ment and coordination of hospital and related facilities and services and all other health activities in order to best meet the public need and utilize the health-care dollar most efficiently.

Mr. Chairman, may I add that it should be brought to your attention that with the acceleration under public works, and FHA and HHFA, our work in the hospital field was almost doubled in the number of plans that were required to be reviewed and our work with people. We found at first in this program a resistance by the State to doing the same kind of assistance and planning with the hospital that was not receiving Hill-Burton aid, because, as you know, the act under Hill-Burton provided for the administration of this at the State level.

Now we believe that the community which is building a hospital on its own should have every bit of assistance that every other has. When it comes to the question of whether or not a community should build a hospital, and we have said in the plan that we don't feel that they should in a specific area, and we will not provide Hill-Burton aid to this community because they are within 13 to 15 miles of another one that has a good hospital, but if you do provide a hospital, if you put up your own money and build one, we will give you every bit of assistance to see to it that it is efficiently and effectively planned and see to it that it is staffed, because we license this hospital.

Unless it comes up to good standards we will not license it as a hospital. I think it has been an effective way to reduce some of the overbuilding in some communities that feel a hospital is terribly important as an economic factor or it is important for recognition. They believe they must have one to prevent their town from disappearing in these farm, rural areas.

I also recognize that there is a variable problem in this modernization and replacement in many States. Some of us have built base hospitals, regional hospitals, at the same time and at the same rate that we have built rural hospitals, and we have been able to take care of some of this need. On the other hand with the rapid development and movement of populations we have seen the growth of new private hospitals. Los Angeles is a good example, Chicago, and some of the eastern States. These are operated for profit; they are substandard in that they are not providing all the services they ought to and they are using up a great many of the technical personnel. This is bad and something ought to be done to prevent this.

One of the items that has come up in discussion is a central community hospital building, plus another as a satellite. A large one, out in the suburbs of a large city. We have one example in a hospital that was built at Southdale that is the Dayton Shopping Center in Minneapolis where the Fairview Hospital Board is building a 225bed hospital with some Hill-Burton assistance and having the same board, but separate staffs.

A 225-bed hospital will take care of a large area in that particular portion of town and the financing is best there. I think in reference to the questions that have been raised about financing I would add that in Minnesota the problems of borrowing money seem not to be too great a problem. On the question of HHFA, which may provide financing assistance only, as I recall it, in the construction of homes for the aged, the law provides that these may not be used as nursing

homes, any portion thereof. This has negated against the development of this kind of facility in the more rural farm areas because you build a home of 100 beds for the aged and in a matter of 4 or 5 or 6 years you find that from one-third to one-half of those people really need nursing home care. Unless it is developed so this can be converted that means tearing people out by the roots and moving them someplace else.

We think this should be changed. As to HHFA and their standards, they should not cut their corridors down, as previously testified, or narrow their doors, because in so doing they make a poor home for the aged facility. In homes for the aged they need room for wheelchairs and crutches for these people. They need to be able to take care of people who have partial disabilities. I think the important thing as far as States are concerned is that they should be in a position to do needed studies, and help and provide assistance, and plan, and to do this, means more staffing and more work.

If we can do So, I am sure you will find a better use of the dollars we have.

When it comes to nursing homes, my particular State is interesting because we have more nursing home beds in Minnesota than we have hospital beds and we still have a greater need for them. I think this is because we had an old-age assistance program and the categorical aids were unlimited. Medical, hospital, and nursing home care was provided for these people since the inception of the program so we have actually had a Kerr-Mills program in a way because people were transferred from old-age assistance, if they had any, when they needed medical care and couldn't afford it.

We only recently passed Kerr-Mills. It goes into effect this July. The estimates are that we will not have a great increase in the need for beds. To give an example, I might say that our State will be spending under old-age assistance, medical care, as they classify it, primarily in hospital and nursing homes, drugs, and all of these things, about $32 million this year for something like 14,000 patients who will be receiving medical care out of the 40,000-some that are on old-age assistance.

Mr. DINGELL. The Chair desires to commend you, Doctor, for a very fine statement and I express the gratitude of the committee for your appearance this morning and for your very helpful testimony.

The Chair adjourns the committee until tomorrow morning at 10 o'clock.

(Whereupon, at 12:20 p.m., the committee adjourned until Thursday, March 12, 1964, at 10 a.m.)

EXTENSION AND REVISION OF HILL-BURTON
HOSPITAL CONSTRUCTION PROGRAM

THURSDAY, MARCH 12, 1964

HOUSE OF REPRESENTATIVES,

COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,

Washington, D.C. The committee met at 10 a.m., pursuant to recess, in room 1334, Longworth Building, Hon. Oren Harris (chairman of the committee) presiding.

The CHAIRMAN. The committee will come to order.

Today, as we continue the hearings on the revision and extension of the Hospital Construction Act, H.R. 10041, we are pleased to welcome as our first witness, Dr. Percy E. Hopkins, chairman of the board of trustees, the American Medical Association.

Dr. Hopkins, on behalf of the committee, I want to welcome you and your associates here this morning. I observe that you have with you Dr. Willard A. Wright, chairman of the American Medical Association Council on Medical Services, and Dr. Francis C. Coleman, chairman of the American Medical Association's Council on Legislative Activities.

We are glad to have all three of you and I want to say now, since I have another commitment with the leadership and another committee has requested my presence, that I will not be able to stay for your entire presentation. I want to say that I appreciate your taking the time from your busy life to come before the committee and give us the benefit of your thinking and the views of your organizations on this very important and worthwhile, and in my judgment, imperative program in the interest of the health and welfare of our people.

Now, having said this on my own, Doctor, I want to also say that one of my lifelong friends and important constituent, whose friendship I have cherished for over many years, being an associate of yours as a member of the board of trustees, Dr. R. B. Robbins, of Camden, Ark., has prewarned me, I should say, of your appearance here. I do not know why, unless it is the fact that he has known me so long, that he would attempt to admonish me to be kind to you. [Laughter.]

I do not want anyone to get any image of me that I am unkind to witnesses that come before this committee. If so, I want to dispel that now and forevermore.

But, seriously, Dr. Robbins did want me to know that he was associated with you during your work together and I know that he joins you in the serious effort to get this revision and extension of the hospital construction program enacted.

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I have just been reminded that the House will also go in session at 11 o'clock, so that is going to make it more difficult and even more necessary that you proceed with your statement and we get along with it with the least possible delay.

So, you may proceed then, without further ado.

STATEMENTS OF DR. PERCY E. HOPKINS, CHAIRMAN, BOARD OF TRUSTEES; DR. WILLARD A. WRIGHT, CHAIRMAN, COUNCIL ON MEDICAL SERVICE; AND DR. FRANCIS C. COLEMAN, CHAIRMAN, COUNCIL ON LEGISLATIVE ACTIVITIES, AMERICAN MEDICAL ASSOCIATION

Dr. HOPKINS. Thank you, Mr. Chairman.

Mr. Chairman and members of the committee, the American Medical Association is grateful for this opportunity to express its views on H.R. 10041, 88th Congress. This is a subject in which the medical profession has a deep and continuing interest. The association hopes that you will find its comments helpful to your committee's discussions and deliberations.

I am Dr. Percy E. Hopkins, a practicing surgeon from Chicago, Ill., and the chairman of the board of trustees of the American Medical Association. With me are Dr. Francis C. Coleman, who is engaged in medical practice in Des Moines, Iowa, and chairman of the American Medical Association's Council on Legislative Activities, and Dr. Willard A. Wright, who is in the practice of general surgery in Williston, N. Dak. Dr. Wright is chairman of the AMA Council on Medical Service.

The American Medical Association heartily approves of the concern and interest in the improvement of the public health and in the provision of adequate health facilities expressed by the chairman and members of this committee. We have shared this concern with the Congress over a period of many years, and the AMA is pleased to have the opportunity of again expressing its views on a matter so vital to the health interests of the American people.

The councils of the American Medical Association which are most directly interested in Federal programs and legislation pertaining to the development of hospital and other medical facilities are the council on medical service and the council on legislative activities. The physicians who are here with me today, as chairmen of these councils, are well qualified through longstanding experience to present the views of the American Medical Association.

With your permission, Mr. Chairman, I would like to ask Dr. Willard A. Wright to begin our comments on H.R. 10041. At the end of his remarks, Dr. Francis C. Coleman will conclude our statement by presenting further comments with respect to the pending legislation. We shall then be pleased to attempt to answer any questions which may be directed to you by members of the committee.

Mr. STAGGERS (presiding). Dr. Hopkins, I think that is satisfactory. We will save the questions until you have all finished your

statements.

Dr. Wright.

Dr. WRIGHT. Thank you, sir. I am Willard Wright.

Mr. Chairman and members of the committee, it is our recommendation that the Hill-Burton program be continued. We agree that some of its objectives should be redefined and some changes made in the program in order to make it more effective.

We believe that, with few exceptions, the Hill-Burton construction program has been administered effectively and in the interest of the public, and while we further believe that the objectives of the original legislation have, for the most part, been achieved, we agree that with a shift in emphasis toward modernization, and some modifications in the existing program, continuation of Hill-Burton is warranted for a period of time.

Our support of this type of legislation is longstanding. The American Medical Association has on numerous occasions gone on record as approving the principle of hospital construction by the use of grants-in-aid. In 1940, the AMA House of Delegates supported President Roosevelt's plan for the construction of hospitals with Federal funds, and, in 1945, endorsed the AMA board of trustees's support of the original Hill-Burton bill, saying:

This action of the board of trustees is within the [AMA] program of constructive action toward improving the health of the American people.

On a number of occasions, AMA representatives have appeared before committees of Congress to give the views of the association with respect to legislative proposals to extend and to amend the HillBurton Act. We have been aware of our obligation to provide the Congress with information and expert opinion which could add additional substance to its discussions and deliberations. And while we have, in the main, approved the Hill-Burton program, we have also from time to time offered what we have believed to be constructive criticism. We hope to do so again today.

Specifically, the American Medical Association supports the principle of matching grants for the construction and modernization of hospitals. We further support what appears to be a shift in emphasis toward grants for the modernization of hospital and related facilities, the combining of cateogrical grants, and the principle of Federal support of construction through guaranteed mortgages. In these areas and in others we support H.R. 10041. However, we shall note also where amendment to the provisions of H.R. 10041 would, in our opinion, establish a more effective program.

We believe that the immediate major emphasis of Hill-Burton should be directed toward the improvement and effective use of existing facilities. It appears to us that the greatest need is for modernization and renovation programs.

According to the State Hill-Burton agencies, as of January 1, 1963, there were 338,170 unacceptable beds which represented approximately 19 percent of existing beds. Between 1957 and 1963, the number of inpatient beds increased from 1,505,695 to 1,786,461, which is an increase of 19 percent. During this same period, the number of unacceptable beds, according to the State Hill-Burton agencies, increased from 285,149 to 338,170, also an increase of 19 percent. Accordingly, in spite of construction during this period of time, the percentage of existing beds which are unacceptable remained the same.

Another study, in 1956 by the American Hospital Association indicated that almost one-half, 48 percent, of all hospitals in the coun