. A clinic care program must be sufficiently varied to provide for the differences in the physical facilities available, in the quality and quantity of professional personnel, in the extent of the professional training program, in the patient load, and in the size and type of the military post involved. A single plan for clinic care will not be applicable to all Army medical installations.
2. Continued care, whether inpatient or outpatient, should be the responsibility of the particular professional department or service concerned and should be on a personalized basis.
3. Emergency cases, patients without appointment, or other patients who request or require immediate attention should be the responsibility of a specifically designated chief of hospital clinics. He would also be responsible for physical examinations, immunizations, and other medical procedures requiring a single clinic visit.
4. The responsibility for integrating outpatient and inpatient treatment in such a way as to insure the best utilization of both staff and facilities should rest with the hospital commander who could delegate various tasks, but not the overall responsibility, to the chief of professional services, to the chief of hospital clinics, or to another senior professional officer.
Plans for implementing these operational principles are being formulated by The Surgeon General. The plans adopted for carrying out the program will be transmitted to army surgeons and class II hospital commanders by appropriate letters and directives. Efforts will be made to create basic doctrine which teaches that continued care should be based upon a close personal bond between the patient and doctor and that this can be accomplished only by patient-doctor continuity. Such doctrine will emphasize that ambulatory patients and bed patients should receive the same high quality of medical care. Also, that in Army hospitals which conduct professional medical training it is important that interns and residents obtain part of such training from the care of clinic patients. Under this doctrine, all patients who require continued care would be referred to a particular specialty clinic, such as the general medical clinic, the general surgical clinic, or the neuropsychiatric clinic.
In making their report to The Surgeon General, members of the com?
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mittee stated their belief that implementation of the operational principles and doctrine evolved would enable the Army Medical Service to accomplish more efficiently its important mission of providing adequate care for clinic patients.
Professional Consultant Activities
The improvement of standards of patient care has continued to be one of the primary objectives of professional consultants to The Surgeon General. Through careful monitoring of personnel assignments and through frequent staff visits to Army medical treatment facilities throughout the world, these consultants have been able to effect better utilization of personnel, equipment, and facilities.
More active participation by professional people in national and international medical and surgical organization meetings has been encouraged at all levels of command, and closer liaison with specialty boards, national societies, and professional groups has been developed in order to provide greater opportunity for professional growth. Smoother, more effective unit operations, improved morale, and a higher caliber of professional care have resulted from this closer inter-group relationship.
General Medicine
The total number of board-certified and board-qualified officers on active duty has increased appreciably in all medical specialties, except pulmonary disease. The increase of 123 was due not only to an augmentation of 63 Regular Army members but also to the entry on active duty of Berry Plan trainees (physicians deferred to acquire training beyond internship) and other 2-year reservists.
Greater stability and improved medical care are being attained as a result of the increased emphasis on the designation of Regular Army officers or career reservists as chiefs of the medical services in CONUS (continental United States) hospitals. It is expected that this objective will be attained in all Army hospitals of 50 beds or more by the end of fiscal year 1960.
The Army Medical Service has kept pace with developments in the field of endocrinology, and a 1-year training program in endocrinology and metabolism has been established with Dr. Peter Forsham at the University of California in San Francisco. The physicians participating in this program are all field-grade officers and diplomates of the American Board of Internal Medicine. One medical officer has completed his training, a second is now in the program, and a third has been designated to begin his training in January 1960.
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Equipment is being procured and personnel are being trained in the continuing effort to establish radioisotope clinics in those teaching hospitals which do not yet have such clinics.
Staff visits were limited during this fiscal year owing to the shortage of personnel in the Office of the Chief Medical Consultant. Every effort was made, however, to maintain contact with Army physicians practicing internal medicine and its related specialties by meeting and talking with these officers at medical meetings and by conducting short courses at Army hospitals.
Surgery
The Army Medical Service has remained abreast of developments in the field of cardiac surgery, and Fitzsimons, Walter Reed, Letterman, and Brooke Army Hospitals have been assigned the additional mission of performing open-heart surgery. Added impetus was lent by the cutback of October 1958 in the Dependents' Medical Care Program, and it is felt that surgical activities will have to be extended significantly in the near future.
Throughout the year there was a shortage of qualified individuals in the surgical specialties, particularly in ophthalmology, otolaryngology, urology, neurosurgery, orthopedic surgery, and general surgery. It is anticipated, however, that these shortages will be substantially reduced in the coming year because of the anticipated full impact of the Berry Plan.
Staff visits were made to U.S. Army hospitals in CONUS and USARPAC (U.S. Army, Pacific). During these visits, personnel requirements were confirmed, topics of professional medical care were discussed, and problems involving supplies and equipment were resolved. The quality of professional care, as assayed by ward rounds, was found to be excellent.
Chiefs of surgical services were reminded of the importance of limiting surgical procedures to the capabilities of the facilities at hand, including ancillary personnel, physical plant, and other considerations.
Efforts continued toward the institution of a comprehensive blood program for the Army in relation to the activities of the Department of Defense and civil defense authorities.
Psychiatry and Neurology
Army neuropsychiatry continued to strengthen and expand its efforts to prevent noneffectiveness among personnel due to psychological reasons. Revision of AR 40-216, Neuropsychiatry, soon to be published, redefines and brings up to date the staff and clinical functions of the
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several echelons of the psychiatric program for both combat and non?combat activities. This revision also authorizes needed changes in the mental hygiene consultation service monthly report.
Mental hygiene consultation services and other Army outpatient psychiatric activities have enlarged their sphere of operations to include behavioral and disciplinary problems in addition to those presented by the more traditional symptomatic disorders. Stockade screening has become an established procedure on all posts and stations in CONUS and overseas where psychiatric personnel are assigned. The objectives of this program, conducted in close collaboration with Military Police Corps personnel and in support of the Army correctional program, are to evaluate the duty potential of all stockade inmates, to make appropriate recommendations for the administrative discharge of recidivistic offenders, and to provide psychiatric treatment to restorable prisoners. Stockade screening has significantly contributed to a continuing reduction of the prisoner population. During the fiscal year, another disciplinary barracks was closed in addition to the two closed in fiscal year 1958, and the stockade population has been reduced by over half on most posts in CONUS and overseas.
Because the optimum period for preventive psychiatry is early in the course of maladjustment, a First Court-Martial Screening Program for disciplinary offenders was initiated in the fiscal year. This program provides for the routine evaluation of all offenders who are convicted by court-martial but who do not receive confinement sentences. First Court-Martial Screening has become operational on several large posts in CONUS and will become a standard procedure in fiscal year 1960. It is known that psychiatric efforts are more profitable if employed before defective attitudes and faulty motivation, commonly engendered by confinement, become fixed. Moreover, individuals of low military potential can be more promptly discharged at the time of their first offense, thus preventing repeated disciplinary infractions and prisoner status and thereby improving their chances of satisfactory postservice integration into the nonmilitary community.
The overall results of the Army preventive psychiatry program was demonstrated by a continuing decrease of hospital admissions for psychiatric disorders. The Army's alltime low rate of 9 psychiatric admissions per 1,000 strength that was achieved in calendar year 1957 was further decreased to a new low rate of 8 per 1,000 strength in calendar year 1958. The average bed occupancy for Army psychiatric patients in CONUS decreased from 682 per month in calendar year 1957 to 560 per month in calendar year 1958. There has been a corresponding decline in the separation of enlisted personnel for
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undesirability (AR 635-208) and inaptitude and unsuitability (AR 635-209), along with a decrease in the number of summary, special, and general courts-martial.
The lessened inpatient psychiatric caseload, the decrease of the prisoner population, and the closure of disciplinary barracks have made possible important personnel savings, particularly of medical officers. There were 160 psychiatrists on duty in fiscal year 1959 as compared to the 190 on duty in fiscal year 1958.
This fiscal year saw a major revision in administrative discharge regulations which incorporated many proposals made by The Surgeon General, the most pertinent of which are-
1. Removal of 'unclean habits (repeated venereal diseases)' as a cause for undesirable discharge. This action completes a historical cycle begun early in World War II when the principle was laid down that venereal disease should be considered an illness in line of duty provided the individual presented himself for treatment. This last removal of punitive action for venereal disease now makes it unnecessary for the individual to evade authorized, or to seek unauthorized, treatment.
2. Removal of 'chronic alcoholism' from AR 635-208 as a cause for undesirable discharge and the placement thereof in AR 635-209 as a cause for a general discharge under honorable conditions. This change will facilitate the administrative discharge of such noneffective personnel.
Considerable progress was made in developing new techniques of inpatient treatment of schizophrenic disorders. For almost 2 years, a special psychiatric treatment ward conducted jointly by Walter Reed Army Institute of Research and Walter Reed Army Hospital has explored the possibilities for a more effective treatment of schizophrenia in young military personnel. A unique technique, milieu therapy, has been evolved, which includes a combined treatment effort of the entire psychiatric team, with considerable emphasis upon the utilization of enlisted neuropsychiatric specialists in order to provide a more or less continuous psychotherapeutic regimen. Preliminary results of a 1-year followup indicate that 50 percent of patients treated by this method can be restored to useful military service. A similar milieu therapy treatment ward was established at Valley Forge Army Hospital during the fiscal year. Other milieu therapy wards will be gradually initiated at other Army neuropsychiatric treatment centers when sufficient personnel have been trained at Walter Reed Army Hospital by the parent unit. It is believed that efforts in this field mark a significant advance in the Army Medical Service.
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Residency training in psychiatry and neurology has been maintained at a level similar to that of the previous fiscal year. Thirty psychiatric residents and seven neurology residents were in training at Walter Reed and Letterman Army Hospitals.
Psychiatric personnel assigned to the Professional Division, OTSG, actively engaged in teaching, in training, and in other educational activities during the fiscal year, in addition to giving professional instruction during visits to mental hygiene units and Army hospitals. Regularly scheduled lectures on military psychiatry topics were given at the U.S. Military Academy, the Command and General Staff College, the Armed Forces Staff College, the Army War College, the Army Medical Service School, the Walter Reed Army Institute of Research, the Judge Advocate General School, the Intelligence School, at symposia held at Sandia Base, and at MEND (Medical Education for National Defense) programs of several medical schools. Technical assistance was provided in the production of a training film on the management of mass casualties (TF 8-2712). Psychiatric personnel of OTSG gave technical support to the WRAMC (Walter Reed Army Medical Center) TV Unit in the production of films aimed at the improvement of interpersonal relations in patient care. As an experiment, one such film produced by WRAMC was shown to several Army hospital staffs, following which a panel discussion was held. It is believed that this provocative type of presentation, followed by discussion, is far more effective in stimulating interest in interpersonal relations than lectures or writings.
Social Work
In fiscal year 1958, each infantry and armored division was authorized by TOE (tables of organization and equipment) one social work officer. During fiscal year 1959, social work officers were assigned to all divisions to fill the spaces provided by these authorizations.
Stabilization of the social work officer career group MOS (military occupational specialty) 3606, continues to be excellent. Of this group, 75 percent are either Regular Army or career Reserve officers. The retention of social work officers beyond completion date of obligated tours approximates 67 percent as compared with a retention rate of 15 to 26 percent for all MSC (Medical Service Corps) officers.
Authorization was obtained to procure and assign 10 social work officers for clinical psychology officer vacancies which could not be filled in the near future. This has enabled preventive psychiatry programs to be maintained on several posts.
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The supply of enlisted social work specialists is adequate based on worldwide authorization. Overages and shortages have occurred however, at individual mental hygiene consultation services and have created problems in operation.
Approval was obtained from USCONARC (U.S. Continental Army Command) to give retirement point credits to Army Medical Service Reserve officers who attend the Annual Army Social Work Conference.
Clinical Psychology
Clinical psychology officers contributed effective support to the neuropsychiatric mission by furnishing professional services in diagnostic testing, in psychotherapy, and in research, and by conducting training for medical and paramedical personnel.
Continued efforts have been made to procure the authorized number of clinical psychology officers. The number on duty remains critically short. Attention is being directed toward introducing a program which will attract a sufficient number of officers in this specialty.
Internship training programs in clinical psychology were conducted at Letterman and Walter Reed Army Hospitals.
Three officers completed the written examination in clinical psychology for the designation of diplomate of the American Board of Examiners in Professional Psychology.
Increased attention is being directed toward carrying out research on psychiatric and psychological problems in the field. During the year, approximately 10 professional papers were prepared, and 6 fairly long term research projects were initiated.
Pathology and Laboratory Activities
In recognition of the increasing importance of pathology in aviation medicine, a consultant in forensic and aviation pathology was added to the pathology consultant staff in OTSG, and a technical bulletin entitled 'Medical Investigation of Aircraft Accident Fatalities' is being developed.
During their tours of active duty for training, the mobilization designees to The Surgeon General in pathology prepared three timely studies entitled, as follows:
1. 'A Post Graduate Course in Clinical Cytology.'
2. 'Survey of Tables of Organization and Equipment Assemblies for Medical Laboratories and Hospitals.'
3. 'Review of Army Regulations, Technical Bulletins, and Training Manuals That Pertain to the Pathology Laboratory.'
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Thirty-five residents in pathology are now in training at five teaching hospitals. Resident training programs in pathology are scheduled to start in September 1959 at William Beaumont and Madigan Army Hospitals. The number of pathology residents has increased, and at present all authorizations are filled.
The six MSC officers who participated during the fiscal year in civilian postgraduate training for laboratory science officers have been granted an additional year of training in the various laboratory specialties leading to the Ph.D. degree. In addition, four MSC officers have recently been approved for civilian postgraduate training in the laboratory sciences leading to both the master's and the Ph.D. degrees. For the second year in succession, there has been a reduction of man-year spaces available for civilian postgraduate training. It is felt, however, that, if 10 man-year spaces continue to be made available for postgraduate training, it will be possible to maintain the existing requirement for postgraduate training of laboratory science officers. It is imperative that postgraduate training be continued at this tempo if the Army Medical Service is to maintain qualified laboratory science officers, for it is evident that few officers on Reserve duty with Ph.D. degrees elect to apply for the Regular Army or for an indefinite category at the conclusion of their obligatory service. The procurement of trained MSC laboratory science officers remains adequate for staffing requirements. At present, very few vacancies exist in the Regular Army for such officers, and only a few limited spaces are available in the Reserves for those satisfying the MOS-3314 requirements.
The course entitled 'Current Trends in Laboratory Activities,' held at Walter Reed Army Medical Center, on 8-13 September 1958, was attended by 20 carefully screened MSC laboratory officers. Commanding officers of CONUS and oversea medical laboratories attended the Preventive Medicine and Laboratory Officers Conference at Walter Reed Army Institute of Research, 12-16 January 1959.
Pharmacy
Shortly after The Surgeon General established the policy that commissioned pharmacists would be assigned to full-time duty as chiefs of pharmacy services in all hospitals of 100 beds or more, he anticipated the growing trend toward increased outpatient care by providing also for the assignment of commissioned pharmacists to those dispensaries and smaller hospitals whose monthly workload exceeded 2,000 work units. On this basis, a requirement for 117 commissioned pharmacists was established as a minimum for fiscal year 1959. Of the 117 officers
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classified as pharmacy officers (primary MOS 3318), 52 were assigned to full-time duty as chiefs of pharmacy.
The Surgeon General also anticipated the need for training, at the master's degree level, a limited number of commissioned pharmacists in the specialized field of hospital pharmacy, and in 1956, upon the recommendation of his Professional Education and Training Committee, he approved a total of 22 officers for such training. These officers will be assigned to such positions as Chief Pharmacy Consultant, OTSG, and chiefs of the pharmacy services at 17 CONUS hospitals of 300 beds or more, at 3 general hospitals in USAREUR (U.S. Army, Europe), and at Tripler Army Hospital in USARPAC. The first two officers to receive their master's degrees in hospital pharmacy were graduated from the University of Michigan, Ann Arbor, Mich., in June 1959. These officers will develop and direct a military hospital pharmacy residency training program to be affiliated with the University of Michigan.
The distribution in the fall of 1958 of the Army Medical Service Formulary (Technical Manual 8-245) climaxed several years of effort devoted to the compilation of a single reference which would provide, in one convenient location, essential data on the Army's current therapeutic armamentarium. This manual, loose leaf in design, will be kept up to date by the Therapeutic Agents Board, OTSG, through periodic publication of revisions and supplements.
Professional Inquiries
The Surgeon General continued his efforts during the year to maintain a close personal relationship between the families of military personnel and the Army Medical Service. These efforts included the processing of some 2,000 inquiries regarding the status of health or physical condition and transfer of individual patients or the investigating of complaints by or on behalf of patients concerning the type of treatment received. Inquiries were received from members of Congress, from various Federal agencies, and directly from families of military personnel. All requests were handled individually by the most expeditious means available. This field of activity is an important one in maintaining a bond of close rapport between the Army Medical Service and the families of servicemen and in providing an important bridge of mutual understanding and communication.
Nursing Service
Continued emphasis was placed upon improving nursing care. The fact that the Army nursing service has been improved and has been
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made more effective despite minimal staffing is due largely to the continuous in-service educational programs for nursing service personnel at all medical installations and to the excellent clinical courses conducted for ANC (Army Nurse Corps) officers and enlisted technicians at the hospital centers and the various teaching hospitals.
More than 90 percent of the ANC officers are directly engaged in nursing care activities. Of the remaining, most are assigned as instructors (that is, of clinical courses at the Army Medical Service School and at Strategic Army Command units) both for professional and for ancillary personnel or are in training as students at the Army Medical Service School, at teaching hospitals, or at civilian institutions to meet the
anticipated needs of the Army Medical Service. A small number are engaged in procurement or research or are serving as consultants in military medical missions.
To define more clearly the positions, duties, and responsibilities that ANC officers are expected to assume in providing effective nursing care, a revision of AR 40-20, Army Nurse Corps, was published as AR 40-6, same title, dated 9 April 1959.
The Army Nurse Corps contributed to civilian nursing by loaning ANC officers, one each to the University of Minnesota, to Columbia University Teachers College, and to the Massachusetts General Hospital to serve as faculty members for 1 year. These three officers assisted the respective faculties in revising student nurse, instructor, and practical nurse courses as well as in-service educational programs to incorporate nursing concepts and practices pertinent to nursing care in the medical management of mass casualties and thereby strengthen the Nation's resources for national defense.
Accreditation of Army Hospitals
Recognition of the need for maintaining the highest degree of profes?sional medical care and treatment throughout the entire system of Army medical treatment facilities has focused attention on obtaining accreditation not only of Army hospitals in the United States but also of those overseas. Arrangements have been completed with the Joint Commission on Hospital Accreditation for a survey visit to U.S. Army hospitals in oversea areas throughout the world.
Every U.S. Army hospital which has been surveyed by the Joint Commission has received a certificate of accreditation. To date, 43 Army hospitals in CONUS have been accredited, and efforts are being made to obtain similar recognition for other CONUS Army hospitals.
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Economy Program
Strong emphasis continued to be placed on economy and efficiency of operations in Army medical installations and treatment facilities. The Surgeon General termed as most gratifying the response he received from his special letter on economy, sent in January 1958 to commanders of class II hospitals, in which he expressed concern over the rising trend in the cost of medical care and in which he requested the commanders' personal interest and active cooperation in the drive to reduce costs without lowering the standards of professional care. All hospital commanders to whom the letter was addressed, as well as Army surgeons to whom courtesy copies were sent, reported effective measures taken to curb unessential costs and channel the savings toward the direct care of patients.
'All that was needed was to call your attention to the problem,' The Surgeon General declared at the Joint Conference of Army Surgeons and Medical Center and Class II Hospital Commanders on 25 August 1958. 'I feel therefore that the purpose of my letter has been accomplished and I have dissolved the Economy Group in my office.' He emphasized, however, that effective economy requires the continued personal attention of the hospital commanders, and pointed out that he had assurances from their letters that sensible and effective economy would continue to receive their personal attention on a day-to-day basis.
Armed Services Medical Regulating Activities
During the year, ASMRO (Armed Services Medical Regulating Office) authorized the movement of 22,192 patients, 545 fewer than in fiscal year 1958. Of the total figure, 7,179 were active-duty Army personnel. This was a reduction of 926 from the previous year and represented decreases of 392 in the number of Army oversea patients moved from debarkation medical facilities to Armed Forces and USPHS (U.S. Public Health Service) hospitals in CONUS, 321 in the number of Army patients moved between Armed Forces hospitals in CONUS, and 213 in the number of active-duty Army patients transferred from CONUS Armed Forces hospitals to VA (Veterans' Administration) hospitals. As has been the case in recent years, nearly all patients were moved by air.
Included in the total movement authorized by ASMRO were 8,880 oversea patients from debarkation medical facilities to Armed Forces and USPHS hospitals in CONUS, 11,701 patients between CONUS Armed Forces hospitals, and 1,611 active-duty military patients from CONUS Armed Forces hospitals to VA hospitals. Table 1 shows how the movement of Army patients compared with those of the other services.
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TABLE 1.-Movement of patients authorized by Armed Services Medical Regulating Office
Service | From debarkation hospitals | Between ZI hospitals | To VA hospitals | Total |
Army | 3,382 | 3,332 | 465 | 7,179 |
Navy | 2,279 | 2,396 | 696 | 5,371 |
Air Force | 1,876 | 5.957 | 448 | 8,281 |
Others1 | 1,343 | 16 | 2 | 1,361 |
| Total | 8,880 | 11,701 | 1,611 | 22,192 |
1Includes civilians, merchant marines, and foreign nationals.
The principal triservice directive governing the regulation of patient movement (AR 40-350/AFR 160-107/BUMEDINST 6320.1A) was rewritten and will be published early in fiscal year 1960. The major changes concern the manner in which returned oversea patients are reported to ASMRO and the extension of ASMRO control over patients' movement to include members of the commissioned corps of the U.S. Coast Guard, USPHS, and U.S. Coast and Geodetic Survey. Both of these changes were placed in effect early in this fiscal year.
Representatives of the three services attended a conference of the Joint Medical Regulating Organization of the U.S. European Command at the command headquarters in Paris, France, on 26-27 May 1959, to discuss formulation of plans for patient evacuation under war?time conditions. The chief of ASMRO attended the meeting and briefed the conferees on ASMRO functions. A similar Joint Medical Regulating Organization is being established in the Pacific area.
Effective 1 January 1959, the Army ASMRO representative replaced the Air Force representative as chief of ASMRO in accordance with the 18-month rotation policy established by the Executive Representative (Army Surgeon General) on 1 June 1953.
Army Health Experience and Trends
General trends.-The major indexes to morbidity among Army troops indicate that fiscal year 1959 was one in which Army health experience was quite favorable. (Data for the current fiscal year may be subject to slight modification in the next annual report; the publication schedule is such that preliminary or partially estimated data for June must be used in some instances.) The previous fiscal year had
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seen sharp increases in admission rates as a result of the epidemic of Asian influenza and the generally high level of respiratory disease incidence. In fiscal year 1959, admission rates decreased markedly, although they did not fall to the extremely low level experienced in fiscal year 1957. While the decreases occurred both in the United States and overseas, all of the decrease was in the disease component of the all-causes rate, with the nonbattle-injury component actually increasing. The noneffective rate for Army troops decreased to the lowest point on record for the Army for any year, although the rate was not significantly different from the previous low in fiscal year 1957. Outpatient visit rates declined from 18.1 per 1,000 Army strength per day to 17.1.
Admissions.-The rate of admissions of Army personnel to medical treatment facilities decreased by more than one-fifth from that of the previous year (table 2). This rate had increased in fiscal year 1958 by almost one-half, and so the fiscal year 1959 rate was still well above the experience of 2 years earlier. Admissions for all causes occurred at a rate of 379 per 1,000 average strength in fiscal year 1959; the rate had been 447 in fiscal year 1958. This decline represents the resultant effect of a decrease of about one-fourth in the disease admission rate partially offset by an increase of nearly one-tenth in the admission rate for nonbattle injury. The decrease in the disease rate took place both in the United States and overseas but was more pronounced overseas where the rate dropped to a level of about 10 percent below that in the United States. Table 3 shows that the disease admission rate in almost every month in fiscal year 1959 was considerably lower than the corresponding rate in the previous year but somewhat higher than the one for fiscal year 1957. The increase in the nonbattle-injury admission rate occurred both in the United States and overseas.
Noneffectiveness.-The average daily noneffective rate which had been 13.5 per 1,000 in fiscal year 1958 declined to 12.3. This rate shows the number of active-duty Army personnel noneffective (that is, in an excused-from-duty status) because of illness or injury on the average day in the period. The record lowness of the disease component of this rate accounted for the decline. The injury noneffective rate remained at the fiscal year 1958 level (table 4).
Hospitalization.-The rate of initial admission to hospitals was 228.3 per 1,000 Army active-duty strength, a decline of about 10 percent from the preceding year. Table 5 shows data on hospital admissions and dispositions, patient census, and bed occupancy for active-duty Army personnel in absolute numbers. The number of patients in the census and the number occupying beds decreased by a little
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[Rates expressed as admissions per 1,000 average strength per year]
Area | All causes | Disease | Injury | ||||||
19592 | 1958 | 1957 | 19592 | 1958 | 1957 | 19592 | 1958 | 1957 | |
Total | 379 | 477 | 327 | 327 | 430 | 282 | 52 | 47 | 45 |
Total Continental United States | 389 | 467 | 331 | 340 | 423 | 289 | 49 | 44 | 42 |
Total overseas | 364 | 492 | 323 | 307 | 440 | 273 | 57 | 52 | 50 |
| Europe | 372 | 501 | 327 | 310 | 444 | 269 | 62 | 57 | 58 |
| Japan-Korea-Ryukyus | 381 | 517 | 385 | 333 | 470 | 343 | 48 | 47 | 42 |
1Admissions to all medical treatment facilities, Army and non-Army. Excludes carded-for-record-only cases reported on summary morbidity reports, largely venereal disease cases treated while individual is in a duty status.
2Data for June 1959 partially estimated.
Source: Morbidity Report, DD Form 442 (RCS MED-78).
more than 10 percent, reflecting the slight decrease in Army strength as well as the decreased rate of admission to hospital. When average daily bed occupancy is related to mean strength, it is seen that 0.94 percent of active-duty Army personnel were occupying hospital beds on the average day in fiscal year 1959 as compared with 1.02 percent in fiscal year 1958.
Utilization of hospitals and dispensaries.-The number of Army hospital beds occupied on the average day in fiscal year 1959 was about 1,000 less than in the previous year, 13,741 as compared with 14,791. This reflected the decline just noted in the number of active-duty Army personnel occupying beds; a slight increase in the average number of dependents of military personnel occupying beds was offset by a greater decline in the occupied-beds figure for other personnel. This increase in the number of military dependents occupying beds continues a trend which had begun in the last half of the preceding fiscal year, as pointed out in the fiscal year 1958 'Annual Report of The Surgeon General.' Table 6 shows average daily numbers of beds occupied by category of patient, along with data on patient census and on admissions. Two Army hospitals in CONUS were closed during the fiscal year; the U.S. Army Hospital, New Cumberland, Pa., on 31 March, and the U.S. Army Hospital, Fort Polk, La., on 15 June.
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[Rates expressed as admissions per 1,000 average strength per year]
Period | Total Army | Total United States | Total overseas | ||||||
19592 | 1958 | 1957 | 19592 | 1958 | 1957 | 19592 | 1958 | 1957 | |
12-month period | 327 | 430 | 282 | 340 | 423 | 289 | 307 | 440 | 273 |
| July | 261 | 318 | 241 | 255 | 255 | 226 | 270 | 413 | 262 |
| August | 274 | 306 | 247 | 267 | 261 | 233 | 285 | 375 | 268 |
| September | 301 | 512 | 242 | 304 | 408 | 231 | 296 | 669 | 259 |
| October | 337 | 794 | 252 | 343 | 832 | 244 | 328 | 737 | 263 |
| November | 333 | 483 | 251 | 341 | 492 | 247 | 321 | 469 | 257 |
| December | 313 | 365 | 239 | 331 | 372 | 228 | 284 | 355 | 255 |
| January | 379 | 399 | 306 | 400 | 400 | 307 | 347 | 398 | 306 |
| February | 439 | 486 | 397 | 477 | 542 | 463 | 380 | 407 | 298 |
| March | 415 | 457 | 373 | 463 | 494 | 434 | 340 | 404 | 282 |
| April | 345 | 365 | 316 | 370 | 375 | 350 | 307 | 349 | 264 |
| May | 276 | 293 | 268 | 282 | 294 | 275 | 267 | 293 | 258 |
| June | 261 | 267 | 267 | 256 | 257 | 244 | 267 | 282 | 301 |
1Admissions to all medical treatment facilities, Army and non-Army. Excludes carded-for-record-only cases reported on summary morbidity reports, largely venereal disease cases treated while individual is in a duty status.
2Data for June 1959 partially estimated.
Source: Morbidity Report, DD Form 442 (RCS MED-78).
TABLE 4.- Noneffective rates during fiscal years 1957, 1958, and 1959
[Rates expressed as daily average number excused from duty because of illness or injury per 1,000 average strength]
Cause of noneffectiveness | 19591 | 1958 | 1957 |
Disease2 | 9.9 | 11.1 | 9.9 |
Injury2 | 2.4 | 2.4 | 2.5 |
| Total | 12.3 | 13.5 | 12.4 |
1Data for June 1959 partially estimated.
2Days lost are not reported separately for disease and injury but were estimated on the basis of number of disease and injury patients remaining.
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[Figures in parentheses are subtotals]
Element of patient flow | 19592 | 1958 | 1957 |
Patient census, beginning of fiscal year | 8,744 | 10,666 | 11,542 |
Admissions (initial)3 | 200,513 | 239,656 | 204,376 |
Final dispositions4 | 200,836 | 241,578 | 205,252 |
| Returned to duty4 | (194,771) | (234,615) | (198,517) |
| Disability retirements | (2,089) | (2,716) | (2,431) |
| Disability separations | (2,189) | (2,294) | (2,311) |
| Other final dispositions | (1,787) | (1,953) | (1,993) |
Patient census, end of fiscal year | 8,421 | 8,744 | 10,666 |
Daily average census | 9,608 | 10,984 | 11,327 |
Daily average occupying beds | 8,213 | 9,543 | 9,912 |
1Includes Army patients occupying beds in VA hospitals who are carried on the rolls of Army hospitals pending discharge for disability. Excludes transient patients; that is, patients remaining in military debarkation hospitals, patients remaining overnight in other military hospitals, and aeromedical-evacuee patients.
2Data for June 1959 partially estimated.
3Includes all direct admissions to hospital for bed care or observation, transfers from dispensary or sick-in-quarters status, readmissions for relapses or sequelae of previously treated conditions, readmission of patients who were absent without leave for more than 10 days' duration, and admissions to ship sick bays while in passenger status at sea.
4Adjusted so that initial admissions plus beginning census equals final dispositions plus end census.
Source: Beds and Patients Report, DD Form 443 (RCS MED-79).
24-25
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During the fiscal year, U.S. Army hospitals and dispensaries reported a total of 12,776,033 outpatient visits. This represents a 6-percent decline for fiscal year 1958. Of the approximately 1 million outpatient visits in the average month in fiscal year 1959, about 450,000 were active-duty military personnel and about the same number were their dependents, with a remaining 100,000 involving other personnel, largely civil service employees. The decline in total outpatient visits reflected a drop of more than 10 percent in the numbers reported for active-duty military personnel; the number for military dependents actually increased slightly (table 7).
Preinduction examination results.-During this fiscal year, local selective service boards referred 301,600 registrants to AFES (Armed Forces Examining Stations) for preinduction examinations. Of these examinees, 46.4 percent were found not acceptable for military service. This disqualification rate is much higher than that of the preceding years 7 (table 8). The increase in the disqualification rate is due to the introduction in August 1958 of additional mental requirements.
Category of patient | 1959 | 1958 | 1957 |
Active-duty military personnel: | |||
| Army | 5,231,395 | 6,016,798 | 6,074,384 |
| Navy and Marine Corps | 86,162 | 75,419 | 74,499 |
| Air Force | 158,723 | 186,708 | 199,827 |
| Total | 5,476,280 | 6,278,925 | 6,348,710 |
Short-tour active-duty military1 | 443,129 | 563,612 | 250,824 |
Dependents of military personnel: | |||
| Army | 4,867,500 | 4,685,167 | 4,511,692 |
| Navy and Marine Corps | 250,585 | 222,031 | 224,910 |
| Air Force | 490,020 | 548,624 | 556,780 |
| Total | 5,608,105 | 5,455,822 | 5,293,382 |
USPHS, Coast Guard, and Coast and Geodetic Survey personnel and their dependents | 6,232 | 5,036 | 1,529 |
Civil service employees | 792,431 | 830,711 | 853,226 |
Other | 449,856 | 470,093 | 476,984 |
| Total | 1,248,519 | 1,305,840 | 1,331,739 |
| Total, all personnel | 12,776,033 | 13,604,199 | 13,224,655 |
1Includes RFA-55 personnel on 6 months' active duty for training.
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Results of examination | 1959 | 1958 | 1957 | 1956 | ||||
Number | Percent | Number | Percent | Number | Percent | Number | Percent | |
Not acceptable: | ||||||||
| Administrative reasons1 | 7,071 | 2.3 | 5,558 | 1.6 | 5,077 | 1.2 | 4,006 | 2.2 |
| Failed mental test only | 266,411 | 22.0 | 54,764 | 15.9 | 70,828 | 16.1 | 26,874 | 14.7 |
| Failed mental test and medically disqualified | 9,857 | 3.3 | 11,321 | 3.3 | 11,980 | 2.7 | 4,057 | 2.2 |
| Medically disqualified only | 56,573 | 18.8 | 67,102 | 19.4 | 57,668 | 15.3 | 29,937 | 16.4 |
| Total | 139,912 | 46.4 | 138,745 | 40.2 | 155,553 | 35.3 | 64,874 | 35.5 |
Acceptable | 161,688 | 53.6 | 206,689 | 59.8 | 285,605 | 64.7 | 117,873 | 64.5 |
| Total examined | 301,600 | 100.0 | 345,434 | 100.0 | 441,158 | 100.0 | 182,747 | 100.0 |
1Refers primarily to individuals disqualified for moral reasons; for example, criminals, individuals discharged from the service under conditions other than honorable, etc. It includes also aliens.
2Includes 16,250 registrants (5.4 percent of all examined) who were classified as "Trainability Limited (V-O)."
Source: Summary of Registrant Examinations for Induction, DA Form 316 (RCS MED-66).
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The underlying basis for the current medical and mental standards for military service is found in the Universal Military Training and Service Act of 1951. This act provides that the minimum physical requirements for acceptability shall not be higher than those applied to persons between the ages of 18 and 26 who were inducted in January 1945 and that the passing score on the prevailing mental test (Armed Forces Qualification Test) shall be fixed at the percentile score of 10 points. In July 1958, these basic provisions were amended by Public Law 85-564 (85th Cong.) to authorize the President to modify these fixed requirements under such rules and regulations as he may prescribe, except in time of war or national emergency declared by Congress. As a result of this amendment, the mental requirements were modified. No change, however, occurred with respect to the medical requirements.
Before the passage of this amendment, the Army had administered additional mental tests at the reception centers to inductees in mental group IV for classification purposes. The additional testing was conducted by means of the Army Classification Battery, a battery of tests developed to determine the individual's potential usefulness in particular kinds of military jobs or assignments, specifically, in the eight major occupational categories into which the jobs for enlisted men are grouped.
This testing revealed that an appreciable number of inductees in mental group IV, though they had met the required minimum of 10 percentile on the AFQT (Armed Forces Qualification Test), did not possess sufficient aptitude to assimilate training in even the most basic military skills, much less in those relating to newly developed weapons and equipment requiring more highly skilled personnel for their operation and maintenance. Many of such low-aptitude persons had to be discharged later as inapt or unsuitable. It was recommended, therefore, that the Army adopt more definitive tests that would identify and hence disqualify such persons at the AFES before induction. This recommendation led to the amendment.
Current Army regulations require that additional testing by Army Classification Battery be administered at the AFES to examinees in mental group IV. Such examinees who fail to attain the required minimum are classified as 'Trainability Limited (V-O),' provided they are medically qualified. These examinees are currently not acceptable, though they would qualify under mobilization or emergency conditions.
As a result of this testing, 16,250 registrants were classified as 'Trainability Limited (V-O)' during fiscal year 1959. The disqualification
29
rate for mental reasons increased from 15.9 percent in fiscal year 1958 to 22 percent in fiscal year 1959.
In fiscal year 1959, the Department of Defense issued calls for 109,000 inductees (table 9). The inductees are assigned to the Army, which supplements its manpower requirements by enlistments. The Navy and the Air Force procure their manpower through enlistments alone.
Dependents' Medical Care Program
Major revisions in the program.-Growing concern in Congress over the high cost of providing medical care in civilian hospitals to the families of military personnel and the fact that many dependents were utilizing civilian sources for such care when medical facilities of the uniformed services were available to them led to major changes during the fiscal year in the Medicare (Dependents' Medical Care) Program.
TABLE 9.- Total calls for inductees (in thousands) fiscal years 1956 through 1959
Month | 1959 | 1958 | 1957 | 1956 |
July | 10 | 13 | 13 | 10 |
August | 10 | 11 | 13 | 10 |
September | 11 | 8 | 14 | 10 |
October | 11 | 7 | 17 | 10 |
November | 11 | 7 | 17 | 20 |
December | 11 | 7 | 17 | 18 |
January | 9 | 10 | 17 | 6 |
February | 9 | 13 | 14 | 6 |
March | 8 | 13 | 14 | 16 |
April | 7 | 13 | 13 | 6 |
May | 6 | 13 | 13 | 12 |
June | 6 | 10 | 13 | 12 |
| Total | 109 | 125 | 175 | 136 |
Source: Annual Reports of the Director of Selective Service.
The House of Representatives, in approving the appropriation bill for fiscal year 1959, directed that the Department of Defense not incur obligations under the Medicare Program in excess of $70,246,000 and that action be taken to effect maximum use of service facilities by dependents and to reduce the cost of medical care provided dependents from civilian sources. To meet these objectives, it was necessary to restrict the scope of the program, and, on 20 July 1958, the Assistant
30
Secretary of Defense (Health and Medical) appointed an ad hoc committee composed of representatives of the four uniformed services to develop a plan for accomplishing this. Based on the recommendations of that committee, two major changes were approved and became effective on 1 October 1958:
1. A Medicare Permit system was established restricting the freedom of choice between uniformed services and civilian medical facilities for dependents residing with their sponsor in CONUS, Alaska, Hawaii, or Puerto Rico. Except under certain limited circumstances (for example, emergencies), such personnel are required to obtain medical care from uniformed services medical facilities if they are available and reasonably accessible.
2. The scope of care available to dependents was restricted by prohibiting certain medical and surgical care from civilian sources, authorized in the Department of Defense Directive 6010.4, but not specifically authorized under the Dependents' Medical Care Act (Public Law 569, 84th Cong., 70 Stat. 252).
On 15 August 1958, the Deputy Secretary of Defense sent a memorandum to the Secretaries of the Army, Navy, and Air Force announcing that the new policy of the Department of Defense was to make optimum use of service facilities in the care of spouses and children and directed that commanders at all echelons inform service personnel of this policy and urge their immediate cooperation. This policy was enunciated by the Department of the Army in Circular 40-31, dated 18 September 1958.
A revision of the Department of Defense Directive 6010.4, Dependents' Medical Care, incorporating the changes in the program, was published on 16 September 1958. Based on this revision, changes in the joint regulations on Dependents' Medical Care (AR 40-121 and AR 40-122) were prepared, were coordinated with the other services, and were published as Changes 2 on 30 September 1958. At the same time, the form for authorizing civilian medicare was developed and, after coordination with the other services, published as DD Form 1251. Medicare Permit.
The Medicare Permit system was adopted, effective on 1 October 1958, as the basic control mechanism for regulating the Medicare Program. Only dependents who reside with the sponsor are required to obtain the Medicare permit. No permit is necessary when (1) the dependent requiring care does not reside with the sponsor, (2) the dependent requiring care normally resides with the sponsor but is currently away on a trip, or (3) the care required is for a bona fide emergency and the physician so certifies. The new regulations specified
31
that, except in emergencies, spouses and children residing with their sponsors in CONUS, Alaska, Hawaii, or Puerto Rico would be authorized medical care from civilian sources only after it had been determined that the required care could not be provided in a uniformed services' medical facility located within a reasonable distance of the patient's residence. In such cases, the dependents would be issued Medicare permits which would allow them to seek care from civilian sources.
Even when it is issued, the permit is not an automatic blanket authorization for care from civilian sources. It was designed for immediate use and for the care specifically authorized from civilian sources under the new restricted Medicare Program. Because many permits are issued by nonmedical personnel, especially in cases where the permit is issued automatically by commanding officers in charge of installations that have no available medical facilities, and to prevent differences of opinion as to diagnosis between service and civilian physicians, the permits do not specify the type of care for which they are issued. The civilian physicians, following the regulations provided to them, must determine if the care needed by a given patient has been defined as eligible for payment by the Office for Dependents' Medical Care.
The restricted range of care eligible for payment was imposed, effective 1 October 1958, because it did not appear that the Medicare Permit system could bring about savings great enough to enable the Medicare Program to finance an unrestricted program through the remaining 9 months of fiscal year 1959. The following care and services from civilian sources were discontinued:
1. Outpatient treatment for bodily injuries.
2. Termination visits (one visit to a civilian physician, who ends his care before or upon hospitalization of the patient).
3. Presurgical and postsurgical tests and procedures, such as X-rays and laboratory tests performed on an outpatient basis, except in maternity cases.
4. Neonatal visits (two well-baby visits following hospitalization) during the first 60 days following delivery.
5. Treatment of acute emotional disorders (previously allowable when certified as an acute emergency).
6. Medical or surgical care that is desired or requested by the patient which can be planned, subsequently scheduled, and effectively accomplished at a later date without detriment to the patient.
Medicare permit reporting system.-In anticipation that a requirement would be established for reporting the number of Medicare per-
32
mits issued, The Surgeon General, by telegram to commanders of Army hospitals in CONUS, Alaska, Hawaii, and Puerto Rico on 21 October 1958, directed that they maintain a record of each permit issued and the reason for issuance. On 2 December 1958, the Director, Statistical Services Center, Office of the Secretary of Defense, directed that three reports on Medicare permits issued be submitted covering the periods October-November 1958, December 1958 through February 1959, and March through June 1959. Publication of DA Circular 40-34, dated 11 December 1958, established a formal requirement that issuing authorities in Army facilities report the number of Medicare permits issued and the reasons for issuance.
Impact of revised program on Army installations.-Reports on the number of Medicare permits issued by Army installations and activities show that the majority have been issued because there were no uniformed services' medical facilities located within a reasonable distance
Pre-school-age child receiving polio immunization injection, in an Army outpatient pediatric clinic
33
of the sponsor's residence. This indicates that Army medical facilities are providing care to most of the dependents who request care and who reside near a military medical facility.
The restriction on freedom of choice imposed on dependents residing with their sponsors has resulted in a greater use of Army medical facilities for the care of dependents, as evidenced by the average daily patient load of dependents in these facilities. This average daily patient load has increased each month since October 1958, when the restrictions were imposed, and as of June 1959 was only about 5 percent below the total capability of these facilities to care for dependents.
As shown in table 7, there was an increase of 182,333 in the number of outpatient visits by dependents of Army personnel during the fiscal year-4,867,500 as compared to 4,685,167 in the previous year.
Restoration of certain care in hardship cases.-Although the curtailment of benefits designed to effect the economies necessitated by the limitations placed on the Medicare budget has resulted in savings, it has also created serious problems which could adversely affect the objectives for which the program was established. Considerable study has been devoted to finding a solution to these problems. At the direction of the Assistant Secretary of Defense (Health and Medical), the Office for Dependents' Medical Care conducted a study which resulted in recommendations that most of the care eliminated by the 1 October revisions be restored in instances where its deletion would work a hardship on certain dependents. These recommendations were unanimously approved at a meeting of the Medicare Advisory Committee to the Assistant Secretary of Defense on 22 May 1959. The restoration of this care, where feasible, is expected to resolve certain recognized inequities and hardship situations and thus promote morale as well as provide a more uniform program of medical care.
Dental care.-One of the most common criticisms of the Medicare Program has been that it does not cover dental care. Two bills were introduced in the 86th Congress to provide dental care for dependents, but no action had been taken on either by the end of the fiscal year, and the regulations in that respect remained unchanged. No dental care is authorized for dependents in a civilian facility except when it is a necessary adjunct to medical or surgical treatment being given to the dependent while he is an inpatient in a hospital. Likewise, dental care is not authorized for dependents in a uniformed service medical facility except for (1) emergency dental care to relieve pain or suffering and that which is a necessary adjunct to medical or surgical treatment, (2) routine dental care specifically authorized in military facilities in CONUS that are designated as 'remote' areas by the Secretary of a
34
uniformed service after approval by the Secretary of Defense, and (3) routine dental care in military facilities overseas.
The only additional areas designated as remote in fiscal year 1959 were Fort Campbell, Ky., and four in Alaska, which, before it was admitted as a State, was considered an oversea area. The stations designated in Alaska were Port of Whittier, Wildwood Station, Fort Greely, and Fort Richardson. Stations declared remote are not authorized additional dental personnel and therefore are greatly restricted as to the amount of dependent care they can provide. Thus, the Army and the other services are attempting to provide dental care to dependents in military facilities on a space-and-facilities availability basis similar to the medical care that was provided before the inception of the Medicare Program. The Dental Advisory Committee to the Assistant Secretary of Defense has studied the problem and has proposed an amendment to the Medicare Act which would authorize limited dental care to eligible dependents on a cost-participating basis. The latest information from the Department of Defense is that action on this proposal has been deferred for at least a year until it gains the support of the American Dental Association.
Trends.-During the course of its study, the ad hoc committee appointed to recommend changes in the Medicare Program made a number of significant discoveries. One of these was that the proportion of married men in the services is increasing and that while there has been a notable decrease in troop strength there has been at the same time a substantial increase in the number of dependent wives and children. They also found that the pattern of medical care was changing and that obstetric-gynecologic cases, as a percentage of all admissions, were steadily increasing from approximately 50 percent early in the program to possibly as high as 70 percent at the time the study was made. On the average, obstetric-gynecologic cases are more costly than medical or surgical cases.
Effect of Medicare Program on morale.-The Surgeon General, in a memorandum to the Executive Director of the Office for Dependents' Medical Care in March 1959, reported, on 30 June 1958, the results of the Sample Survey of Military Personnel conducted to determine the effects of the Medicare Program on the reenlistment intentions of enlisted personnel as well as its influence on the decisions of officers to remain in the service. Three-fourths of all enlisted men queried gave the opinion that Medicare is an important consideration in deciding whether or not to enlist or reenlist. Only 5 percent reported they felt that Medicare was of little or no importance in making this decision. Of every 10 officers surveyed, 7 gave the opinion that Medicare is a
34
very important, or important, consideration in deciding whether to remain in the service.
Budget request for fiscal year 1960.-In January 1959, a Medicare budget request of $88.8 million for fiscal year 1960 was sent to the Congress. The Army request, approximately $20 million, was considerably lower than the amounts requested for the other two military services, as shown in the following tabulation:
| Amount |
Army | $20.0 |
Navy | $28.9 |
Air Force | $38.1 |
U.S. Public Health Service | $ 1.8 |
| Total | $88.8 |
The full amount of the request was approved by the House Appropriations Committee early in June 1959. No further action had been taken in Congress by the end of the fiscal year. The $88.8 million is about $5 million less than was spent on the program in fiscal year 1959.
Payments to contractors.-The restrictions placed upon the Medi?care Program have resulted in a downward trend in expenditures to physicians and hospitals as well as in administrative costs. During fiscal year 1959, the Office for Dependents' Medical Care processed 495,945 claims from physicians, amounting to $39,936,946, as compared to 549,452 claims in the amount of about $41,363,319 in fiscal year 1958. The number of claims processed from hospitals in fiscal year 1959 was 306,171, totaling $38,632,422, as contrasted to 332,742 claims amounting to $37,731,622 in the previous year. The administrative costs for processing claims for physicians declined from $1,171,160 to $991,549, and for hospitals, from $645,670 to $520,496. At the same time, the average cost per claim for physicians increased from $75.28 to $80.53, and for hospitals, from $113.40 to $124.48. Tables 10 and 11 show how the claims and administrative costs were distributed among the four services. These claims and costs do not represent all authorized service provided during the period, because there is a considerable lag between the time the services are performed and the time the claims are received and processed.
As of 31 May 1959, major commanders in CONUS had processed 665 claims for reimbursement from uniformed services personnel for bills which they had already paid in the amount of $78,909, as compared to 754 claims totaling about $64,180 during the same period in the preceding year.
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TABLE 10.-Physicians' claims processed by the Office for Dependents' Care, fiscal year 19591
Branch of service | Claims | Costs | ||||
Number | Percent | Physicians' | Administrative | Total | Percent of total | |
Army | 125,681 | 25.3 | $10,075,960 | $245,623 | $10,321,583 | 25.2 |
Navy | 159,613 | 32.2 | $12,908,248 | $331,045 | $13,239,293 | 32.3 |
Air Force | 200,705 | 40.5 | $16,129,931 | $395,339 | $16,525,270 | 40.4 |
U.S. Public Health Service | 9,946 | 2.0 | $ 822,807 | $ 19,542 | $ 842,349 | 2.1 |
| Total | 495,945 | 100.0 | $39,936,946 | $991,549 | $40,928,495 | 100.0 |
1These claims and costs do not represent all authorized service provided during the fiscal year, because there is a considerable lag between the time the services are performed and the time the claims are received and processed.
Source: Records, Office for Dependents' Medical Care.
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TABLE 11.- Hospital claims processed by the Office for Dependents' Care, fiscal year 19591
Branch of service | Claims | Costs | ||||
Number | Percent | Physicians' | Administrative | Total | Percent of total | |
Army | 81,157 | 26.5 | $10,152,814 | $136,503 | $10,289,317 | 26.6 |
Navy | 97,360 | 31.8 | $12,334,690 | $173,233 | $12,507,923 | 32.4 |
Air Force | 121,130 | 39.6 | $14,798,507 | $199,002 | $14,997,509 | 38.8 |
U.S. Public Health Service | 6,524 | 2.1 | $ 825,915 | $ 11,758 | $ 837,673 | 2.2 |
| Total | 306,171 | 100.0 | $38,111,926 | $520,496 | $38,632,422 | 100.0 |
1These claims and costs do not represent all authorized service provided during the fiscal year, because there is a considerable lag between the time the services are performed and the time the claims are received and processed.
Source: Records, Office for Dependents' Medical Care.
