Hospital and Public Health Resources in New Jersey A SOURCE BOOK Part 1 of Report of New Jersey Survey of Hospital and Health Center Facilities under Federal Hospital Survey and Construction Act STATE OF NEW JERSEY DEPARTMENT OF INSTITUTIONS AND AGENCIES TRENTON Hospital Advisory Council CHAIRMAN Commissioner Sanford Bates MEMBERS Samuel 0. Alexander, M. D. Park Ridge John; H. Annis , Camden Edgar S. Bamberger Newark *C. Byron Blaisdell, M. D. Long Branch Donald Borg Hackensack #George H. Buck Trenton Mrs. Margaret Crammer Somerville Caroline DiDonato, R. N. Newark Hon. Howard Eastwood Trenton Frank B. Gail Trenton Mrs. Albert L. Gardner Perth Amboy *V. Rev. Msgr. Ralph J. Glover, Ph, D, Newark * Frederick P. Lee, M. D. Paterson Samuel A. Loveman, D. D. S. Perth Amboy J. Lynn Mahaffey, M. D. Haddonfield Louis P. Marciante Trenton Franklin C. Nixon Trenton George O’Hanlon, M. D. Jersey City Frank J. Osborne Fast Orange *Frederic J. Quigley, M. D. Union City Hon. John G. Sholl Trenton Spencer T. Snedecor, M. D. Hackensack *Lt. Herbert H. Tate Newark Mrs. Geraldine L. Thompson Red Bank * Mrs. Stephen W. Waterbury Hillside Henry A, Cotton, M. D. Trenton Deputy Commissioner for Hospitals *Member of Executive Committee The Survey Staff Emil Frankel, Director {Director, Division of Statistics and Research, New Jersey State Department of Institutions and Agencies) William H. MacDonald, Associate Director {Chief, Bureau of Local Health Administration, New Jersey State Department of Health) 1947 FOREWORD Under the Federal Hospital Survey and Construction Act (Public Law 725) passed by Congress in the fall of 1946, the New Jersey State Department of Institutions and Agencies was designated by the Governor and the Legislature as the "single state agency" to administer the Federal program in New Jersey. A prerequisite to the distribution of Federal funds in New Jersey is the development of a State plan to show the overall require- ments for additional hospitals and public health center facilities throughout the State. This plan is now being evolved by the Depart- ment of Institutions and Agencies with the cooperation of the Hospital Advisory Council. To date a great deal of basic statistical material has been gathered on the basis of a survey originally sponsored by the New Jersey State Commission on Post-War Economic Welfare which utilized the research facilities of the New Jersey State Department of Insti- tutions and Agencies and the New Jersey State Department of Health. It is the purpose to present this material here as a SOURCE BOOK preliminary to the Issuance of the State Plan. Appreciation is expressed to the New Jersey Commission on Post- War Economic Welfare and the several hospital, health and medical organizations for their part in the preliminary survey; and to Emil Frankel, Director, and William H. MacDonald, Associate Director of the Survey for having taken on voluntarily this added responsibil- ity. '^CMx/rui Sanford Bateas, Commissioner New Jersey State Department of Institutions and Agencies 1 CONTENTS Page Foreword by Commissioner Sanford Bates i I. Federal Hospital Survey and Construction Program In Brief ... 1 II. Summary of Hospital Facilities and Services 2 III. General Hospitals 5 Beds by Counties and Communities 5 County Facilities and In-Patient Admissions 10 In-Patient Services 11 Average Length of Hospital Stay 12 Maternity Facilities and Services 14 Births in Hospitals 15 Emergency Maternity and Infant Care Program 17 Summary of Hospital In-Patient Admissions ... 18 Occupancy Rates 18 Trend in Use of Different Hospital Accommodations 19 Out-Patient Visits 21 Hospital Expenditures and Costs 2-4 Average Daily Per Capita Cost 26 Annual Hospitalization Expense of the General Population . . 27 Hospital Service Plan of New Jersey (Blue Cross) 29 Medical-Surgical Plan of New Jersey 31 Technical Personnel in All Hospitals 32 IV. Tuberculosis Sanatoria 33 Facilities and Services 33 Trend in Sanatoria Utilization 35 Tuberculosis Patients by Counties 36 Tuberculosis Clinics 37 Tuberculosis Deaths by Counties 37 Trend in Tuberculosis Case and Death Rates 40 V. Mental Hospitals 41 Facilities and Services 41 Overcrowding in State Mental Hospitals 42 Mental Hospital Patients by Counties 42 Trend in Mental Patients 45 The Aged Mentally 111 46 Mental Hygiene Clinics 46 Mental Hygiene Program 48 Related Mental Hygiene Institutions 49 Page VI. Facilities for Chronics and Convalescents ... 50 Facilities and Services 50 Number of Chronically 111 51 The Aging of the Population 53 Program for the Long-Term Patient 57 VII. Communicable Disease Hospitals 58 VIII. Physicians 61 Number of Practising Physicians 61 Age of Practising Physicians 64 Residencies Training in Hospitals 64 Internships in Hospitals 66 IX. Dentists 67 Number of Practising Dentists 67 Dental Services in Hospitals 69 Dental Facilities in Rounded Program . . 69 X. Nurses 71 Number of Graduate Registered Nurses 71 Fields of Nursing of Graduate Registered Nurses 71 Graduate Registered Nurses by Counties 72 Schools of Nursing 73 XI. Pharmacists 74 XII. Public Health Services 75 Municipal Health Department Facilities 75 Public Health Nursing 78 Visiting Nurse Associations 80 Dental Services 82 Laboratories 84 Industrial Hygiene 85 Communicable Diseases 86 Venereal Diseases 87 Tuberculosis 89 Rabies 90 Malaria and Mosquito Control 91 Infantile Paralysis 92 Heart Disease 92 Cancer - American Cancer Society - New Jersey Division, Inc. . 98 Cancer - State Health Department 93 Health Services in Public Schools 94 Page XIII. Population Statistics 96 Trend in General State Population 96 County Population 97 Changes in Age Distribution 98 Population by Municipalities 100 Population Density 103 XIV. Vital Statistics 105 State Summary: Births, Marriages and Deaths, 1900-194:6 .• 105 Births, Marriages and Deaths, 1946, By Counties 107 Infant Mortality (Average 1941-1945), By Counties .... 108 General Death Rates, 1920, 1930 and 1940, By Counties . . Ill Death Rates from Principal Causes, 1910-1945 112 1 I. THE FEDERAL HOSPITAL SURVEY AND CONSTRUCTION PROGRAM IN BRIEF The Federal Hospital Survey and Construction Act defines "adequate facilities" as follows: 1. Tuberculosis hospitals — beds per average annual death from tuberculosis 2. Mental hospitals — 5 beds per 1,000 population 3. Chronic disease hospitals — 2 beds per 1,000 population 4. Public health centers — 1 per 30,000 population 5. General hospitals — 4£ beds per 1,000 population Within the State, general hospitals are to be planned on an area basis setting a pattern for a coordinated hospital system. The base area, with a large hospital — if possible, associated with a medical school — serves several intermediate areas having smaller general hospitals. Each of these in turn serves neighboring rural areas with more limited facilities. The ratio of beds to population is graded so that there are proportionately more beds in the larger medical centers where more complete service is available. On the basis of these criteria for the consideration of "adequate facilities" the following facilities would be required for the State of New J ersey: 1. General hospitals —18,720 beds 2. Tuberculosis sanatoria — 4,640 beds 3. Mental hospitals — 20,800 beds 4. Chronic disease hospitals — 8,320 beds 5. Public health centers — 135 health centers 2 II. SUMMARY OF HOSPITAL FACILITIES AND SERVICES IN NEW JERSEY 1946 Type of facility Number of hospitals Number of beds (a) Average census Admis s ions 1. General Hospitals 94 14,431 10,613 349,968 a. Voluntary, non-profit 78 11,546 8,760 308,159 b. Governmental 3 2,615 (b 1,701 35,912 c. Proprietary 13 270 152 5,897 2. Allied Special Hospitals 43 2,195 1,024 23,998 a. Maternity 18 424 318 11,390 Governmental 1 345 272 10,380 Proprietary 17 79 46 1,010 b. Babies - voluntary, non-profit 1 70 33 1,925 c. Eye, Ear, Nose and Throat 6 87 41 3,338 Voluntary, non-profit 1 65 36 2,550 Proprietary 5 22 5 788 d. Orthopedic 5 347 201 1,525 Voluntary, non-profit 3 196 116 1,345 Charitable 2 151 85 180 e. Cardiac - charitable 2 170 92 340 f. Communicable Disease Hospitals 11 1,097 339 5,480 Governmental 10 1,064 329 5,159 County 3 585 214 3,702 Municipal 7 479 115 1,457 Voluntary, non-profit 1 33 10 321 3 Type of facility Number of hospitals Number of beds (a) Average census Admissions 3. Tuberculosis Sanatoria 20 3,609 (cl 2,650 4,037 a. State 1 316 285 335 b. County and city 14 2,847 2,029 3,026 c. Charitable 2 346 257 615 d. Proprietary 3 100 79 61 4. Mental Hospitals 22 13,782 17,758 5,599 a. State 3 8,877 p> to • o 1942 90.2 92.0 82.2 1944 92.5 93.8 87.0 Source: U. S. Census Bureau 17 EMERGENCY MATERNITY AND INFANT CARE PROGRAM During the war period a most significant development has been the Emergency Maternity and Infant Care program which was put into effect in April, 1943 to give assistance from Federal funds to the families of en- listed men in the armed services. The plan provided for the complete cost of physicians’ and hospitals’ maternity services and for the treatment for illness of Infants up to one year of age, both according to fixed scales of charges. The program in New Jersey was administered by the Bureau of Maternal and Chilv. Health of the State Health Department and the numbers of mothers and babies involved are summarized in the following table. The plan was still in effect (June,194?) but is operating at a greatly reduced rate. After each birth occurred the family was referred to the Public Health Nursing organization in the community of residence and a large amount of follow-up service was thus rendered of which there is no state- wide record. OPERATIONS OF E.M.I.C. PROGRAM IN NEW JERSEY Period Mothers Infants Total Cost May 1 - June 30, 1943 5,335 190 $1,181.95 July 1, 1943 - June 30, 1944 10,568 1,302 458,800.21 July 1, 1944 - June 30, 1945 9,112 1,517 1,138,995.10 July 1, 1945 - June 30, 1946 5,222 1,096 1,114,371.63 July 1, 1946 - Mar. 30, 1947 395 252 582,175.74 Total 30,632 4,357 $3,295,524.63 Source: N. J. Dept*Health 18 SUMMARY OF HOSPITAL IN-PATIENT ADMISSIONS A summary of the relative proportion In the hospital admissions of the general patients and of the maternity patients is offered in the following table: HOSPITAL ADMISSIONS BY GENERAL AND MATERNITY SERVICE 1930 - 1946 Year Per cent of total admissions General patients Maternity patients 1930 86.0% 14.0% 1935 84.8 15.2 1940 82.8 17.2 1941 81.0 19.0 1942 77.3 22.7 1943 76.7 23.3 1944 78.7 21.3 1945 79.4 20.6 1946 77.3 22.7 Source: N, J, Dept. Institutions & Agencies OCCUPANCY RATES The occupancy rates in the general hospitals in New Jersey in recent years have been quite high and have been at a point beyond which they should not go in order to insure adequate care to the individual patient. Administrative experience in general hospitals has demonstrated that efficient and adequate provision for community requirements cannot be carried on with an average annual bed occupancy of more than 75 per cent to 80 per cent. This is in large part due to the fact that the general hospital must provide segregated departments for various age and therapeutic classifica- tions, i.e., separate wards for men and women, for surgical, medical, obstetric and pediatric cases and for isolation of communicable and infectious conditions and patients in disturbed or critical condition. There is also the obvious necessity of providing for the peak loatis which occur at unpredictable periods during the year. The vast difference in minimum load and peak load is aggravated by the previously mentioned 19 segregation requirements. For example, a general hospital may, even at a time when its total occupancy is considerably below its total capacity, be very much over-crowded in certain of its departments with patients who can- not properly be cared for in other locations. OCCUPANCY RATES OF GENERAL HOSPITALS IN NEW JERSEY 1929 - 1946 Year Total General (Excluding mothers and new born) Maternity (Excluding new born) 1929 68.6% 73.4% 41.4% 1930 67.3 70.4 49.9 1931 68.3 74.3 40.9 1932 66.2 71.7 41.9 1933 64.9 69.5 44.3 1934 67.3 72.8 42.6 1935 67.7 72.7 44.6 1936 68.3 72.8 47.3 1937 72.0 76.6 50.3 1938 70.4 73.9 53.7 1939 70.1 73.3 54.9 1940 72.7 76.0 57.5 1941 73.8 76.6 61.6 1942 72.0 72.0 71.9 1943 70.4 70.5 69.9 1944 69.5 69.7 63.7 1945 73.4 76.3 61.9 1946 75.5 77.1 68.8 Source: N, J. Dept, Institutions & Agencies TREND IN USE OF DIFFERENT HOSPITAL ACCOMMODATIONS The very favorable economic situation engendered by the war period which expressed itself in correspondingly higher Incomes for the great mass of the people, and the increasing number of Blue Cross subscribers is reflected in the growing proportion of patients able to avail themselves of the higher-priced general hospital accommodations. 20 TREND IN IN-PATIENT SERVICES IN VOLUNTARY GENERAL HOSPITALS BY TYPE OF ACCOMMODATION (EXCLUDING NEWBOEn) 1940-1946 Source'. NJ.J Dept. Institutions 4- Agencies 21 In 1940, 34.3 per cent of the admissions were to semi-private rooms as against 51.3 per cent in 1946. Likewise ward-private patient admissions increased from 16 per cent in 1940 to 19.9 per cent in 1946. The notable fact is the decrease in ward-general admissions Per cent in 1940 to 16.3 per cent in igqd) the bulk of whom constitute the so-called "charity" patients who are largely the responsibility of the public welfare bodies. TREND IN IN-PATIENT ADMISSIONS IN VOLUNTARY GENERAL HOSPITALS IN NEW JERSEY Type of Accommodation 1940 - 1946 Year Typ« j of Accommodation - Per cent Private Semi- private Ward Private General 1940 12.5% 34.3% 16.0% 37.2% 1941 12.1 38.5 17.5 31.9 1942 ] 1.7 44.5 17.0 26.8 1943 12.7 47.3 18.8 21.2 1944 12.4 00 • 20.3 19.5 1945 12.7 49.3 20.4 17.6 1946 12.5 51.3 19.9 16.3 Source: N, J. Dept, of Institutions & Agencies OUT-PATIENT VISITS It has long been the practice for the New Jersey general hospitals to utilize the out-patient clinics as an effective device to meet the needs of the sick poor who are able to come to some fixed point. Through the cooperation and generosity of the medical professions the clinics have been able to bring together well-equipped specialists representing the dif- ferent branches of medicine utilizing to the fullest the available diagnostic and therapeutic facilities. 22 OUT-PATIENT VISITS TO GENERAL HOSPITALS IN NEW JERSEY (voluntary and governmental) 1929-1946 v Source: N-J. Dept. Institutions + Agencies 23 OUT-PATIENT VISITS IN GENERAL HOSPITALS IN NEW JERSEY, 1930 - 1946 Year Number of out-pat ient visits 1930 1,114,121 1931 1,304,079 1932 1,441,830 1933 1,572,425 1934 1,509,921 1935 1,520,208 1936 1,353,525 1937 1,404,297 1938 1,659,607 1939 1,486,636 1940 1,536,121 1941 1,460,633 1942 1,261,113 1943 981,587 1944 926,669 1945 837,417 1946 925,873 Source: N, J, Dept. Institutions & Agencies There is to be noted a sharp Increase in out-patient visits to general hospitals beginning with the depression in 1929. As the employment situation improved there is a noticeable drop in out-patient visits, which shoot up again with the onset of the "secondary" depression in 1936. From 1940 to 1945 there is a continuous drop in out-patient visits re- flecting, no doubt, the improved economic situation of the average wage-earner and his desire to seek medical advice through the private practitioner and pay for such services. In the one year period 1945-1946, which marks the ending of World War II and a complete alteration in the employment situation, the number of out-patient visits to general hospitals is again on the Increase. 24 HOSPITAL EXPENDITURES AND COSTS The current operating expenditures of the 87 general hospitals amounted to more than forty million dollars in 1946, with receipts from patients es- timated at thirty million dollars, thus presenting an operating deficit of some ten million dollars. The sharp increase in the cost of living in the last few years is re- flected in an increase of the current operating expenditures of $2,932,895 between 1943 and 1944; $3,732,640 between 1944 and 1945; and $7,277,830 between 1945 and 1946. TOTAL GENERAL HOSPITAL EXPENSES IN NEW JERSEY 1930 - 1946 Year Total annual expend!ture 1930 $15,909,370 1931 15,664,450 1932 14,784,135 1933 13,687,260 1934 15,001,095 1935 lo,386,43o 1936 16,169,900 1937 17,453,045 1938 18,459,685 1939 18,151,610 1940 19,627,195 1941 22,135,625 1942 24,419,910 1943 26,622,910 1944 29,555,805 1946 33,288,445 1946 40,566,275 Source: N. J, Dept. Institutions & Agencies Regarding the problem of meeting the mounting hospital deficits and the problem of securing adequate reimbursement by the hospitals for the care of the indigent patient, the following comments quoted from a study* made recently "Hospital Care of the Indigent and Medically Indigent in New Jersey" A Review of the Policies and Legal Resources for Adequate Hospital Care. Source : N.J. Dept. Institutions 4- Agencies ESTIMATED ANNUAL HOSPITAL RECEIPTS AND EXPENDITURES (voluntary and governmental hospitals)* 1929-1946 * General Hospitals only 26 by the New Jersey Hospital Association and the New Jersey Department of Institutions and Agencies, will be of interest: "Even before the depression there was a strong feeling that govern- ment, particularly local government, held the basic responsibility for financing the care of the indigent sick in hospitals. While subscribing to this point of view as a principle, however, most hospitals found it satisfactory in practice to combine revenues received from contributions, endowments and from service to patients able to pay full hospital charges, with occasional governmental subventions in financing charitable services. This remains true today, although the proportion of total Income from the several sources has changed. "With the depression, however, the trend toward governmental support of the Indigent sick was considerably accelerated. The number of patients unable to meet the cost of hospital care greatly increased, the revenues available from endowment diminished sharply because of the deterioration of investments and the reduction of interest rates. Philanthropic giving decreased. Only through governmental payments could the hospitals continue to furnish the service upon which communities had come increasingly to de- pend as a central feature of the total health and welfare program." AVERAGE DAILY PER CAPITA COST The average daily per capita cost of patients in voluntary general hospitals has doubled between 1940 and 1947. It has been remarked by hospital administrators that in spite of these mounting per capita costs the total cost of a hospital stay has not materially increased to the individual paying patient in recent years as there has been a reduction in the average stay of the patient in the hospital. 27 AVERAGE DAILY PER CAPITA COST Voluntary General Hospitals in New Jersey 1940 - 1947 Year Based on adult hospital days only Based on adult hospital days, plus 1/4 infant days 1940 $5. 95 $5.73 1941 6.31 6.04 1942 6.91 6.57 1943 7.64 7.26 1944 8.64 8.15 1945 9.13 8.71 1946 10.49 9.99 1946 First quarter $9.62 $9.22 Second quarter 9.80 9.36 Third quarter 10.85 10.27 Fourth quarter 11.71 11.09 1947 First quarter $11.79 $11.21 Source: N. J. Dept. Institutions & Agencies ANNUAL HOSPITALIZATION EXPENSE OF THE GENERAL POPULATION Taking the total general hospital expenditures which were estimated at $40,566,275 in 1946, the calculation may be made that the average ex- penditure for general hospital purposes amounted to $9.75 per New Jersey inhabitant that year. These figures could be used to gauge the extent to which the people of given counties may be able to support and maintain local hospital facilities. 28 ANNUAL HOSPITALIZATION EXPENSES IN GENERAL HOSPITALS OF THE NEW JERSEY POPULATION Counties 1946 County Estimated annual hospital expense for total county population All counties $40,566,275 Essex S,165,005 Hudson 6,358,120 Bergen 3,994,510 Union 3,201,720 Passaic 3,016,540 Camden 2,493,625 Middlesex 2,116,745 Mercer 1,924,070 Monmouth 1,572,250 Morris 1,226,030 ’ Atlantic 1,209,785 Burlington 945,985 Somerset 725,385 Cumberland 713,625 Gloucester 704,215 Warren 489,320 Salem 412,220 Ocean 367,675 Hunterdon 358,510 Sussex 288,945 Cape May 281,995 Source: N, J, Dept. Institutions k Agencies It might be noted parenthetically that taking the adult bed capacity of the hospital as a whole it cost $2800.18 to maintain an adult hospital bed in 1946; and it cost $3711.46 to maintain an occupied hospital bed. It cost $112.60 per hospital adult admission during 1946, and $91.80 if all patient admissions Including new-born are considered. 29 HOSPITAL SERVICE PLAN OF NEW JERSEY (Blue Cross) The Hospital Service Plan of New Jersey, the first of the Blue Cross Plans as they are known today, was organized in 1932 through the cooperative movement of the hospitals. Today, there are 200 member hospitals. The New Jersey Plan was also the first to provide inclusive family en rollment at a flat family subscription rate. The Plan is 100% non-profit and is approved by the New Jersey Hospital Association and the Medical Society of New Jersey. It is the only plan in the State approved by the American Hospital Association. It is under the supervision of the Department of Banking and Insurance and the Department of Institutions and Agencies for the State of New Jersey. The Plan provides hospital protection for its members and their fami- lies. The Plan agrees to pay for hospital bills up to a total of 21 days' hospitalization for the following hospital services rendered in semi-private or ward accommodations: 1. Bed and board 2. General nursing service 3. Routine laboratory examinations 4. X-rays connected and consistent with actual treatment 5. Routine medications, dressings, and plaster casts normally supplied by the hospital 6. Use of the operating room 7. Use of the delivery room in cases eligible for maternity services 8. Anesthetics if supplied by the particular hospital and administered by salaried employee of hospital If the subscriber selects a private accommodation in a cooperating hospital, or any accommodation in any other general hospital, the Plan payment serves as a credit toward the total hospital bill for these services and any balance of the bill is chargeable to the patient. After the first 21 days of benefits, the Plan allows up to $3.00 per day toward the hospital bill up to 90 additional days. 30 In the event that an eligible person requires hospital emergency services through accidental injury which does not result In admission as a hospital bed patient, the Plan will reimburse the person up to $8.00 for hospital services received for each such injury. Since its organization to the end of March, 1947, Blue Cross payments for hospitalization totalled $23,801,191 for 358,623 persons hospitalized. HOSPITALIZATION EXPERIENCE UNDER HOSPITAL SERVICE PLAN OF NEW JERSEY (Blue Cross) 1933 - 1946 Year Persons enrolled Total cases hospitalized Payments to hospitals 1933 2,798 123 $5,764 1934: 4,107 332 11,694 1935 10,900 619 38,842 1936 18,977 1,567 84,709 1937 31,189 2,901 137,939 1938 111,893 3,986 265,825 1939 180,057 12,845 782,073 1940 241,770 17,618 1,115,250 1941 340,179 24,161 1,564,813 1942 417,821 33,365 2,124,030 1943 570,267 43,996 2,882,266 1944 651,411 53,531 3,413,942 1945 767,000 66,537 4,492,469 1946 929,915 75,336 5,100,215 Aggregate to April 1, 1947 990,333 358,623 $23,801,191 Source: Hospital Service Plan of New Jersey A summary of the operation of the Hospital Plan of New Jersey for 1946 is given below: NON-MATERNITY AND MATERNITY CASES HOSPITALIZED UNDER HOSPITAL SERVICE PLAN OF NEW JERSEY (Blue Cross) Service Total cases hospitalized Patient days Paid to hospitals Non-maternity 60,391 585,401 $3,913,910.08 Maternity 14,945 136,455 1,186,304.99 Total 75,336 721,856 $5,100,215.07 1946 Source: Hospital Service Plan of New Jersey 31 Of the 75,336 cases hospitalized 19.8 per cent were maternity patients, who were served 18.9 per cent of the total hospital days. The average payment to the hospital per non-maternity case was $64.81 and per maternity case $79.38 The per diem payments for each non-maternity case amounted to $6.6& and per diem payments for maternity cases were $8.69. A. study of the relative proportion of "Blue Cross" patients to the total patient load obtaining in 16 general voluntary hospitals in one year showed 22.2 per cent of total admissions were Blue Cross cases and had been served 19.1 per cent of all the patient days. The range in admissions was from 6.4 per cent to 39.0 per cent, and in-patient days from 5.8 per cent to 34,6 per cent. The significant place of the Blue Cross patient in the operation of the voluntary general hospital is further graphically illustrated on the basis of a special study made in one of the large voluntary general hospitals in Essex County. Type of accommodation Per cent of Blue Cross patients to total Number of patients Number of patient days Total 36.8% 30.1% Private 44.6 to • Semi-private 47.2 40.7 Ward-Private 11.1 11.7 Ward-General 7.4 to Source: N, J. Dept. Institutions & Agencies MEDICAL-SURGICAL PLAN OF NEW JERSEY The Medical-Surgical Plan of New Jersey is a non-profit corporation organized by the Medical Society of New Jersey supplementing the activities of the Hospital Service Plan of New Jersey. Subscribers of the Hospital Service Plan with under-average income may also subscribe to the Medical-Surgical Plan and be eligible to medical, surgical, maternity, anesthesia, and consulting services rendered to them while bed patients in hospitals by fully licensed physicians. 32 In addition, the Plan has found it possible to pay benefits under the following conditions: 1. Tonsillectomies performed in physician's office; 2. Maternity services rendered anywhere at time of full term delivery; 3. Emergency surgical services rendered in the out-patient departments of hospitals without admission for bed occupancy; 4. Emergency surgical services occasioned by accidental Injury rendered anywhere within 24 hours after the accident, if in the Plan's opinion such treatment should ordinarily require hospital bed occupancy, for which the Plan will pay in accordance with its schedule of benefits, but not to exceed $25.00 in connection with any one accident. All matters pertaining to enrollment, billing, collections and general accounting are serviced through the facilities of Hospital Service Plan of New Jersey (Blue Cross) * A.11 matters respecting physician and patient rela- tionship, standards of medical care, determination of eligibility of claims, and claim payments are handled through a separate office maintained by Medical-Surgical Plan. The first contract for enrollment of employees and their dependents was issued on July 1, 1942. The enrollment as of April 30, 1947 was 104,840 persons. During the month of April, 1947, the earned subscription of the Plan amounted to $70,700.17 and the claims incurred in that month in accordance with its schedule of benefits totalled $55,946.50. The earned reserve of the Plan as of April 30, 1947 was $199,581.35. TECHNICAL PERSONNEL IN ALL HOSPITALS On the basis of reports furnished to the American Medical Association New Jersey had 1443 full-time and 180 part-time technical personnel employed in all of its hospitals. TECHNICAL PERSONNEL IN NEW JERSEY HOSPITALS Classification Number Full- time Part -time Total 1443 180 Medical Technologists 438 47 X-Ray Technicians 206 27 Die tit ians 262 10 Physical Therapists 132 23 Pharmacists 85 21 Medical Records Librarians 105 35 Occupational Therapists 122 9 Nurse Anesthetists 87 4 Clinical Photographers 6 4 Source: American Medical Association 33 IV. TUBERCULOSIS SANATORIA facilities and services Details concerning the facilities available to tuberculous patients in public sanatoria in New Jersey are listed in the table below on which are also given figures on the services rendered during 1946. TUBERCULOSIS SANATORIA FACILITIES AND SERVICES IN NEW JERSEY 1946 Number of beds Average census Admissions Total 3609 2650 4037 State Sanatorium Glen Gardner 316 285 335 County and City 2847 2029 3026 'Atlantic County 103 38 70 Bergen County 147 147 192 Burlington County 112 80 71 Camden County Essex County 237 140 181 Verona 444 277 417 Belleville 30 21 23 Newark City Hospital 31 16 373 Hudson County Mercer County (Trenton) 589 412 634 Donnelly Memorial 100 74 170 Middlesex County 221 183 237 Monmouth County 100 84 95 Morris County 76 47 57 Passaic County 225 204 201 Union County 432 306 305 Charitable (2) 346 257 615 Proprietary (3) 100 79 61 Source: N. J. Dept. Institutions & Agencies Included in the above facilities are approximately 430 beds for children with an average census of 298 and 654 admissions. In addition to these facilities there are approximately 1050 beds set aside in mental hospitals for the accommodation of tuberculosis patients. Chapter developed with the cooperation of the superintendents of the state and county sanatoria and the New Jersey Tuberculosis League. C-' 34 PUBLIC TUBERCULOSIS SANATORIA AND CLINICS IN NEW JERSEY 1046 SANATORIA Municipalities having Clinics. Source:N,J. Dept Institutions 4- Agencies 35 TREND IN SANATORIA UTILIZATION The trend In the utilization of public tuberculosis sanatoria during the period 1930-1946 is shown in the following table:* Year Average number of adult patients Number of adult admissions during year 1930 1768 3006 1936 2123 2792 1940 2724 2997 1941 2745 3066 1942 2739 3196 1943 2646 3113 1944 2367 2896 1945 2240 2638 1946 2167 2883 Source: N, J, Dept. Institutions & Agencies *Excluding Newark City Hospital (Tuberculosis Ward) used primarily as receiving unit for transfer of patients to the Essex County Sanatorium It appears that during the war period there was a considerable decline in tuberculosis sanatoria admissions and a resultant reduction in the patient load. Sanatorium administrators agree that this decline was largely due to the unusual employment opportunities available during the war years which kept some patients from entering sanatoria and caused other patients to leave even against the advice of the physician. It wll] be noted that since the ending of the war the admissions to tuberculosis sanatoria are again on the increase. 36 TUBERCULOSIS PATIENTS BY COUNTIES $ Around 2250 adult patients were maintained In 18 of the 20 tubercu losis sanatoria (public and private) on June 30, 1946, shown by county of residence in the following table: COUNTY OF RESIDENCE OF ADULT PATIENTS IN TUBERCULOSIS SANATORIA IN NEW JERSEY (State, County, and Private) 1946 County Resident population June 30, 1946 All counties 2250 Atlantic 59 Bergen 145 Burlington 60 Camden 134 Cape May 8 Cumberland 24 Essex 396 Gloucester 23 Hudson 380 Hunterdon 19 Mercer 115 Middlesex 174 Monmouth 103 Morris 56 Ocean 20 Passaic 209 Salem 16 Somerset 40 Sussex 10 Union 226 Warren 17 Out of State 16 Source: N, J, Dept, Institutions & Agencies *The two sanatoria not included are: the ward at Newark City General Hospital, at which patients stay short periods while awaiting transfer to the Essex County Sanatoria, and Deborah Sanatorium which takes primarily out-of-state patients. 37 TUBERCULOSIS CLINICS Some 36 clinic services report monthly to the New Jersey Tuberculosis League. They operate under auspices of sanatoria, boards of health, county tuberculosis leagues and general hospitals. The 88 centers are located in 6 sanatoria, 33 general hospitals, 13 municipal buildings, 2 tuberculosis association offices, and various other health centers. Equipment is available in sanatoria and general hospitals for the services required for modern diagnostic treatment. Clinicians, nurses, and clerical workers are supplied by sanatoria, health department, county free- holders, Red Cross, and tuberculosis associations. Private practitioners sometimes contribute services as clinicians, while Glen Gardner extension clinicians supply a large share of the medical service for rural communities. In 1945, clinic sessions numbered 6,144 extending over a period of 11,114 clinic hours. The sessions were attended by 28,152 patients of whom 14,920 were new cases. Of the new patients, 1,469 were diagnosed as rein- fection pulmonary tuberculosis. There were 21,783 patients on the active clinic register December 31,1945. The Portable X-ray unit is increasingly employed in mass screening operations conducted in schools, factories, housing projects, migrant camps, and community centers. Three units are now in operation under State Health Department auspices. County tuberculosis associations own equipment in Cam- den, Somerset, Middlesex, and Union Counties. Draftees have had the benefit of X-ray examination since the beginning of selective service in New Jersey and 6,112 persons have been referred for follow-up service. TUBERCULOSIS DEATHS BY COUNTIES In the five-year period 1941-1945 the number of deaths from tuberculo- sis in New Jersey averaged 1836 and represented a death rate of 45 per 100,000 of the total general population. A.s the following table shows there are considerable variations in the tuberculosis death rate among the several counties. *From "Tuberculosis Control In New Jersey - 1995" New Jersey Tuberculosis League, Inc., 1996. 38 TUBERCULOSIS DEATHS BY COUNTIES IN NEW JERSEY Five Year Averages 1941 - 1945 County Number of deaths Rate per 100,000 general population All counties 1,836 45.0 Atlantic 73 67.9 Bergen 119 28.3 Burlington 39 43.4 Camden 115 45.3 Cape May 10 35.6 Cumberland 26 35.4 Essex 437 53.0 Gloucester 27 36.1 Huds on 346 57.9 Hunterdon 10 29.2 Mercer 112 57.0 Middlesex 91 40.6 Monmouth 69 40.1 Morris 45 35.4 Ocean 17 45.8 Passaic 117 39.8 Salem 14 32.9 Somerset 23 33.5 Sussex 9 27.9 Union 117 35.1 Warren 20 41.2 Source: N, J. Dept, Health 39 c o mmmm ——i o .2 S.-2 8.S o o 0> p c *- ?« O O ° o O'®* 28 «7 *_ '*r=. £ -i o o r o,§ w o ~o E £ 3 L. X o >3 0/ 2