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Summary of the American Medical Association’s Study on Medical Care
DENTAL ECONOMICS SUMMARY OF THE AMERICAN MEDICAL AS SOCIATION’S STUDY ON MEDICAL CARE H E Am erican M edical Association’s study on medical care was con ducted, for the most part, during i 938, by thirty-eight constituent state medical societies and 615 component county medical societies. Forms were prepared by the Bureau o f M edical E co nomics for the use o f these medical so cieties in the collection of data pertaining to the availability and utilization of ex isting medical, dental, hospital and allied services and facilities. T h e final report was published recently.1 T h e study, as stated in the preface to the final report, was to be “ . . . a study of the demand and supply o f medical care.” T he report continued : “ The ade quacy o f the supply was not determined by statistical manipulation and interpre tation o f the returns in a central office, but was judged by the most competent agencies and individuals in each com m unity that had first collected and an alyzed the information upon which their judgments were based.” This study was not o f the type that can be summarized by a statement o f some of its m ajor conclusions, since most o f the information is contained in the opinions and recommendations ex pressed rather than in statistics. Fur thermore, the need and supply o f medical care are reported as they exist in each community and state, rather than on a nation-wide basis. T h e report attempts to avoid any na tional generalization on the ground that such generalizations are usually false or misleading owing to the fact that differ
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ent localities have widely varying needs and facilities. It does s a y : A careful examination of the reported facts and opinions . . . seems to justify the conclusion that with the exception of iso lated localities . . . there is no important section of the population of the United States that now fails to receive the medical care it needs and desires. Physicians every where have shown not only by their re ports in this survey, but throughout many years that they have been willing to give service far beyond their obligations to the profession or as citizens to ensure that no one should be deprived of needed and de sired medical care. Nurses, hospitals, schools, welfare workers and every other or ganization in touch with medical needs tes tified, in their reports, that there are few instances where it is impossible to secure needed and desired medical care. Another general conclusion which is made is that this country has “ . . . a fairly well correlated and constantly im proving program of medical care.” The report continues : This program has not been planned in detail and then applied by authority, but has grown and developed with infinite di versity to correspond to an infinite variety of local and historical differences. . . . This program meets the practical, pragmatic test— it works. Measured by the statistical test that is applicable to any phase of med ical care— that of morbidity and mortality— it has proved to be more efficient in attain ing its purposes— to reduce illness and post pone death— than any of the autocratic and official programs existing in other countries and which are urged for adoption here. In the part o f the study entitled “ Study 476
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D en ta l E conom ics
o f Free M edical Services” is a section which presents a compilation o f the in formation obtained from the 1,558 den tists who cooperated in the survey. These dentists were asked to keep a record form for one week during each o f three periods selected to give a representative sample of services rendered during one year. These reports represented actual daily records kept by physicians and dentists. T h e information obtained from the den tal records and as presented in the report was as follow s: Weekly reports were also received from 1,558 dentists in 28 states and Hawaii. The geographic distribution of the dentists who completed the records was similar to that of physicians. Therefore, these records were received from a fairly representative cross-section of the dentists in the United States. However, due [sic] to the fact that only one dentist in Hawaii submitted a report, these figures should not be considered representative of the dentists in Hawaii. According to the data supplied by 1,512 den tists the average number of years in prac tice was 17. A previous study2 based on data collected from a larger sample of den tists in 1929 by the American Dental Asso ciation showed that, at that time, the den tists had been in practice for an average of only 15 years. It is apparent that the present data which gives [sic] an average of 17 years is [sic] weighted by dentists who have been in practice longer than the average; that is, fewer reports were received from dentists who recently entered practice. It is also possible that the average length of time in dental practice may have increased since
1929. Assuming that the data is [sic] based on reports from dentists who as a group have been in practice slightly longer than the average period, the figures obtained are still of value for this study if it is borne in mind that the conclusions do not apply to dentists who have just entered the practice of dentistry. The average number of patients treated in a week by each dentist was 58, based on the information from 1,539 dentists who re ported treating 88,886 patients in one week. The number of free patients, according to reports from 1,431 dentists who treated 8,880 patients without charges, was an av erage of 6 each week for each dentist. Weekly reports from 1,013 dentists indi cated that 576 patients were referred to some sources of dental care, an average of approximately 1 person every 2 weeks per dentist. Only 651 dentists reported on the number of free surgical operations. These dentists performed a total of 2,436 free operations in one week or an average of approximately 4 free operations per week per dentist. The reporting dentists gave free services to approximately 10 per cent of the patients they treated during the year. This 10 per cent does not include the patients who received treatment with the understand ing that they were to pay for the service but later failed to do so. B IB LIO G R A PH Y 1. M edical Care in the U nited States, D e mand and Supply, 1939. Bureau of M edical Economics, American M edical Association, 535 N. Dearborn St., Chicago, . 2. L e v i n , M a u r i c e , and B e c k , D o r o t h y F . : Practice of Dentistry and Income of D en tists in T w en ty States. Chicago: University of Chicago Press, 1932.
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ent localities have widely varying needs and facilities. It does s a y : A careful examination of the reported facts and opinions . . . seems to justify the conclusion that with the exception of iso lated localities . . . there is no important section of the population of the United States that now fails to receive the medical care it needs and desires. Physicians every where have shown not only by their re ports in this survey, but throughout many years that they have been willing to give service far beyond their obligations to the profession or as citizens to ensure that no one should be deprived of needed and de sired medical care. Nurses, hospitals, schools, welfare workers and every other or ganization in touch with medical needs tes tified, in their reports, that there are few instances where it is impossible to secure needed and desired medical care. Another general conclusion which is made is that this country has “ . . . a fairly well correlated and constantly im proving program of medical care.” The report continues : This program has not been planned in detail and then applied by authority, but has grown and developed with infinite di versity to correspond to an infinite variety of local and historical differences. . . . This program meets the practical, pragmatic test— it works. Measured by the statistical test that is applicable to any phase of med ical care— that of morbidity and mortality— it has proved to be more efficient in attain ing its purposes— to reduce illness and post pone death— than any of the autocratic and official programs existing in other countries and which are urged for adoption here. In the part o f the study entitled “ Study 476
477
D en ta l E conom ics
o f Free M edical Services” is a section which presents a compilation o f the in formation obtained from the 1,558 den tists who cooperated in the survey. These dentists were asked to keep a record form for one week during each o f three periods selected to give a representative sample of services rendered during one year. These reports represented actual daily records kept by physicians and dentists. T h e information obtained from the den tal records and as presented in the report was as follow s: Weekly reports were also received from 1,558 dentists in 28 states and Hawaii. The geographic distribution of the dentists who completed the records was similar to that of physicians. Therefore, these records were received from a fairly representative cross-section of the dentists in the United States. However, due [sic] to the fact that only one dentist in Hawaii submitted a report, these figures should not be considered representative of the dentists in Hawaii. According to the data supplied by 1,512 den tists the average number of years in prac tice was 17. A previous study2 based on data collected from a larger sample of den tists in 1929 by the American Dental Asso ciation showed that, at that time, the den tists had been in practice for an average of only 15 years. It is apparent that the present data which gives [sic] an average of 17 years is [sic] weighted by dentists who have been in practice longer than the average; that is, fewer reports were received from dentists who recently entered practice. It is also possible that the average length of time in dental practice may have increased since
1929. Assuming that the data is [sic] based on reports from dentists who as a group have been in practice slightly longer than the average period, the figures obtained are still of value for this study if it is borne in mind that the conclusions do not apply to dentists who have just entered the practice of dentistry. The average number of patients treated in a week by each dentist was 58, based on the information from 1,539 dentists who re ported treating 88,886 patients in one week. The number of free patients, according to reports from 1,431 dentists who treated 8,880 patients without charges, was an av erage of 6 each week for each dentist. Weekly reports from 1,013 dentists indi cated that 576 patients were referred to some sources of dental care, an average of approximately 1 person every 2 weeks per dentist. Only 651 dentists reported on the number of free surgical operations. These dentists performed a total of 2,436 free operations in one week or an average of approximately 4 free operations per week per dentist. The reporting dentists gave free services to approximately 10 per cent of the patients they treated during the year. This 10 per cent does not include the patients who received treatment with the understand ing that they were to pay for the service but later failed to do so. B IB LIO G R A PH Y 1. M edical Care in the U nited States, D e mand and Supply, 1939. Bureau of M edical Economics, American M edical Association, 535 N. Dearborn St., Chicago, . 2. L e v i n , M a u r i c e , and B e c k , D o r o t h y F . : Practice of Dentistry and Income of D en tists in T w en ty States. Chicago: University of Chicago Press, 1932.
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