SURVEY 0 F MEDICAL CARE 
AND HEALTH STATUS OF RFC IPI ENTS OF PUBLIC ASS I STANCE 
NEW MEXICO DEPARTMENT OF PUBLIC WELFARE 
IH 
Division of Research and Statistics 
Santa Fe, new Mexico 
January, i944 TABLE OF CONTENTS 
Page 
I. Background of the Study 1 
Objectives 1 
Medical Facilities in New Mexico 2 
Organization and Administration 2 
Policies 3 
II. Summary of Findings 5 
How Many Families Needed Medical Care? 5 
How Many Families Were Cared For? 5 
Did All Families in Need of Care Receive it? . 5 
What Diseases Mere Most Frequent? * 5 
Who Provided Treatment? 5 
How Much Did it Cost? 6 
Was This Sum Sufficient? 6 
What Was the Money Spent For? 6 
Who Received Treatment? 6 
To What Extent Was Recommended Treatment Provided? .... 6 
What Were Results of Treatment? 6 
III. Recommendations 7 
IV. Health Status and Medical Needs of Public Assistance Families 8 
Recency of Medical Care 8 
Health Status 8 
V. Incidence of Illness and Disability Among Persons Receiving 
Medical Care from DPW Funds 11 
VI. Recipients of and Expenditures for Medical Care 18 
Source of Funds 18 
Recipients of Medical Care 21 
Expenditures for Medical Care 25 
, Method of Payment 29 
- Object of Expenditure ..... 32 
Volume and Cost of Hospitalization 33 
VII * Extent to Which Recommended Care Was Received ill 
VIII. Outcome of Treatment * . * Ifi; 
Status of Treatment, March 31 > 19l|3 Mt- 
Cases Closed as a Result of Treatment l(l| 
Favorable Changes in the Family Situation as a Result of 
Treatment 1+7 LIST OF TABLES 
Page 
Table 1. Families Approved for Public Assistance, Classified by Assis- 
tance Program and Recency of Medical Care, March 51» 191+5 • • • 8 
Table 2. Families Without Medical Care, Classified by Assistance Program 
and Health Status, March 31* 191+3 9 
Table 3» Persons Receiving Medical Care Classified According to Diagnosis 
Group, by Sex and Age . 13 
Table I4., Percentage Distribution of Persons Receiving Medical Care 
Classified According to Diagnosis Group, by Sex and Age .... 11+ 
Table 5* Persons Receiving Medical Care (3 DPW Funds), by Sex, Age and 
Number of Disabilities Present . 17 
Table 6. Families Receiving Medical Care, by Category and Source of 
Funds, October 1, 191+2 - March 31* 191+3 18 
Table ?• Families Receiving Medical Care from DPW Funds Other Than .assis- 
tance Payment, GA Funds and Medical Care Project Funds, 
October 1, 19i+2 - March 51* 191+3 . . . . 19 
Table 8. Families Receiving Medical Care Financed Wholly or in Part from 
Sources Other Than DPW Funds, October 1, 191+2 - March 31* 191+3 20 
Table 9* Number and Percentage Distribution of Families Receiving Medical 
Care Paid for Wholly or in Part from Three DPW Funds, by Assis- 
tance Program and Fund, October 1, 191+2 - March 31* 191+3 .... 21 
Table 10. Number and Percentage Distribution of Persons Receiving Medical 
Care (3 DPW Funds), by Assistance Program, Sex and Age, 
October 1, 191+2 - March 31* 191+5 22 
Table 11, Estimated Percentage of Persons in Public Assistance Families 
Who Received Medical Care (3 DPW Funds), October 1, 191+2 - 
March 31* 19l+3» by Assistance Program, Ago, and Sex 23 
Table 12. Expenditures for Medical Care from 3 DPT* Funds, by Assistance 
Program and Source of Funds, October 1, 191+2 - March 31* 191+5 • 25 
Table 13. Amount and Percentage Distribution of Medical Care Expenditures 
(3 DPW Funds), by Assistance Program, Sex and Age, 
October 1, - March 31* 191+3 26 
Table ll+. Average Expenditure Per Person Receiving Medical Care (5 DPW 
Funds), by Assistance Program, Sex and Age, October 1, 191+2 - 
March 51, 191+3 * 2? LIST OF TABLES (Cont’d.) 
Page 
Table 15. Expenditures for Medical Care Per Person Eligible for 
Care (Per Capita) Based on Total Medical Expenditures 
for Six Months (October 1, 191+2 - March 31, 191+3) and on 
Estimated Age and Sex Distribution of Ml Persons in 
Public Assistance Families ... 28 
Table 16. Percentage Distribution of Expenditures for Medical Care 
(3 DPW Funds) and of Persons Receiving Cere, by Category 
and Method of Payment 30 
Table 17. Percentage Distribution of Persons Receiving Medical 
Care, by Status of Treatment and Method of Payment ... 31 
Table 18. Expenditures for Medical Care (3 DpW Funds), by Object 
and Method of Payment, October 1, 191+2 - March 31* 191+3 33 
Table 19. Percentage Distribution of Expenditures for Medical Cere 
(3 DPW Funds), by Object of Expenditure and Method of 
Payment, October 1, 191+2 - March 31, 191+3 3l+ 
Table 20. Persons Receiving Medical Care (3 DPW Funds), by Object 
of Expenditure and Method of Payment, October 1, 191+2 - 
March 31, 191+5 35 
Table 21. Average Expenditure Per Person Receiving Specified Types 
of Medical Care (3 DPW Funds) by Object of Expenditure 
and Method of Payment, October 1, 191+2 - March 51, 191+3 36 
Table 22. Per Capita Expenditures for Medical Care (3 DpW Funds), 
by Object of Expenditure and Method of .Payment, 
October 1, 191+2 - March 31, 191+3 37 
Table 23. Percentage Distribution of Persons Receiving Hospital 
Care, by Assistance Program and Type of Service .... 38 
Table 21;. Hospital Care: Average Cost Per Patient, Average Cost 
Per Day and Average Days Per Patient, by Assistance 
Program and Type of Surgery 3^ 
Table 25- Persons Receiving Medical Care (3 DPW Funds), by Extent 
to Which Recommended Treatment Was Received and Assis- 
tance Program 1+1 
Table 26. Number and Percentage Distribution of Persons Receiving 
Medical Care (3 DPW Funds) by Type of Recommendation, 
Assistance Program and Whether or Not Recommended Treat- 
ment Was Received 1+3 
Table 2?. Persons Receiving Medical Care, According to Status of 
Treatment, by Assistance Program, March 31, 191-+3 .... 1+5 
Table 28. Percentage Distribution of Persons Receiving Medical 
Care, According to Status of Treatment, by \ssistancc 
Program, March 31, 191+3 1+6 I. BACKGROUND OF THE STUDY 
In October 1942, for the first time in its history, the Department of 
Public Welfare allocated funds to local offices for the specific purpose of 
providing medical care to public assistance recipients. This allocation 
was possible because of increased funds from tax sources earmarked for the 
Department of Public Welfare. Prior to October 1942, practically the only 
expenditures by the Department for medical care were small amounts of 
general assistance funds and allowances made,in the family budgets of cases 
receiving cash payments from OAA, ADC or ANE funds. 1/ Under the regulations 
of the Department medical allowances could not be made in an amount which 
caused the payment to exceed the amount of individual payments subject to 
federal matching. Hence, the total amount of such allowances was extremely 
limited, especially in the ADC program where the maximum payments subject to 
federal matching are relatively lower than in the other programs. 
The important new features of the program were that temporary policies 
and rules were set up governing the expenditure of medical funds, and that 
funds available for direct payments to doctors, hospitals, etc., were 
increased, although still much below a desirable minimum. In the 6 months 
period from April-September, 1942, inclusive, direct payments to doctors, 
hospitals, etc., (entirely from GA funds) were less than 1)5,000, In the 
period from October 1942-March 1943, direct payments exceeded $50,000. 2/ 
The Department of Public Welfare before undertaking this survey 
recognized that many aspects of its medical program fell below desirable 
standards both in quantity and quality of service rendered and in principles 
of administration and organization. A survey of New Mexico’s medical care 
practices made by the Social Security Board in 1939 did much to bring the 
attention of the agency to its practices in this field. 
Objectives 
The present survey of medical care and of the health of all public 
assistance families was undertaken in order a) to summarize the experience 
of the Department with medical care and the medical care program, and 
b) to secure as complete a picture as possible of the amount of unmet need 
for medical and health care among the open cases as of March 31, 1943. An 
attempt was made to assemble the necessary facts in a form that would not 
only provide a basis for future planning but also permit comparison with 
similar studies in other parts of the country, and contribute to the pooled 
knowledge required for an attack on the problem of medical care among low 
income families, nationally. 
Specifically, the questions to be answered included the following: 
How many families needed medical care,and how many 
received it? How many needed medical care, but did not receive 
lt? 
What types of illness and disability were found among 
the persons receiving medical care, by sex and age groups? 
In addition, some public assistance cases received medical services from 
the Crippled Children’s and Blind Service Programs fcr these special 
types of care« 
2/ The term direct payments as used in this report, refers to direct payments 
to doctors, hospitals, druggists, etc., and the use of the term here 
should not be confused with its frequent usage, meaning cash payments 
directly to clients. What agencies and organizations provided treatment? 
What was the cost of providing medical care, the average expendi- 
ture per person treated, and the per capita expenditure based on the 
total population eligible for such care? (This figure is especially 
useful as a basis for estimating future needs and determining allot- 
ments for the medical care program.) 
To what extent did patients receive the types of care recommended 
by the medical examiner? What reasons were most frequent for failure 
to begin treatment recommended and for interruption or suspension of 
treatment before it was completed? 
How many cases were closed as a result of the treatment given, and 
how many showed other favorable changes in the family situation? 
Medical Facilities in New Mexico 
In the following pages a brief review is presented of medical facilities 
in‘New Mexico and of the organization and administration of the Department’s 
medical care program. The Social Security Board Survey of 1939 showed that 
there were too few doctors of medicine, dentists and nurses in New Mexico. The 
number of dentists and registered nurses was particularly low in relation to 
estimated needs. The capacity of general hospitals was adequate for the State 
as a whole, but there were 9 counties in which there was no hospital. The 
ample facilities of some areas were not easily available to persons living in 
sections in which the number of general hospital beds was less than the 
suggested standard. Specialized hospital facilities were completely inadequate 
for care of the feeble-minded, and persons suffering with mental diseases and 
there were no hospitals for epileptics and no psychiatric wards in general 
hospitals* Absence of adequate facilities places severe restrictions on 
service which can be given by the Department, since medical care for public 
assistance cases is provided through existing facilities and agencies. 
Organization and Administration 
Operation of the public assistance medical care program of the Department 
in local offices is under the supervision of the Division of Public Assis- 
tance. A state office medical care committee coordinates the public assistance 
medical care program with special programs operated by the Divisions of Crip- 
pled Children Services, Services to the Blind and the State Tuberculosis 
Sanatorium. The purpose of this committee is to review all activities of 
the Department which pertain to medical care and to make recommendations 
directed toward a more effective and better coordinated program of medical 
care. The committee consists of the Supervisor of the Division of Services 
to the Blind, Chairman, and the Supervisors of Public Assistance and Crippled 
Children Services. 
The Division of Services to the Blind employs a part-time state super- 
vising ophthalmologist to supervise the medical aspects of that program and 
a medical social worker who serves as a consultant to local offices in the 
field of eye care. The Division of Crippled Children Services employs a 
part-time medical consultant and an orthopedic nursing consultant. Both 
divisions are under the general supervision of social workers. The State 
Tuberculosis Sanatorium operates under a part-time medical director and a 
business manager (non-medical). The public assistance medical care program 
operates without the benefit of medical supervision or consultation, except 
when it is sought from members of the medical staff of other divisions. 3 
The medical care program is closely integrated with the provision of 
public assistance. Local workers who determine eligibility for assistance 
are responsible for authorizing medical treatment and for providing social 
services. There are no professionally trained social workers serving public 
assistance cases in other than supervisory positions. Considerable stress 
is laid in training and supervision on coordination of medical services and 
assistance and the case work aspects of medical care. These efforts are 
severely handicapped particularly for Aid to Dependent Children and General 
Assistance, because of funds so limited that adequate food, shelter, clothing 
and other essentials of life cannot be provided. Under such circumstances, 
new medical problems are created and efforts at rehabilitation are often 
futile. 
The principal public sources of medical care for public assistance 
recipients are the Department of Public Welfare, the Department of Public 
Health,and the County Commissioners through county indigent funds. The 
Department has no official relationship with the Public Health Department 
relative to medical care for public assistance families, and no formal agree- 
ments have been worked out between the two agencies setting up a cooperative 
relationship, although an informal cooperative relationship has existed both 
on a State and local level. County indigent funds, under the law, are for 
the "relief of deserving indigent persons who are objects of charity.,.,." 
In practice, the major portion of these funds are expended for medical care, 
since DPW funds are even less adequate for medical care than for other types 
of need. In many counties, the commissioners have entered into agreements 
with the Department of Public Welfare providing that the Department shall 
establish eligibility and authorize payments from indigent funds. In 
operating under these agreements* the Department follows its usual methods 
of determining eligibility and authorizing payment. These agreements, how- 
ever, like the informal relationship with the Department of Public Health do 
not constitute a functionally coordinated public medical care program. 
In planning for and administering medical service to public assistance 
cases, the Department has obtained little consultative service from profes- 
sional groups. Representatives of the State Medical Association have 
conferred with the Department on problems relating to payment for services 
and on a fee schedule, but no continuing relationship has been developed. 
The Department has no formal relationship with professional groups repre- 
senting dentists, nurses, pharmacists and hospitals* 
Policies 
All medical treatment paid for by the Department must be authorized in 
writing by the Department, Treatment is authorized only on the recommen- 
dation of the examining physician. All persons eligible for public assis- 
tance are automatically eligible for medical care if it has been recommended. 
Under the policies of the Department as outlined above, any person whose 
medical needs plus regular living expenses are higher than his income is 
eligible for medical care. Thus, a large number of persons are potentially 
eligible for public medical care in addition to regular recipients of 
subsistence under public assistance programs. In view of limited funds, how- 
ever, counties are encouraged to concentrate on public assistance recipients, 
so that during the 6 months covered by this survey only 25 "non-assistance" 
families received medical care from DPW funds. Thus it may be said that the 
Department makes almost no provision for the so-called "medically needy" 
aside from services to the blind, crippled children services and tuberculous 4 
persons. This leaves a very wide gap in the provision of public medical 
services in New Mexico, since no other state-wide agency is equipped with 
funds or facilities to meet this need. 
The policies and procedures of the Department place no restriction on 
the types of medical care which may be provided, so that preventive as well 
as curative services may be given. Limited funds, however, and limited facil- 
ities in many communities often have had the effect of restricting medical 
care to the more emergent situations, thus preventing a well-balanced program. 
Payments for medical care are based on authorized service rendered, and 
the amount of the payment is determined by the physician’s charge. The 
Department has no fee schedule, so that varying amounts may be paid for the 
same type of service. The State Medical Association has appointed a committee 
which is working with the Department in setting up a fee schedule, but no 
schedule has yet been agreed upon. Lack of a fee schedule causes many 
inequities and harms relationships with the medical profession. County 
directors, with only limited funds available, are often placed in the posi- 
tion of bargaining for cheaper rates and physicians, already overworked, 
have little incentive to serve on a reduced basis. 5 
II. SUMMARY OF FINDINGS 
Some of the facts revealed by this study stand out above all others, 
and help us to answer the more basic questions in regard to health and 
medical care of public assistance recipients. These questions and the facts 
bearing on the questions are briefly reviewed here. To see these facts in 
their context is not possible in so brief a presentation. (For a detailed 
analysis of findings see Sections IV-VIII.) 
How Many Families Needed Medical Care? 
Mere than 7 out of 10 families receiving public assistance were 
considered in need of medical care. (Approximately 9,000 
families received public assistance.) 
How Many Families Were Cared For? 
Only 4 out of 10 families receiving public assistance were 
examined or treated by a physician; in the general population 
more than 8 out of 10 families receive the care of a physician 
* in any one year. 
Did All Families in Need of Care Receive It? 
3 out of 10 families receiving public assistance needed medical 
care, but did not receive it. 
What Diseases Were Most Frequent? 
For persons under 18 - diseases of the respiratory system. 
For persons 18-64 - diseases of the digestive system. 
For persons 65 and over - diseases of the circulatory system. 
Who Provided Treatment? 
More than 50 different agencies and organizations provided 
medical care for public assistance recipients; in addition 
there were numerous individual contributions. 
More than 4 out of 10 families receiving medical care obtained 
it from DPW funds only. (Approximately 3,700 families received 
medical care.) 
3 out of 10 families receiving medical care obtained it from 
a combination of DF/7 funds and other funds, 
3 out of 10 families receiving medical care obtained it from 
other sources only. 
Other agencies and organizations serving the largest number 
of families were the Public Health Department, County Indigent 
Funds and the Proctor Eye Clinic, named in the order of the 
number of families served. 6 
How Much Did it Cost? 
Expenditures for medical care from DFW funds were approximately $85,000 
in the 6 months ending March 31, 1943, Of this amount, 40 per cent was 
included in the assistance payments to clients and 60 per cent was in 
the form of direct payments by the Department to physicians, hospitals, 
etc. 
Was This Sum Sufficient? 
Estimated average annual expenditures per person eligible for care 
(including medical care from sources other than DFW) is less than $13 
annually. In the general population, the average annual per capita 
expenditure for medical care for persons with incomes of-more than 
$2,000 annually is above $20, 
What Was the Money Spent for? 
All types of medical care were provided. There were no legal 
restrictions or regulations preventing a well-rounded program of 
preventive and curative services, although inadequate funds resulted 
in emphasis on cure rather than prevention. 
Who Received Treatment? 
More than 4 out of 10 persons treated from DPtf funds were 65 years of 
age or over. (2,538 persons were treated.) 
2 out of 10 were children less than 18 years of age. 
Almost 5 out of 10 persons treated were members of families receiving 
0AA and 3 were members of families receiving ADC. 
The highest recipient rate (more than 25 per cent of those eligible 
for care) was among males of the years, 18-64, since in 
every instance men of this age receive assistance because of a 
physical or mental handicap. 
To What Extent was Recommended Treatment Provided? 
8 out of 10 persons receiving medical care from DPW funds received 
the care recommended by the examining physician. 
The extent to which different types of recommendations were carried 
out varied from 97.1 per cent for medication to 28.6 per cent for 
psychiatric treatment. 
What Were the Results of Treatment? 
Although the period covered by the survey was short (6 months) and a 
majority of the conditions treated were chronic, many favorable results 
of treatment were shown. 
3 out of 10 persons treated were cured or received maximum benefit, (4 
out of 10 persons treated were still under treatment as of March 31, 1943 
49 cases were closed as a result of treatment. 
The family situation was improved in at least 68 other cases by in- 
creasing the capacity of a mother to care for her children, of a child 
to attend school, etc. 7 
III. RECOMMENDATIONS 
The outstanding finding of the Medical Survey is that the medical 
needs of the Public Assistance case load are not adequately met. The 
Department of Public Welfare should develop plans to meet medical reeds 
because, first, the Department has a legal obligation to provide for 
the medical needs as well as for the other subsistence needs of Public 
Assistance recipients and, second, because provision of medical care in 
many cases serves to terminate, reduce or prevent dependency. 
Following are the recommendations of the Medical Care Committee 
as steps necessary for the continuation and development of the Medical 
Care Program: 
1. The Department of Public Welfare should request and support 
an appropriation for this purpose. Approximately $200,000 
a year is needed to meet the medical needs of families 
receiving public assistance, l/ 
2. A medical social worker, working under the administrative 
direction of the Supervisor of Public Assistance, should 
be appointed to develop a medical care plan and to serve 
as a Medical Social Work Consultant. 
3. Closer working relationships and better understanding 
should be established between the Department of Public 
Welfare, the State and County Health Departments, and the 
State and County Medical Societies. 
1;. The Department of Public Welfare should encourage Federal 
legislation whereby Federal funds would be made available 
to match State expenditures for medical care of Public 
Assistance recipients. 
l/ Estimate excludes portion of medical care costs now included in 
assistance payment. 8 
IV. HEALTH STATUS AND MEDICAL NEEDS OF PUBLIC ASSISTANCE FAMILIES 
Recency of Medical Care 
Of the 8,857 cases open on March 31, 191+3, 5>151 families (56*2 per cent) 
included no member who had been examined or treated by a medical practitioner 
during the year ending March 31, 191+3 (See Table 1). The range among the 
categories was quite wide, from 18.3 per cent for the non-assistance cases 
to 61;,5 per cent for those receiving Old \ge Assistance. 1/ The term "non- 
qssistance case" as used in this survey applies to those cases approved for 
general assistance, but receiving medical care only. 
TABLE 1. FAMILIES APPROVED FOR PUBLIC ASSISTANCE, CLASSIFIED BY 
ASSISTANCE PROGRAM AND RECENCY OF MEDICAL CARE, MARCH 31, 191+3 
Families Approved for Public Assistance 
Item 
All 
Programs 
OAA 
ADC 
ANB 
GA 
NA a/ 
All families 
8,857 
5,ooi* 
2,285 
238 
1,248 
82 
No person examined or 
treated, April 1, 1942 - 
March 31, 1943 
5,151 
3,230 
1,203 
120 
583 
15 
One or more persons exam- 
ined or treated, 
April 1, 1942-March 31,1943 
3,706 
1.771* 
1,082 
118 
665 
67 
Percentage Distribution 
All families 
All 
Programs 
100.0 
100.0 
100.0 
100.0 
100.0 
No person examined or 
treated, April 1, 1942 - 
March 31, 1945 
58.2 
61*. 5 
52.6 
50. i* 
1*6.7 
18.3 
One or more persons exam- 
ined or treated, 
April 1, 1942-March 31,1943 
41.8 
35.5 
1*7.1* 
49*6 
53.3 
81.7 
a/ nNon-assistancen cases as used in this survey inc 
approved for general assistance, but receiving me< 
.ude those cases 
iical care only. 
Nationwide studies show that more than 8 out of 10 families with incomes 
of $1,200 or more receive physician’s services during a year. 2/ This study 
shows that only 1+ out of 10 public assistance families received medical 
examination or treatment in the 12 months ending March 31> • 
Health Status 
T ■ » ...i 
The fact of having received no medical care may of course indicate 
either exceptionally good family health or some degree of unmet need. For 
the families under discussion the latter interpretation would bo most often 
1/ However, when persons are considered rather than cases, it is found that 
relatively more of those in OAA cases received care, See T&ble 11. 
2/ Hollingsworth, Helen,* and Klem, Margaret C., Medical Care and Costs in 
“ Relation to Family Income; Washington; U. S., Federal Security Agency, 
Social Security Board, Bureau of Research and Statistics, Division of 
Health and Disability Studies; Bureau Memorandum No. 51* March, 19-4-3> 
p. 53 (Table 16). 9 
true. In more than half of these 5>151 families without care (or one-third 
of all families) the case record indicated that medical examination or treat- 
ment or both was needed; in 22.3 per cent the family health was described as 
good; and in 15.2 per cent health was not mentioned (See Table 2). Relative- 
ly, the greatest amount of unmet need was found among the OAA cases, 6l.6 
per cent needing care, and in the GA group (6l.l per cent). Among the ADC 
families without examination or treatment, slightly over one-third enjoyed 
a health status described as good - a larger proportion than was found for 
the other assistance categories. 
TABLE 2. FAMILIES WITHOUT MEDIC A>L CARE, CLASSIFIED BY ASSISTANCE 
PROGRAM AND HEALTH STATUS, MARCH 51, 19h3 
Health Status 
Families 
Without 
Medical Care 
a/ 
Total 
OAA 
ADC 
ANB 
GA 
NA b/ 
No person examined or treated. 
April 1, 19l4.2-March 51, 191+3 
5,151 
3,230 
1,203 
120 
585 
15 
Record indicates examination 
needed . 
2,969 
1,991 
561 
55 
356 
6 
Health described as good 
l,ll+6 
600 
l+io 
36 
98 
2 
Health status not recorded 
785 
1+55 
213 
15 
97 
5 
Other c/ 
251 
182+ 
19 
Hi- 
32 
2 
Percentage Distribution 
No person examined or treated, 
April 1, 191+2-March 31, 19U3 
100.0 
100.0 
100.0 
100.0 
100.0 
100.0 
Record indicates examination 
needed 
57.6 
61.6 
1+6.6 
1*5.8 
61.1 
1+0.0 
Health described as good 
22.3 
18.6 
31*. 1 
30.0 
16.8 
13.3 
Health status not recorded 
15.2 
li+.l 
17.7 
12.5 
16.6 
33.J* 
Other c/ 
U.9 
5.7 
1.6 
11.7 
5.5 
13.3 
a/ Approved for assistance as of March 31 
, 191*3. 
F/ ,!Non-as si stance11 cases as used 
in this 
survey 
include those cases 
approved for general assistance, but receiving medical care only. 
c/ Medical care refused; health fair for 
age; permanent 
handicap, health 
otherwise good; condition hopeless; and miscellaneous. 
A small part (1+.9 per cent) of the families without care could not be 
classified under the groups just described. Though health was mentioned in 
the record, it was not specified as good, nor was medical examination 
recommended. Of the 251 such families, 91 refused treatment, 67 did not 
receive treatment, though suffering from a permanent disability, because it 
was believed that medical treatment was not needed, and 5l+ of advanced age did 
not receive care because ‘'health fair, despite advanced ago." 
The families in which one or more members received some form of medical 
care during the year totalled 3,706, or 1+1,8 per cent of the total open case 
load. Of these, slightly more than three-fourths received examination or 
treatment during the 6 months of the survey period. This survey was made as of the end of the first 6 months of the 
medical care project, during which time health needs were more adequately 
met than in the past, due to availability of increased funds. In spite of 
this expanded program, however, an unmet need remained in at least 2,969 
cases or one-third of the total, as has been shown. This is an under- 
statement of the actual situation existing, since the survey schedules did 
not provide for reporting the care which may have been needed in the 
families whose health condition was not recorded, or additional needs among 
other members of families where one or more persons were examined or 
treated. The main reason for this lack of needed care has been insufficient 
funds. Other contributing factors are lack of facilities and shortage of 
medical personnel, especially in some areas of the State, 
The significance of long-standing unmet need for medical care is 
illustrated in the following excerpt of a report by a county director: 
"The recording indicates at the beginning of the case history 
that Mrs. B. stated she was in poor health, suffered with 
rheumatism and gynecological trouble. In 19i+0, it was 
recorded that both were in good health. In 191+1, Mr. B. 
stated he had been suffering with kidney trouble for the 
past 10 years and it is aggravated when he labors hard.,.. 
He stated that his physical condition has never been diag- 
nosed properly as he has been financially unable to pay 
for the examination. He gets severe pains in his back and 
is unable to keep up his farm properly. Mrs. B. suffers 
from arthritis and teeth are irregular. She depends mostly 
on liquids for a diet, being unable to masticate properly. 
She requested an increase in the grant to get treatment, 
but at that time funds were limited,” 
Combining from Tables 1 and 2 those families which needed medical 
care but did not receive it (33*5 per cent) with those receiving such care 
(l+l• 8 per cent), it is evident that 75*5 per cent or throe out of every 
four families either had medical assistance or were considered in need but 
did not receive it during the year ending March 31 , 191+3* V. INCIDENCE OF ILLNESS AND DISABILITY AMONG PERSONS 
RECEIVING MEDICAL CARE FROM DPW FUNDS 
The medical diagnoses of persons receiving medical care from DPW funds 
were classified according to the Code for Tabulating Impairments Found on 
Medical Examinations prepared by the U~ S. Public Health Service, i / 
Since reports on medical examinations were not available for persons 
receiving medical care from sources other than DPW funds, or on persons who 
may have needed but did not receive medical care, these data cannot be 
considered a picture of the incidence of disabilities appearing in the case 
load, but rather a picture of the incidence of disabilities among persons 
treated from DPW funds. 
During the six survey months 2,538 persons received examination or 
treatment from the three DPW sources under study (Medical care program, 
general assi stance, and "assistance payment”). One hundred of these persons 
were excluded from the tabulations - 18 with diagnosis of ”no pathology” 
and 82 with "diagnosis unknown.” 
Diseases of the digestive system (including dental defects) had the 
highest frequency for all sex and age groups combined (See Table 3)« 
Diseases of the circulatory system and of the respiratory system ranked 
next in importance in the order named. The patterns of illness at different 
ages vary decidedly; thus for children under 18 diseases of the respiratory 
system had the highest frequency; among adults, 13—6L|., diseases of the 
digestive system ranked highest; and among persons 65 years of age and over, 
diseases of the circulatory system occurred most frequently. 
Sex variations in distribution of disabilities among the various 
diagnosis groups were relatively minor for all age groups combined, 
although musculo-skeletal impairments occurred relatively more frequently 
for males and diseases of the genito-urinary system more frequently for 
females (See Table I*.), The classification ”genito-urinary diseases” 
includes 51 normal pregnancies which although not technically a disease 
were included in this group since medical care is required. This accounts 
for the relatively high frequency of this classification among females, 
18-1*9. 
Table 5 shows the number of persons having diseases falling within 
the 10 main diagnosis groups and 3h sub-groups. Frequencies for the 350 
individual diagnoses are not shown because of the complexity of the 
tabulation and the relative infrequency of many of the classifications. 
These were tabulated, however, and will be made available to anyone 
interested in further analysis. 
*/Code not in its final form at the time of this survey. Some adjust- 
“ ments were made in the code to allow for classification of illnesses 
not considered as "impairments.” Within each diagnosis group the frequencies tend to cluster about certain 
diagnoses. The few in each group which account for the largest numbers are 
listed below in order of importance. 
Diagnosis Frequency 
Infectious and parasitic diseases, neoplasms and other 
general systemic diseases: 
Anemia (not specified as pernicious) Ijlj. 
Diabetes mellitus 3^4- 
* Tuberculosis, site unspecified 25 
Syphilis, form-unspecified 2U 
Infectious and parasitic diseases 21 
Malignant neoplasm (cancer) of skin ,. 20 
Diseases of the nervous system: 
Epilepsy I(.2 
Neuritis ■ 3S 
’‘Other” mental and nervous diseases 12 
Diseases and impairments of the eye and ear; 
Defective vision - cause unspecified 229 
Cataract (all forms) 57 
Otitis media 10 
Diseases of the circulatory system: 
High blood pressure, etc 180 
’’Other” diseases of the heart (non-specific diagnoses)... 82 
’’Other” diseases of the myocardium 73 
Arteriosclerosis 69 
Diseases of the respiratory system: 
Infected tonsils 188 
Asthma 51+ 
Bronchitis (not specified as chronic) 36 
Pneumonia 35 
Bronchitis, chronic 30 
Enlarged tonsils 22 
Diseases of the digestive system, including dental defects: 
Decayed teeth, number unspecified 163 
’’Other” diseases of stomach and intestines (Miscellaneous) 75 
Ulcer of stomach and intestine 50 
Hernia, site unspecified 39 
Appendicitis 37 
Defective or deficient teeth, not otherwise specified.... 35 
Diseases of the genito-urinary system: 
Nephritis 53 
Normal pregnancy 51 
’’Other” diseases of female genital organs 39 
Cystitis 31). 
’’Other” diseases of the prostate (not hypertrophy) 30 
Diseases of the skin: 
’’Other” diseases of the skin 25 
’’Other” local infections 19 
Other and ill-defined diseases and defects; 
Ill-defined diseases, senility, etc, 159 
General debility 20 
Diseases and impairments of the musculo-skeletal system: 
Arthritis and rheumatism 215 
’’Other” diseases or injuries of the organs of movement - 
(Miscellaneous) 7^ TABLE 3. PERSONS RECEIVING MEDICAL CARE CLASSIFIED ACCORDING TO DIAGNOSIS GROUP, BY SEX AND AGE a/ 
B 
oth Sexes 
Male 
Female 
Diagnosis Group 
UNDER 
65 & 
AGE 
UNDER 
65 & 
AGE 
Under 
65 & 
AGE 
ALL 
6 
6-17 
18-49 
50-64 
OVER 
UNK. 
All 
6 
6—17 
I 8—49 
50-64 
OVER 
UNK. 
All 
6 
6-i 7 
18-49 
50-64 
OVER 
Unk . 
all Persons b/ 
52 
424 
62i 
306 
1,020 
'5 
1,183 
30 
i93 
243 
156 
559 
2 
1.255 
22 
231 
37b 
150 
401 
13 
Infectious and parasitic diseases, neoplasms, and 
OTHER GENERAL SYSTEMIC DISEASES 
372 
17 
31 
143 
... in 
A 
168 
, 2 
62 
21 
60 
A 
19 
27 
67 , 
u 
I I 
0 
O 1 
Tuberculos IS . . . . 
66 
29 
2 
10 
J 
44 
18 
3 
4 
7 
5 
0 
4 
n 
32 
16 
2 
4 
25 
i 2 
1 
0 
2 
1 
0 
34 
13 
4 
0 
t 
6 
19 
6 
3 
2 
0 
SV PH 1 LIS 1,,, 
| 
n 
0 
n 
0 
1 
2 
0 
1 
3 
0 
Other venereal diseases i... 
0 
0 
4 
n 
2 
0 
1 
0 
0 
0 
0 
0 
4 
0 
3 
0 
0 
Other infectious and parasitic diseases *... 
3i 
12 
6 
J 
4 
1 
18 
8 
3 
4 
2 
13 
4 
3 
0 
2 
1 
Malignant neoplasms »i... 
6o 
25 
0 
0 
4 
8 
6 
48 
10 
n 
35 
11 
0 
0 
2 
3 
30 
4 
0 
0 
25 
14 
0 
0 
2 
5 
18 
6 
0 
Nonmalignant neoplasms . ...... i... 
0 
0 
9 
0 
0 
0 
3 
4 
0 
0 
6 
2 
0 
Diseases of the endocrine glands 
36 
4 6 
0 
0 
4 
25 
16 
f; 
n 
2 
0 
0 
1 
0 
l 
0 
34 
30 
0 
4 
24 
1 1 
1 
5 
0 
Diseases of the blood & blood-forming organs j... 
4 
8 
■ 7 
1 
.6 
0 
1 
5 
4 
6 
0 
0 
3 
4 
11 
1 
Nutritional diseases & chronic poisoning 
80 
148 
8 
22 
63_ 
14 
21 
32 
. 45. 
39 
83 
1 
3 
i3 
38 
7 
11 
>5 
27 
0 
41 
65 
2 
4 
Q 
7 
10 
■ 7 
18 
2 
Diseases of the nervous system . 
4 
/ 
i5_ 
0 
1 
6 
0 
3 
9 
25 
0 
Diseases of the central nervous system f 
14 
0 
0 
3 
a 
n 
0 
J 
14 
u 
U 
4 
3 
5 
c 
u 
0 
1 
u 
1 
u 
Diseases of the cranial & peripheral nerves ..... 
42 
0 
0 
12 
6 
24 
0 
22 
0 
0 
5 
2 
i5 
0 
20 
0 
0 
7 
4 
9 
0 
Psychoses 
l | 
0 
0 
8 
r 
0 
n 
A 
J 
j 
3 
O 
u 
U 
3 
1 
C 
u 
5 
U 
u 
c. 
C. 
1 
u 
Other mental and nervous diseases 
80 
4 
15 
42 
9 
1 n 
0 
aO 
A 
27 
0 
38 
«5 
7 
0 
4 C 
1 
O 
5 
3 
3 
9 
4 
Diseases and impairments of the eye and ear 
m 
_5. 
106 
_2i_ 
44 
»71 
2 
171 
3 
45 
17 
15 
90 
1 
228 
2 
6. 
54 
29 
81 
1 
Blindness 
17 
0 
j 
4 
0 
0 
lO 
0 
7 
0 
1 
0 
0 
6 
0 
1 
4 
5 
0 
Diseases and impairments of the eye, except 
blindness 
363 
103 
65 
37 
1 88 
2 
151 
43 
>3 
12 
80 
212 
60 
52 
25 
73 
• jj 
2 
1 
l 
1 
Deafness 
8 
0 
0 
0 
5 
0 
0 
0 
0 
J 
4 
0 
0 
0 
2 
2 
4 
0 
1 
3 
0 
Diseases of the ear, except deafness 
16 
2 
2 
7 
3 
2 
0 
12 
1 
1 
6 
2 
2 
0 
4 
1 
1 
1 
1 
0 
0 
Diseases of the circulatory system 
485 
1 
1.. 
47... 
71 
—35Q. 
3, 
239 
1 
3 
22 
38 
175 
0 
246 
0 
4 
25 
39 
175 
3 
Diseases of the heart, valves, endocardium and 
myocardium 
12 
1 16 
247 
48 
5 
2 
QO 
n 
63 
65 
m3 
24 
1 
1 
8 
5 
48 
0 
58 
5* 
134 
24 
0 
1 
3 
9 
45 
35 
0 
Other diseases of the heart 
0 
2 
12 
13 
) | 
22 
24 
IQ 
93 
79 
208 
18 
| 
0 
1 
6 
14 
44 
0 
0 
1 
6 
8 
1 
Diseases of the arteries 
0 
0 
0 
2 
0 
0 
5 
1 0 
98 
9 
0 
0 
0 
8 
14 
110 
2 
Diseases of the veins 
0 
0 
0 
0 
1 
4 
11 
1 
0 
0 
0 
7 
0 
8 
9 
0 
Other diseases of the circulatory system 
0 
8 
0 
1 y 
1 
0 
3 
0 
0 
1 
0 
2 
0 
2 
0 
0 
0 
Diseases of The respiratory system, except 
96 
tuberculosis 
401 
20 
184 
66 
. 29 
100 
2 
188 
11 
88 
28 
12 
49 
0 
213 
9 
38 
■ 7 
5i 
2 
Diseases of the nasal fossae and accessory 
sinuses 
88 
7 
173 
8 
Q 
8 
16 
0 
9 
1 
3 
I 
0 
4 
0 
29 
107 
2 
4 
8 
3 
12 
0 
Diseases of the throat 
204 
l70 
606 
y 
22 
J 
2 
0 
91 
237 
0 
97 
3 
84 
9 
1 
0 
0 
4 
89 
13 
1 
0 
0 
Diseases of the lungs, bronchi & pleurae 
/ 
lO 
35 
185 
24 
2 
87 
7 
3 
18 
t 1 
48 
0 
83 
3 
5 
i7 
i3 
43 
2 
Diseases of the digestive system 
6 
76 
lOl 
1 
293 
3 
35 
6s 
51 
136 
0 
3l3 
3 
4| 
m7 
50 
lOl 
1 
Defective Teeth 
245 
| 
54 
7 2 
4Q 
6s 
2A 
1 Q 
21 
46 
1 Q A 
A 
Q O 
CO 
00 
* * 
£ I 
u 
134 
U 
30 
53 
4 O 
1 
Diseases of the buccal cavity, esophagus, and 
ANNEXA (EXCEPT TEETh) , 
39 
0 
5 
i7 
8 
9 
0 
i5 
0 
5 
5 
2 
3 
0 
24 
0 
0 
|2 
6 
6 
0 
Diseases of the stomach and intestines 
2 66 
1 
22 
76 
42 
125 
0 
i55 
1 
10 
43 
30 
7« 
0 
1 1 1 
0 
12 
33 
12 
54 
0 
Diseases of other digestive sites 
85 
4 
2 
24 
15 
21_ 
40 
0 
36 
1 
1 
7 
8 
19 
0 
49 
188 
3 
1 
i7 
1O8 
7 
11 
21 
0 
Diseases of The genito—urinary system ..... 
1_ 
l3 
122 
ii2_ 
3 
131 
1 
5 
14 
18 
92 
1 
2 
8 
57 
2 
Diseases of the kidney t 
1 09 
| 
4 
19 
15 
69 
1 
82 
0 
2 
O 
57 
39 
Other nonvenereal diseases of the urinary system 
20 
u 
1 
c 
10 
4 
1 
52 
1 
3 
4 
7 
37 
0 
35 
0 
1 
2 
5 
27 
0 
<7 
1 
2 
2 
2 
10 
0 
Nonvenereal diseases of the male genital organs.. 
65 
1 
2 
4 
5 
52 
1 
65 
1 
2 
4 
5 
52 
I 
0 
0 
0 
0 
0 
0 
0 
Nonvenereal diseases of the female genital 
organs 
1 l 8 
0 
4 
98 
6 
q 
1 
0 
0 
0 
0 
0 
0 
0 
I 1 8 
0 
4 
98 
6 
g 
j 
i 
/diseases of the skin 
4 
•?/i 
n 
46 
6 
/I 
0 
19 
1 1 
1 1 
5 
lO 
lO 
15 
0 
25 
1 
9 
5 
1 
9 
0 
Other and ill-defined diseases and defects except 
r 
MUSCU LO—SKELET AL 
>77 
0 
0 
lO 
9 
156 
2 
102 
0 
0 
7 
6 
89 
0 
75 
0 
0 
3 
bl 
2 
Diseases and impairments of the musculo-skeletal 
SYSTEM .. 
385 
92 
7' 
199 
2 
20 
1 
234 
' 
13 
64 
40 
116 
0 
151 
1 
7 
28 
3i 
83 
1 
,itAbts & impairments limited to the feet 
n 
0 
2 
7 
2 
0 
0 
Other diseases and impairments limited to a 
9 
0 
1 
7 
1 
0 
2 
0 
0 
1 
0 
1 
0 
specific site . 
8 
0 
| 
8 
4 
0 
0 
6 
0 
0 
3 
n 
n 
O 
A 
n 
Lost members (musculo-skeletal) by anatomical 
J 
j 
u 
1 
site 
12 
0 
1 
5 
4 
2 
0 
12 
0 
1 
5 
4 
2 
0 
0 
0 
0 
0 
0 
0 
0 
Other musculo-skeletal diseases & impairments ... 
358 
2 
18 
83 
59 
195 
1 
2 1 
1 
12 
56 
29 
113 
0 
147 
1 
6 
27 
30 
82 
i 
—/ 'pERSONS excluded from this table — 18 W1 TH * 
NO pathology” 
and 82 
WITH DIAGNOSIS 
UNKNOWN. 
— 
1 
■I 
—/ DNOUPL1CATEO COUNT OF PERSONS RECEIVING MEDICAL CARE 
. Totals less 
THAN BUB-HEADINGS SINCE 
ONE PERSON OFTEN HAD TWO OR MORE DISABILITIES. TABLE 4. PERCENTAGE DISTRIBUTION OF PERSONS RECEIVING MEDICAL CARE CLASSIFIED ACCORDING TO DIAGNOSIS GROUP, BY SEX AND AbE 
14 
DIAGNOSIS GROUP A/ 
all 
Under 
6 
BOTH 
6-17 
SEXES 
, 
18-49 
50-64 
65 & 
OVER 
AGE 
UNK . 
ALL 
UNDER 
6 
Mal 
6-17 
E 
'8~45_. 
50-64 
OVER 
AGE 
UNK. 
ALL 
UNDER 
6 
Fem; 
6-i7 
LE 
18-49 
50-64 
55 & 
OVER 
AGE 
JNK . 
All Persons ......................... 
2,438 
52 
424 
621 
30b 
1,020 
'5 
','83 
30 
193 
243 
156 
559 
2 
1,255 
22 
231 
378 
150 
46l 
'3 
Infectious and parasitic diseases, neoplasms. 
16.2 
2i .4 
18.0 
14.6 
30.7 
AND OTHER GENERAL SYSTEMIC DISEASES 
15.2 
32.7 
7.3 
23.0 
15.6 
12.4} 
39.9 
14.2 
36.7 
6.2 
25.5 
'3.4 
10.7 
lOO.O 
27.2 
8.2 
Tuberculosis ...* 
Syph 1 LIS 
Other venereal diseases 
Other infectious & parasitic diseases 
Malignant neoplasms 
Nonmalignant neoplasms 
2.7 
1.2 
0.2 
1.3 
2.5 
0.1 
3.8 
1.9 
0 
23.0 
0 
0 
2.3 
0.2 
0.2 
1 .4 
0 
0 
7.0 
2.8 
0.8 
0.6 
0.6 
1 .4 
0.9 
1-3 
0 
• .3 
2.6 
'.9 
0.6 j 
0.4 
0 
0.3 
4.7 
0.9! 
0 
0 
0 
6.6 
0 
0 
2.7 
1.3 
0.1 
1.6 
2.9 
0.9 
~~dr 
0 
0 
26.7 
0 
0 
2.0 
0 
0.5 
1.5 
0 
0 
10.2 
5.0 
0.4 
1.6 
0.8 
1.2 
n a 
0 
1.2 
0 
0.6 
1.9 
2.5 
0 
0.1 
0.3 
0 
0.3 
5.3 
0.7 
0.1 
0 
0 
0 
0 
0 
0 
0 
2.8 
1 .0 
0.3 
I .0 
2.0 
1.1 
2.7 
0 
4.5 
0 
18.1 
0 
0 
0 
2.5 
0.4 
0 
1 .2 
0 
0 
1.7 
5.0 
1.5 
I .0 
0 
0.5 
1.5 
6.3 
2.0 
1.3 
0 
2.0 
3-3 
1.3 
0.6 
' .3 1 
0.6 
°i 
0.4 
3.9 
i.3 
1.0 
0 
0 
0 
7.6 
0 
0 
0 
Diseases of the endocrine glands 
1 .4 
0 
0.9 
4.0 
0.3 
0.5 
0 
0.1 
u 
u 
0.5 
1.5 
2.0 
5.3 
7 R 
1 0 
0 
2.4 
0 
1.2 
3.0 
2.7 
2.3 
7.6 
Diseases of the blood & blood-forming organs 
1.8 
0 
0.9 
2.5 
2.6 
1.6 
6.6 
' .3 
0 
4 4 
2.6 
0 
3.3 
9.0 
1.7 
2.3 
4.7 
3.7 
15.3 
nutritional diseases & chronic poisoning .. 
3.2 
5.7 
1.6 
3-5 
4.5 
3.1 
i3.3 
3.2 
3*3 
diseases of the nervous system 
Diseases of the central nervous system 
Diseases of the cranial & peripheral nerves. 
6. i 
7.6 
3.5 
1 0. 1 
6.8 
4.4 
0 
7.0 
3-3 
3.1 
15.6 
7.0 
4.8 
0 
5.' 
13.7 
3.9 
6.6 
6.7 
4.0! 
0 
o.6 
1 .8 
0 
■ 0 
0 
0 
0.8 
1.9 
0.9 
'*9 
0.5 
2.3 
0 
0 
1.0 
1 .8 
0 
0 
0 
0 
1.6 
2.0 
1.9 
1.2 
0.8 
2.6 
0 
0 
0. 1 
1.6 
0 
0 
0 
0 
0.2 
1.9 
0 
2.7 
0.2 
2.0 
0 
0 
0 
pKyrHOsrs , , , , . 
0.5 
3.2 
0 
0 
0.8 
0.9 
0.2 
0 
0.5 
3.5 
0 
0 
I .2 
0.6 
0.3 
0 
0.3 
0 
0 
0.5 
1.3 
0.2 
1.6 
Drum iiTMTAI AMn NIFRuniJS DISEASES .......... 
7.6 
9.6 
3*5 
6.7 
1 1 .4 
2.9 
0.9 
16.7 
0 
3.3 
lO.O 
3.1 
11.1 
3.2 
0.5 
0 
3.0 
13.7 
3.9 
3.9 
2.7 
0 
Diseases and impairments of the eye and ear.... 
... .6.3 
24.9 
14.3 
'3.3 
14.4 
23.3 
6.9 
9.6 
,6.1 
50.0 
18.1 
9.0 
26,4 
14.2 
19.4 
17.5 
7.6 
Blinonfrr * 
o.7 
0 
0.2 
0. 1 
1.3 
1.0 
0 
n r 
0 
0.5 
0 
o' 
1.0 
0 
0.7 
0 
0 
0.2 
2.7 
1 .0 
0 
Diseases and impairments of the eye, except 
16.9 
'3-7 
,6.7 
15.9 
7.6 
14.9 
0.3 
o.6 
5.7 
0 
24.2 
10.4 
1 2.0 
14.9 
0.4 
'3-3 
'2.7 
0.3 
I .0 
6.7 
0 
22.2 
5.3 
7.6 
14.3 
50.0 
4.5 
25.9 
Drafnf-ss 
0 
0 
0.9 
0.9 
0 
0 
0 
1 .2 
0.3 
0 
0.3 
0 
0 
0 
0.6 
0.6 
0 
DISEASES OF THE EAR, EXCEPT DEAFNESS 
3.8 
0.4 
I . 1 
0.1 
0 
3.3 
0.5 
2.4 
1 .2 
0.3 
0 
0.3 
4.5 
0.4 
0.2 
0.6 
0 
0 
Diseases of the circulatory system 
19.9 
'.9 
1 .6 
7.5 
25.1 
34.3 
19.9 
20.2 
3.3 
1.5 
9.0 
24.3 
0 
19.7 
0 
1.7 
6.6 
26.0 
38.0 
23.0 
Diseases of the heart, valves, endocardium 
and MVOEARDIIIM 
4.9 
1.9 
0.4 
1.7 
1.9 
4.5 
7-1 
9.1 
0 
5.3 
5.4 
3.3 
0.5 
3.2 
3.2 
8.5 
0 
4.7 
0 
0.4 
0.7 
6.0 
9.7 
7.5 
23.8 
0 
7.6 
'5-3 
Other diseases of the heart 
4.8 
0 
0.4 
7*7 
6.6 
0 
0.5 
2.4 
8.9 
7.8 
0 
4.0 
0 
0.4 
1 .□ 
5.3 
Diseases oe the arteries 
10.1 
0 
0 
2.0 
7.8 
6.2 
20.3 
13.3 
9.6 
0 
0 
2.0 
6.4 
'7.5 
0 
10.7 
0 
0 
2.1 
9*3 
Diseases oe the veins 
1.9 
0 
0 
'.7 
0 
1.7 
0 
2.0 
0 
0 
1 .6 
7.0 
1.6 
0 
1.9 
0 
0 
1.9 
5.3 
1.9 
0 
0 
0 
OTHER DISEASES OE THE CIRCULATORY SYSTEM ... 
0.2 
0 
0.7 
0.3 
0.9 
0 
0.2 
0 
0.5 
0 
0.6 
0.1 
0 
0.1 
0 
0.8 
0 
0 
Diseases of the respiratory system, except 
38.0 
43.3 
10.6 
9.4 
9.8 
'3.3 
15.8 
36.7 
45.6 
11.5 
7.6 
8.7 
0 
17.0 
41 .0 
41 ,5 
lO.O 
".3 
11.0 
'5.3 
Diseases of the nasal fossae and accessory 
1.7 
2.6 
0 
S INUSES - 
1.6 
5.7 
13.4 
19.2 
1.6 
1.4 
0.9 
0.6 
' -5 
0 
0.7 
8.1 
3.4 
1.5 
0.4 
0 
o.7 
0 
2.3 
9.0 
2.1 
2.0 
Diseases of the throat 
8.4 
40.8 
3.5 
5.6 
0 
0 
10.0 
43.5 
3.7 
0.6 
0 
0 
8.6 
18.1 
38.5 
3.4 
0.6 
0 
0 
i5.3 
Diseases of the lungs, bronchi and pleurae.. 
6.9 
1 .8 
7.8 
8.9 
i3.3 
7.3 
23.3 
1.5 
7.4 
7.0 
8.5 
0 
6.6 
13.6 
2.1 
4.5 
8.7 
9.3 
D'SEASES of the digestive system 
24.8 
m.5 
'7-5 
29.7 
33.0 
23.2 
6.6 
24.7 
lO.O 
18.1 
27.9 
32.6 
24.3 
0 
24.9 
13.6 
17.7 
3'.0 
33.3 
—7. 
22.0 
7.6 
Defective teeth 
lO.O 
1 .9 
.2.7 
i 
".5 
16.0 
6.6 
9-3 
3.3 
12,4 
7.8 
13.4 
8.2 
0 
10.6 
0 
12.9 
14.0 
18.6 
4.7 
7.6 
Diseases of the buccal cavity, esophagus. 
0 
4.0 
i.3 
".7 
4.5 
n 
AND ANNEXA (EXCEPT TEETH) i. 
1.6 
0 
1. t 
2.7 
2.6 
0.8 
0 
1.2 
0 
2.5 
2.0 
1.2 
0.5 
0 
1.9 
0 
3-1 
n 
Diseases of the stomach and intestines t.... 
10.9 
1.9 
5.i 
12.2 
13.7 
12.2 
0 
'3.1 
3.3 
5.1 
i7*6 
19.2 
12.7 
0 
8.9 
0 
5.1 
8.8 
8.0 
JL £ 
n 
Diseases of other digestive sites ..t 
3.9 
7.6 
0.4 
3.8 
4.9 
3.9 
0 
3.0 
3.3 
0.5 
2.8 
5.i 
3.3 
0 
3.9 
13.6 
0.4 
4.5 
4.C 
Diseases of the genito-urinary system 
13.0 
5-7 
3.0 
19.6 
9.4 
14.6 
'9.9 
1 I .0 
3.3 
2.6 
5.7 
".5 
16.4 
50.0 
15.0 
9.0 
3.4 
29.0 
7-3 
'2.3 
15.3 
Diseases of the kidney 
4.5 
1.9 
o.9 
3.0 
4.9 
6.7 
6.6 
4.3 
0 
1.0 
3.7 
7.0 
5.3 
0 
4.5 
4.5 
0.8 
2.7 
TT7 
8.4 
7.6 
Other nonvenereal diseases of the urinary 
0.5 
i.3 
0 
system 
2. I 
1 .9 
o.7 
0.6 
2.2 
3.6 
0 
2.9 
0 
0.5 
0.8 
3.2 
4.8 
50.0 
1.3 
4.5 
0.8 
2., 
Nonvenereal diseases oe the male genital 
6.6 
9-3 
0 
0 
0 
0 
0 
ORGANS 
2.6 
1 *9 
0.4 
0.6 
1.6 
5.o 
5.4 
3.3 
1.0 
i .6 
3.2 
0 
0 
u 
Nonvenereal diseases of the female genital 
organs - 
h A 
4.9 
0 
0,9 
i5.7 
i.9 
0.8 
6.6 
0 
0 
0 
0 
0 
0 
0 
9.4 
0 
1.7 
26.0 
3.9 
' *9 
y.D 
Diseases of the skin 
2.9 
H.5 
4.6 
'.7 
3.5 
2.4 
0 
3.8 
16.7 
5.1 
2.4 
6.4 
2.6 
0 
1.9 
4.5 
3.8 
1.3 
0.6 
1.9 
0 
Other and ill-defined diseases and defects 
15.3 
except musculo-skeletal 
7.3 
0 
0 
1.6 
2.9 
'5.2 
'3-3 
8.6 
0 
0 
2.8 
3.8 
i5.9 
0 
5.9 
0 
0 
0.7 
2.0 
14.5 
Diseases and impairments of the musculo- 
6.6 
7.6 
SKELETAL SYSTEM 
15.7 
3.8 
4.7 
14.8 
23.2 
19.6 
19-7 
3.3 
6.7 
26.3 
25.6 
20.7 
0 
12,0 
4.5 
3.0 
7.4 
20.6 
iao 
Diseases and impairments limited to the feet 
0.4 
0 
0 
0.3 
2.2 
0.1 
0 
0.7 
0 
0 
0.4 
4.4 
0.1 
0 
0.1 
0 
0 
0.2 
0 
0.2 
0 
Other diseases and impairments limited to a 
0.6 
0 
SPEC 1 F 1 C SITE 
0.3 
0 
0.2 
0.4 
1.3 
0 
0 
o.5 
0 
0 
1.2 
'.9 
0 
0 
0.1 
0 
0.4 
0 
0 
LOST MEMBERS (MUSCULO-SKELETAL) BY ANATOMIC- 
0 
0 
0 
AL SITE 
0.4 
0 
0.2 
0.8 
1.3 
0.1 
0 
1.0 
0 
0.5 
2.0 
2.5 
0.3 
0 
0 
0 
0 
0 
Other musculo-skeletal diseases and impair- 
6,6 
ments 
14,6 
3.8 
4.2 
• 3-3 
'9.2 
19.1 
17.8 
1 3.3 
6.2 
23.0 
18.5 
20.2 
0 
11.7 
4.5 
2.6 
7.' 
20.0 
17- 7 
7.6 
a/ percentages total to more than 100, SINCE c 
)NE PERS 
D'N OFTEf 
HAD tv 
0 OR MO 
RE DISABILITIES. The seriousness of the many forms of rheumatism and arthritis is often 
underestimated,and often the client, case worker and physician assume that 
treatment is not needed. Thus on one of the survey schedules the home 
visitor’s notation read, "only rheumatism, no medical care needed.” In 191+1, 
a former miner was examined by the company physician in a New Mexico mining 
community. The diagnosis read, "Mr. M. suffers from rheumatoid arthritis, 
for which there is no cure.” The case record continued, "Dr. H. explained 
to the visitor that although Mr. M.Ts condition is crippling and most painful, 
there is nothing to be done. Special diet or care is - not needed." In 191*2 
a new company doctor replaced the former one in this community. After 
examining Mr. M. he stated that although the progress of the disease could 
not be reversed, it could be arrested, and recommended sulfanilimide, 
vitamins B and C, and heat. He added, "If you want to furnish these drugs I 
shall bo glad to administer them and supervise the treatment for a nominal 
fee. ” 
Such differences of opinion among physicians are not infrequent. How- 
ever, in reporting a 1930 study of chronic illness in New York City, 
Mary C. Jarrett says; 
Progress in medicine in the last half century has put the 
whole subject of chronic illness in a new light. As medicine 
progresses the concept of incurability is constantly changing. ... 
To pronounce a patient incurable in the present state of 
medical knowledge places a serious responsibility on the 
physician and implies, at times, a greater knowledge than 
he possesses. ...Much of the illness that exists today may 
be charged to the attitude on the part of physicians and the 
public that chronic disease is incurable. ... 
The indifference of the medical profession as well as the 
general public that lies back of this neglect of the chronic 
sick is the result of a number of causes.... the misconcep- 
tions. ...that chronic diseases are peculiar to the aged and 
that they are incurable, have hampered medical investigation 
of these conditions. ...Another deterrent. ... is the 
greater necessity for dealing with social factors in the 
treatment of chronic diseases than in acute diseases. ... 
(Also) the mental component in chronic diseases.... is just 
beginning to receive definite consideration from physicians, l/ 
In regard to rheumatism the report just quoted states; 
Rheumatism. ... is a more serious cause of suffering and 
economic loss than any other chronic disease. ...Nearly two- 
thirds of the persons suffering from rheumatism in Massachusetts 
were not receiving medical care,.... Over a third of the persons 
with rheumatism in the (New York City) census of the chronic 
sick were not receiving care suited to their condition. ... 
Physicians who have studied arthritis believe that favorable 
treatment in early stages might arrest the disease in many 
cases. ... The plans of the Massachusetts Department of Public 
Health include diagnostic clinics. This will bo 
the first attempt of official health authorities in this country 
to control the disease. 2/ 
1/ Jarrett, Mary Cromwell; Chronic Illness in New York City; 2v; Now York; 
Columbia University Press, 1933; Vol* I, pp. £-6. 
2/ Ibid., Vol. I, pp. 168-175. The report also quotes a statement issued in 1929 hy the American 
Branch of the International Committee for the control of rheumatism, 
recognizing chronic arthritis as r,one of the most important, if not the most 
important of existing social and industrial handicaps,” and urging more 
general use of ''methods of treatment of proved value.” 3/ 
Outstanding among the illnesses and disabilities treated were defective 
vision, cause unspecified (229 persons), and rheumatism and arthritis (215 
persons). Next highest are infected tonsils, high blood pressure, decayed 
teeth and senility, all with frequencies above 150. 
Of the entire list of over 350 code numbers, 95 were not used in the 
present study, indicating that these disabilities were either not present or 
not diagnosed in the 2,538 persons receiving medical care. The reasons for 
the non-appearance of a certain condition may vary considerably, of course. 
Many of the numbers not used refer to congenital abnormalities of various 
parts of the body or to unusual diseases which it is no doubt safe to assume 
occur only rarely in any population. Others, such as alcoholism and drug 
addiction, may not be commonly considered as illnesses requiring treatment. 
The fact that no case of rickets was reported is less easily explained. 
Does it mean that this condition to is frequently overlooked or its serious- 
ness not recognized? It may also be that most or all cases of rickets in 
the families studied have been referred to Crippled Children’s Services and 
have not therefore received care financed by the three DPW funds covered in 
the survey. This explanation also applies in large measure to other bone 
and joint conditions among children in public assistance families. Lastly, 
there is a group of conditions, illustrated by the diagnosis "gonococcus 
infection of the joints” which probably do occur in the population studied 
but have not been described due to non-specific or inadequate diagnosis by 
the examining physician. 
Among the 2,i|58 persons receiving medical care for whom diagnoses were 
available, a total of 3#838 disabilities were present. The average number 
of disabilities present per person was 1.57* The variation among the age 
and sex groups is as follows: 
Sex 
and Age 
Average Number 
of Diagnoses 
Per Person 
Both Sexes 
1,57 
Under 6 
6 * 1? 
18 - 1+9 
30 - 6U . 
65 and over .,... 
I.76 
Hale ...,, 
1.62 
Under 6 
6 - 17 
18 - 
50 - 6J4 
65 and over . . . . , 
1.75 
Female ... 
....... 1.55 
Under 6 ........ 
l.-^T 
6 - 17 
1,16 
is - to 
50 - 6U 
65 and over .,... 
1.77 
3/ Jarrett, Mary Cromwell, Op. Git., Vol, I, pp. 170-171. This would indicate that multiple diagnoses tend to be present more often 
in the higher age groups than in the lower, and that the number is sightly 
higher for males than for females. Among children less than 6 the number is 
higher than among children 6-17. 
Table 5 shows that 60.i_j. per cent of persons treated had one diagnosis; 
26.2 per cent had two diagnoses; and 13 •U per cent had three. Although not 
presented in this report, data on diagnoses were tabulated according to number 
of diagnoses present, by sex and age. These data may serve for further analysis 
of the association of various diagnoses. 
TABLE 3. PERSONS RECEIVING MEDICAL CARE (3 DPW FUNDS), BY SEX, AGE 
NUMBER OF DISABILITIES PRESENT 
AND 
Persons With 
Persons With 
Persons With 
Sex and Age 
All Persons a/ 
One 
Two 
Three 
or More 
Disability 
Disabilities 
Disabilities 
Nunbe r 
Percent 
Number 
Percent 
Number 
Percent 
Number 
Percent 
All 
2,1*38 
100.0 
1,1*72 
60.14 
639 
26.2 
327 
13.1* 
Under 6 
52 
100.0 
ho 
76.9 
9 
17.3 
3 
5.8 
6 - 17 
U2U 
100.0 
351+ 
83.1* 
59 
II4.O 
11 
2.6 
18 - 1*9 
621 
100.0 
398 
614.0 
162 • 
26.0 
61 
10.0 
50 - 6U 
306 
100.0 
162 
53.0 
92 
30.0 
52 
17.0 
65 and over 
1,020 
100.0 
505 
1+9.5 
316 
51.0 
199 
19.5 
Age unknown 
15 
100.0 
13 
86.7 
1 
6.6 
1 
6.7 
Male 
1.183 
100.0 
689 
58.2 
319 
27.0 
175 
lll.e 
Under 6 
30 
100.0 
23 
76.6 
5 
16.7 
2 
6.7 
6 ~ 17 ..... ,,,« 
193 
100.0 
156 
80.9 
30 
15.5 
7 
3.6 
18-1*9 
21*3 
100.0 
1I46 
60.0 
70 
28.9 
27 
11.1 
50-61* 
156 
100.0 
77 
1*9-3 
51 
32.7 
28 
18.0 
65 and over 
559 
100.0 
285 
51.0 
163 
29.1 
111 
19.9 
Age unknown 
2 
100.0 
2 
100.0 
0 
0 
0 
0 
Female 
1.255 
100.0 
783 
62.14 
320 
25.5 
152 
12.1 
Under 6 
22 
100.0 
17 
77.3 
1+ 
18.2 
1 
14.5 
6-17 
231 
100.0 
198 
85.7 
29 
12.6 
h 
1.7 
18 - 1*9 
378 
100.0 
252 
66.7 
92 
21*. 3 
3h 
9.0 
50 - 6I4 
150 
100.0 
85 
56.7 
i+i 
27.3 
2I4 
16.0 
65 and over...... 
i4.6l 
100.0 
220 
1*7.8 
153 
35.2 
88 
19.0 
Age unknown 
13 
100.0 
11 
814.6 
1 
7.7 
1 
7.7 
a/ Not including 18 persons with "no pathology" and 82 with ? 
diagnosis 
unknown." VI. RECIPIENTS OF AND EXPENDITURES FOR MEDICAL CARE 
Source of Funds 
Table 6 presents the sources of funds through which medical care was 
provided for the 2,849 families who received it from all sources during 
the six months from October 1, 1942 to March 31, 1943. 
TABLE 6. FAMILIES RECEIVING MEDICAL CARE, BY CATEGORY AND 
SOURCE OF FUNDS, OCTOBER 1, 1942 - MARCH 31, 1943, 
Source of Funds 
Families Receiving Medical Care 
Total 
OAA 
ADC 
ANB 
GA 
NA 
All Funds .. ,... 
2,849 
1,338 
847 
81 
519 
64 
Three DPW funds only a/ .......... 
1,244 
664 
370 
23 
175 
12 
Three DPW funds and other sources^/ 
713 
342 
218 
20 
120 
13 
Other sources only Jb/ 
865 
317 
253 
38 
218 
39 
Source unknown 
27 
15 
6 
0 
6 
0 
Percentage 
Distribution 
All Funds 
100.0 
100.0 
100.0 
100.0 
100.0 
100.0 
Three DPW funds only a/ 
43.7 
49.6 
43.7 
28.3 
33.7 
18.8 
Three DPW funds and other sources^/ 
25.0 
25.6 
25.7 
24.7 
23.1 
20.3 
Other sources only b/.. 
30.4 
23.7 
29.9 
47.0 
42.0 
60.9 
Source unknown 
0.9 
1.1 
0.7 
0 
1.2 
0 
a/ Includes assistance payment (OAA, ADC, ANB), Medical Care Project, and 
General 
Assistance funds. 
b/ "Other sources" includes the following DPW funds; Services to 
the Blind, 
Crippled Children’s Services, Child Welfare Services, 
State Tuberculosis 
Sanatorium and administrative funds used for medical examinations to determine 
eligibility for assistance. 
Of the total families receiving care, 50.4 per cent received care only 
from sources other than the three DFW funds under study, 43.7 per cent from 
DPW funds only (assistance payment, general assistance, and medical care 
project), and 25.0 per cent from a combination of DPW funds and other funds. 
These figures roughly indicate the importance of other sources in providing 
medical care. An exact indicator of relative importance is not available 
since there is no data on expenditures or services received from other 
sources. Other sources of medical care included 5 funds financed by the Department 
of Public Welfare. The number of public assistance families receiving funds 
from these sources is indicated in Table 7 below; 
TABLE 7, FAMILIES RECEIVING MEDICaL CARE FROM DPW FUNDS OTHER 
THAN ASSISTANCE PAYMENT, GA FUNDS AND MEDICAL CARE PROJECT 
FUNDS, OCTOBER 
I, 1942 
- MARCH 
31, 1943 
Source of Funds 
Families 
Receiving Medical Care 
Total 
OAA 
ADC 
ANB 
GA 
NA 
Services to the Blind 
179 
83 
50 
19 
27 
0 
Crippled Children's Services., 
33 
3 
20 
1 
8 
1 
Child Welfare Services 
4 
0 
1 
0 
3 
0 
Administrative Funds a/ 
25 
3 
14 
3 
5 
0 
State Tuberculosis Sanatorium, 
21 
4 
11 
0 
6 
0 
a/ To determine eligibility for 
ADC or ANB. 
Table 8 shows that more clients received free medical care from 
physicians than from any other single source. Next in importance to physician’s 
services were funds paid by the client himself. In these cases, 256, the money 
for medical care came from the assistance payment or the family’s own re- 
sources, when medical care was not included in the family budget. This means 
that funds intended for food, shelter, clothing, etc., were used for medical 
care, in spite of the increased hardship which this involved. 
The most important public source of medical care (other than the DPW), 
was the Department of Public Health, .among 207 families receiving medical 
care from this source, 72 received care from venereal disease clinics and 3 
from care for servicemen’s dependents. The number receiving care from 
maternal and child health clinics of the Public Health Department was not 
specified, but it is undoubtedly a relatively high proportion of the 207 
families. 
County indigent funds were also an important source of public funds, 186 
families having received medical care from this source. Total expenditures 
from county funds for medical care during the 12 months ending March 31, 1943 
were approximately $27,000. The portion of this sum expended for public 
assistance recipients is not known, but it seems likely that public assistance 
recipients received a substantial part. 
More than 50 different agencies and organizations provided medical care 
for public assistance recipients. The multiplicity of organizations from 
which medical care is available suggests the need of coordination for 
effective use of available sources. TABLE 8. FAMILIES RECEIVING MEDICAL CARE FINANCED 'VHOLLV OR IN PART FROM SOURCES 
OTHER THAN DRW FUNDS, a/ - OCTOBER I, 1942 - MARCH 3l , 1943 
Source or Funds 
Families 
Receiving medical Care 
Total 
OAA 
ADC 
ANB 
GA 
NA 
Public sources: 
Department of Public health ....... 
207 
33 
103 
9 
58 
4 
County Indigent Funds 
CD 
o\ 
59 
45 
3 
74 
5 
veterans’ Facility 
14 
0 
11 
0 
3 
0 
State Hospital for the Insane 
7 
2 
2 
3 
0 
0 
U. S. Army , 
3 
2 
0 
0 
0 
1 
Vocational Rehabilitation 
3 
1 
2 
0 
0 
0 
Miscellaneous 
10 
2 
5 
0 
3 
0 
Private Organizations; 
Proctor Eye Clinic 
7i 
30 ' 
24 
6 
11 
0 
Catholic Clinic (Santa Fe) 
37 
2 
19 
4 
10 
2 
Community League (Quay) 
\6 
9 
4 
0 
3 
0 
Tuberculosis Seal Fund 
12 
1 
10 
0 
1 
0 
Maternal Health Center (Santa Fe) ....... 
10 
1 
5 
0 
4 
0 
Missionary Catechists * 
6 
1 
2 
0 
2 
1 
red Cross » . 
5 
0 
2 
0 
1 
2 
Miscellaneous 
20 
2 
i3 
0 
4 
1 
1ND1V1 DUALS ; 
Physicians 
355 
189 
83 
i3 
69 
1 
CLI ENTS b/ *, . 
256 
116 
75 
7 
53 
5 
Relatives of Client 
187 
119 
34 
5 
28 
1 
OTHER; FRIEND, EMPLOYER. ETC 
54 
29 
9 
0 
14 
2 
DENTISTS 
7 
3 
4 
0 
0 
0 
Taos County Cooperative {FSA) 
ON 
36 
1 
23 
1 
0 
8 
0 
Miscellaneous Funds 
0 
1 
0 
Source Unknown 
27 
15 
6 
0 
6 
0 
a_/ This is a multiple count, as one family may have been assisted from two or more of the 
SOURCES LISTED HERE, OR IN ADDITION MAY HAVE BEEN ASSISTED FROM ONE OR MORE OF THE OP'V 
SOURCES LISTED IN TABLES 6 AND 7. 
b/ Medical care paid by client from his assistance payment (medicals not budgeted), or 
FROM HIS OWN RESOURCES. The families receiving medical care paid for by the three DPW funds 
studied, whether alone or in combination with other community sources, 
totaled 1,957. Table 9 gives the number and percentage distribution of 
these cases, by assistance program and fund. Since one family may have 
received care financed from two or more funds, the percentages do not total 
to 100. 
TABLE 9, NUMBER AND PERCENTAGE DISTRIBUTION OF FAMILIES RECEIVING 
MEDICAL CARE PAID FOR WHOLLY OR IN PART FROM THREE DPW FUNDS, 
BY ASSISTANCE PROGRAM AND FUND, OCT. 1, 1942-MARCH 31, 1943’ 
Source of Funds 
Families 
Receiving Medic 
3.1 Care 
Total 
0AA 
ADC 
ANB 
GA 
HA 
All Sources a/ 
1,957 
1,006 
588 
43 
295 
25 
Assistance Payment 
996 
762 
202 
32 
- 
- 
General Assistance ,,, 
191 
21 
35 
1 
129 
5 
Medical Care Project 
1,011 
334 
431 
16 
209 
21 
Percentage Distribution b/ 
Assistance Payment 
50.9 
75.7 
34.4 
74.4 
- 
- 
General Assistance 
9.7 
2.1 
6.0 
2.3 
43.7 
20.0 
Medical Care Project 
51.7 
33.2 
73.3 
37.2 
70.8 
84.0 
a/ An unduplicated count of persons receiving medical care from the 5 DPW 
funds. 
b/ Percentages do not total to 100.0 as 
a given family may have been assisted 
from two or more resources. 
Here the variation in agency policy, as to financing medical care 
within the several assistance categories, is clearly evident. There is a 
marked tendency to use the assistance grant for OAA and ANB cases, three 
out of every four aided being from this source. On the other hand, over 70 
per cent of the ADC, GA and NA cases receiving medical care were helped 
through medical care project funds. General assistance funds were used 
much less often throughout. Many factors, of course, affect these existing 
policies - limitations as to maximum grants, availability of other funds, 
type of illness, age of persons needing care, possibility of rehabilitation, 
etc. 
Recipients of Medical Care 
Among 1,957 families for whom expenditures were made from DFW funds, 
there were 2,538 persons who received medical treatment (see Table 10), 
Fewer than 20 per cent of persons treated were less than 18 years of age. 
More than 40 per cent were persons 65 years of age or over. 
The proportion examined or treated of the total eligible population 
(persons in public assistance families) at different age levels is 
significant for estimating future needs. These percentages are given in 
Table 11. TABLE lO. NUMBER AND PERCENTAGE DISTRIBUTION OF PERSONS RECEIVING 
MEDICAL CARE (3 DRW FUNDS), BY ASSISTANCE PROGRAM, SEX AND AGE 
October i, 1942 - March 31, 1943 
Sex and age 
persons Receiving Medical Care 
All Programs 
OAA 
ADC 
ANB 
GA 
N A 
Both Sexes 
2,538 
1,167 
833 
51 
402 
85 
UNDER 6 
61 
4 
36 
0 
17 
4 
6 - i7 
440 
36 
310 
4 
47 
43 
18-49 
644 
67 
373 
19 
156 
29 
VJ1 
0 
1 
322 
64 
99 
|2 
140 
7 
65 AND OVER 
1,056 
990 
12 
.6 
36 
2 
AGE UNKNOWN 
15 
6 
3 
0 
6 
c 
Male 
1,226 
582 
37i 
24 
210 
39 
UNDER 6 
35 
3 
20 
0 
9 
3 
6 - I? 
199 
.6 
148 
2 
16 
'7 
18-49 
249 
24 
130 
5 
76 
14 
50 - 64 
162 
8 
6l 
8 
81 
4 
65 AND OVER 
579 
53 \ 
1 1 
9 
27 
1 
AGE UNKNOWN 
2 
c 
1 
c 
' 
0 
Female 
I,3i2 
585 
462 
27 
192 
46 
Under 6 
26 
1 
16 
0 
8 
1 
6 - 17 
241 
20 
l62 
2 
3' 
26 
18-49 
395 
43 
243 
14 
80 
i5 
50-64 
160 
56 
38 
4 
59 
3 
65 AND OVER 
477 
459 
1 
7 
9 
1 
AGE UNKNOWN 
13 
6 
2 
0 
5 
0 
percentage distribution 
BOTH sexes . . 
100.0 
100.0 
100.0 
100.0 
100.0 
100.0 
Under 6 
2.4 
0.3 
4.3 
0 
4,2 
4.7 
6 - 17 
t7.3 
3.« 
37.2 
7.8 
m.7 
50.6 
18-49 
25.4 
5.7 
44,8 
37.3 
38.8 
34.1 
>vjn 
0 
1 
• 
• 
• 
• 
• 
• 
• 
12.7 
5.5 
M.9 
23.5 
34.8 
8.2 
65 AND OVER 
41 .6 
84.9 
1.4 
31 .4 
9.0 
2.4 
AGE UNKNOWN 
0.6 
0.5 
0.4 
0 
!.5 
0 
Male 
48.3 
49.9 
44.5 
47.1 
52.2 
45.9 
Under 6 
1.4 
0.3 
2.4 
0 
2.2 
3.5 
6 - 17 
7.8 
1 .4 
l7.8 
3.8 
4.0 
20.0 
18-49 
9.8 
2.1 
15.6 
9.8 
18.9 
16.5 
50-64 
6*4 
0.7 
7.3 
*5-7 
20.2 
4.7 
65 AND OVER 
22.8 
45.4 
1.3 
17.8 
6.7 
1.2 
AGE UNKNOWN 
0.1 
0 
0. l 
0 
0.2 
0 
Female 
51.7 
50. I 
55.5 
52.9 
47.8 
54.1 
Under 6 
1,0 
0.1 
1-9 
0 
2.0 
1.2 
6- l7 
9.5 
1.7 
19.4 
3.9 
7*7 
30.6 
18-49 t , , , 
15.6 
3.7 
29.3 
27.5 
19.9 
l7.6 
50 - 64 f , t , 
/r 
6.3 
4.8 
4.6 
7.8 
14.7 
3.5 
05 AND OVER 
18.8 
39.3 
0.1 
13.7 
2.2 
1.2 
Age unknown 
— L 
o.5 
0.5 
0.2 
0 
1.3 
0 TABLE M . ESTIMATED PERCENTAGE OF PERSONS IN PUBLIC ASSISTANCE FAMILIES WHO 
RECEIVED MEDICAL CARE (3 DPW FUNDS) OCTOBER I, 1942 - MARCH 3l, 1943, 
BY ASSISTANCE PROGRAM, AGE, AND SEX 
Sex and age 
all Programs 
OAA 
ADC 
ANB 
GA a/ 
both Sexes 
% 
Total 
1 0.8 
13.5 
8.0 
8.6 
.2.7 
Under 6 
2.4 
7.7 
2.0 
y 
3.7 
6 - 17 
5.7 
3.0 
5.9 
3.0 
7.7 
18-49 
13.4 
8.2 
14.0 
12.9 
15.8 
vn 
0 
1 
£ 
• 
• 
• 
• 
• 
• 
13.3 
7.3 
15.5 
6.7 
20.5 
65 AND OVER 
I 7.6 
17.4 
y 
15.0 
19.8 
Male 
Total 
12.5 
15.9 
8.7 
7.3 
15.9 
Under 6 
2.9 
b/ 
2.3 
y 
4.1 
6- .7 
5.1 
3.3 
5.5 
2.7 
5.1 
18-49 
25.8 
18.5 
29.5 
5.6 
29.7 
50-64 
29.5 
y 
29.2 
8.9 
4l . 1 
65 and over 
18.3 
18.0 
y 
12.2 
29.2 
FEMALE 
Total 
9.6 
ii-7 
7.5 
10.3 
10.5 
Under 6 
2.0 
y 
1.7 
y 
3.3 
6-i7 
6.2 
2.9 
6.3 
3.5 
I 1.0 
18-49 
10.3 
6.2 
11.0 
24.6 
1 1 . I 
50 - 64 * 
8,6 
6.7 
8.9 
4.4 
12.2 
65 AND OVER 
16.7 
16.9 
y 
y 
10.4 
a/ Non-assistance included with GA, since data on age and sex distribution are not 
SEPARATELY 
available for GA and NA programs. 
B/ Less thaw O.05 per cent. Among the females, considering all assistance categories together, 
the proportion of the eligible population receiving medical care increases 
for successive age groups up to age 50, then drops in the group 50-64 years 
of age, and rises again for those 65 and over. Among the males the 
increase continues through the 50-64 age group. These patterns are shown 
graphically in Chart 1. 
CHART 1. ESTIMATED PERCENTAGE OF PERSONS IN PUBLIC ASSISTANCE 
FAMILIES TOO RECEIVED MEDICAL CARE, OCTOBER 1, 1942 TO 
MARCH 51, 1943, BY SEX AND AGE GROUPS, ALL ASSIS- 
TANCE CATEGORIES 
(Based on data of Table 11) 
Differences between males and females in percentage of persons 
treated are relatively slight for persons under 18 and for persons 65 and 
over. In the employable years 18-64, however, the percentage of males 
treated is roughly 3 times as great as for females. This undoubtedly 
results from the fact that males of this age do not ordinarily appear in 
the case load, unless there is some physical or mental handicap. This 
would also indicate that some emphasis is being placed on economic reha- 
bilitation of families receiving assistance. Expenditures for Medical Care 
A state total of $84,749.18 was expended through the three DF.¥ funds 
studied to provide care for 1,957 public assistance families during the six 
months of the survey period. Table 12 presents a distribution of medical 
care payments according to category and method of payment. 
TABLE 12. EXPENDITURES FOR MEDICAL CARE FROM THREE DFV FUNDS, 
BY ASSISTANCE PROGRAM AND SOURCE OF FUNDS 
October 1, 1942 - March 31, 1943 
Here again the proportion of funds included in assistance payment for OAA 
cases (69,3 per cent) is in contrast to that for the ADC group, where medical 
care project funds again predominated. 
Expenditures for males were slightly higher than for females (see Table 13), 
Males in the age group 65 and over received more than $21,000 in medical care, 
or approximately one-fourth of the total expenditure. 
The per person expenditures for 'persons receiving medical care are shown 
in Table 14, The figure of $33,39 per person receiving medical care re- 
presents average expenditure for care given during a six-months’ period for all 
programs, all ages and both sexes. For the separate programs the range is 
from $28,37 for persons in ADC families to $65.63 for the ANB group - an 
exceptionally high figure, due largely to the five males between 18 and 49 
years of age who received average expenditures above $200 each. The persons 
treated in GA families apparently required large or complicated forms of 
care, the average expenditure being $40.54, about 25 per cent above the 
general mean. 
The largest average expenditure for both sexes occurs in the age group, 
18-1;9* Average expenditures tend to increase rapidly in each age group up to 
18-[i9, and to decrease slightly after this age group. There are some 
variations from these patterns in individual categories, but this may result 
from the small number of cases involved in some of the sex and age groups. 
In general, there tends to be below average expenditures for persons under 
18 and above average expenditures for persons 18 and over. TABLE 13 . AMOUNT AND PERCENTAGE DfSTRI BUT I ON OF MEDICAL CARE EXPENDITURES 
(3 OPW FUNDS), BY ASSISTANCE PROGRAM, SEX AND AGE 
October i, 1942 - March 31, 1943 
SEX AND AGE 
Expenditures 
FOR MEDICAL 
Care 
all Programs 
UAA 
ADC 
ANB 
GA 
NA 
BOTH SEXES 
$ 84,749.18 
$ 38,767.80 
$ 23,628.80 
$ 3,347.22 
$ 16,296.46 
$ 2,708.90 
Under 6 
701.27 
9.291.17 
26,633.96 
11.894.17 
35,794.39 
434.22 
44,183.01 
51.50 
699.17 
2,531.43 
2,334.99 
32,853.36 
297.35 
20,766.46 
482.50 
6,111.01 
0 
149.87 
1,521.54 
7.887.33 
4.540.33 
2,082.52 
114.87 
9,293.10 
l7-40 
879.45 
i,335.85 
459.20 
17.00 
0 
6 — 17 
80.00 
18-49 
3,78i.66 
• i75.75 
22.00 
1,823.47 
777-99 
665.76 
0 
*50 — 64 
6f> and over 
Age unknown 
Male 
10,549.88 
2,103,92 
1,469.65 
Under 6 
42l.28 
2i.50 
407.79 
1,055.18 
361.00 
18,920.99 
0 
271.64 
2,682.61 
4,772.14 
2,676.74 
145.75 
1.00 
n 
120.74 
829.07 
4,122.05 
2,575.72 
1,643.02 
2.50 
7,003.36 
7.40 
479.80 
720.95 
256.50 
5.00 
0 
6 - \1 
4,429.27 
m,789.25 
6,509.95 
21,029.76 
3.50 
40,566.17 
30.00 
1,118.93 
639.99 
3i5.00 
0 
18-49 
50-64 
65 AND OVER 
AGE UNKNOWN 
Female 
18,001.34 
13,078.92 
1,243.30 
I 
1,239.25 
Under 6 
279.99 
4,86i .90 
14,844.7) 
5,384.22 
14,764.63 
430.72 
30.00 
291.38 
1,476.25 
1,973.99 
13,932.37 
297.35 
210 .e6 
3,428.40 
0 
29.13 
692.47 
3,765.28 
1,964.61 
439.50 
112.37 
10.00 
399.65 
614.90 
202.70 
12.00 
0 
6 - »7 
50.00 
704.54 
138.00 
350.76 
c 
18 - 49 
8,283.74 
1,104.92 
30.00 
21.00 
*50 — 64 
65 AND OVER 
AGE UNKNOWN 
Percentage distribution 
Both sexes 
iOO.O 
100.0 
100.0 
100.0 
100.0 
100.0 
Under 6 
0.8 
0.1 
2.0 
0 
0.9 
9.3 
48,4 
0.6 
6 - 17 
1 T . 0 
i» 8 
6.5 
6. D 
25.9 
55.3 
16, n 
2.4 
54.5 
23.2 
19.9 
0 
32.5 
49.3 
17.0 
0.6 
18-49 
31.4 
14,0 
50 — 64 
27.9 
i2.e 
0.7 
57.Q 
65 AND OVER 
42.3 
84.8 
0.7 
0.1 
AGE UNKNOWN 
0.5 
52.1 
0.8 
0 
Male 
53.6 
44,6 
62.9 
54.3 
Under 6 
0.5 
5.2 
13.9 
7.7 
24.8 
0. 1 
1 . 1 
1 • 1 
0 
0.7 
5.1 
0.3 
.7.7 
26.6 
6 - i7 
11,4 
0.9 
33.5 
19.1 
9.4 
0 
18-49 
2.7 
0.9 
48.8 
20.2 
H.3 
0.6 
25.3 
15.8 
1 0.1 
50-64 
9.5 
0.2 
65 and over 
Age unknown 
0.0 
_ 47.9 
0 
0.0 
0.0 
0 
Female 
46.4 
55.4 
37.i 
43.0 
45.7 
Under 6 
0.4 
0.1 
0.8 
3.8 
5.1 
35.8 
0,8 
0.9 
14.5 
35.1 
4.7 
0.1 
0 
i.5 
21,0 
4 * 1 
0.2 
4.2 
23.1 
l2.| 
2.7 
0.7 
0,4 
6 - l7 
18-49 
5.7 
17.5 
6*4 
14.8 
22.6 
7.5 
0.4 
50 — 64 
65 AND OVER . , 
17.4 
0.5 
10,5 
0 
Age unknown 
0.1 
0 Average expenditures for males are higher than for females in each age 
group (see Table ll+). The differences are relatively smaller for younger 
persons than for the middle and higher ages. The explanation of the 
difference in average, charges apparently lies in the relative severity of 
illnesses treated for the two sexes. 
TABLE Ik. AVERAGE EXPENDITURE PER PERSON RECEIVING MEDICAL CARE 
(3 DPW FUNDS), BY ASSISTANCE PROGRAM, SEX AND AGE a/ 
October 1, 19i+2 - March 31 j — 
Sex and Age 
Average Expenditure 
All Programs 
OAA 
ADC 
ANB 
GA 
NA 
Total .... 
$ 33.39 
5 33.22 
1 28.37 
$ 65.63 
$ 1*0.51* 
5 31-87 
Unde r 6 ........ 
11.50 
12.88 
15.1*0 
0 
• 8.82 
1+.35 
6 - 17 
21.12 
19.1*2 
19.71 
20.00 
32.37 
20.1*5 
18 - 1*9 
I4.I.36 
37.78 
35.00 
95.97 
50.56 
I16.06 
50 - 6I| 
36.91* 
56.U8 
38.20 
64-83 
32.1+5 
65.60 
65 and over .... 
33.90 
33.19 
11*. 65 
111. 61 
57.85 
8.50 
Age unknown .... 
28.95 
U9.56 
7.33 
0 
19.11+ 
0 
Male 
id. Qk 
35.63 
26.kk 
87.66 
■ i*i*.25 
57.68 
Under 6 
12.Oil 
7.17 
13.58 
c 
13.1+2 
2.1+7 
6 - 1? 
22.26 
25.1*9 
18.13 
15.00 
51.82 
28.22 
18 - 1*9 
1*7.35 
1*3.97 
36.71 
223.79 
51*. 2l* 
51.50 
50 - 6U 
kO'lQ 
1+5.12 
1+3.88 
80.00 
31.60 
64-12 
65 and over .... 
36.32 ’ 
35.63 
13.25 
35.00 
60.85 
5.00 
Age unknown .... 
1.75 
0 
1.00 
, 0 
2.50 
0 
Female 
30.92 
30.77 
28.31 
l|6.05 
.36. I|8 
26.91* 
Under 6 
10.77 
30.00 
13.18 
0 
3.6I| 
10.00 
6-17 
20.17 
11+.57 
21.16 
25.00 
22.31* 
15.37 
18 - 1*9 
37.58 
51*. 33 
31*.09 
50.32 
1*7.07 
1+0.99 
50 - 6k 
33-65 
35.25 
29.08 
31*.50 
33.30 
67.57 
65 and over .... 
30.95 
30.35 
30.00 
50.11 
1*8.83 
12.00 
Age unknown .... 
33.13 
i+9.56 
10.50 
0 
22.1*7 
0 
a/ Based on data 
of Tables 10 and 13. 
The average expenditure per person treated (Table ll+) is a useful figure 
in judging adequacy and economy of a medical care program. More important, 
however, as a basis for estimating future need and allocating medical funds is 
the amount expended per person eligible for care. In the literature of 
medical care this figure is commonly referred to as the amount spent per head. or per capita, of the eligible population - i.e., all persons in public 
assistance families. Table 15 presents such per capita expenditures for New 
Mexico, covering the six months of the survey period only. 
TABLE 13- EXPENDITURES FOR MEDICAL CARE PER PERSON ELIGIBLE FOR CARS 
(PER CAPITA) BASED ON TOTAL MEDICAL EXPENDITURES FOR SIX MONTHS 
(OCTOBER 1, 19U2 TO MARCH 31. I9h3) AND ON ESTIMATED AGE AND 
SEX DISTRIBUTION OF ALL PERSONS IN PUBLIC ASSISTANCE, FAMILIES 
Sex and Age 
All 
OAA 
ADC 
ANB 
Ga a/ 
Both Sexes 
& 3.60 
5 1+.1+8 
$ 2.26 
t 5.67 
S 1+.95 
Under 6 
.28 
.99 
.26 
b/ 
.30 
6 - 17 .. 
1.00 
.59 
1.16 
.61 
2.05 
16 - 1+9 
5.53 
3.08 
1+.91 
12.1*0 
7.88 
50 - 61+ 
1+.92 
£.65 
5.93 
1+.52 
6.97 
63 and over 
5.95 
5.78 
b/ 
6.22 
10.91+ 
XIcl X G 
1+.50 
5.66 
2.1+7 . .. 
6, lil 
Under 6 
•35 
i/H 
.31 
b/ 
.U* 
6 - 17 
1.13 
.81+ 
•99 
.1*0 
2.01 
18 - IiQ 
12.2l\. 
8.12 
10.85 
12.M 
15.98 
50 - 61* 
11.86 
b/ 
12.81 
7.11 
13.68 
65 and over 
6.66 
6.1*0 
V 
1*.26 
17.17 
Female ......... 
2.96 
3.61 
2.11 
1+.71+ 
3.62 
Under 6 
.22 
b/ 
.22 
b/ 
• Hi 
6 - 17 
1.26 
.1*2 
1.53 
.88 
2.11 
18 - 1+9 
3.87 
2.13 
3.73 
12.36 
5.05 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
• 
♦ 
• 
« 
O 
LT\ 
2.88 
2.35 
2.58 
b/ 
1+.25 
65 and over 
5.18 
5.H 
b/ 
b/ 
1+.70 
a/ Non-assistance included with GA, since estimates on age and sex 
distri- 
bution not separately available for GA and NA programs. 
b/ Not computed because base less 
than 50. 
The per capita expenditure during the six months period for both sexes 
and all categories was ft3*60 (see Table 15). The range among categories was 
from ft5.67 for Aid to Needy Blind to ft2.26 for Aid to Dependent Children. 
The relatively high per capita expenditures under the GA program are ex- 
plained by the nature of the case load which is so largely composed of persons 
with illnesses or physical disabilities,The relatively low expenditures under 
the ADC program are explained by the high proportion of children in the case 
load for whom average expenditures are low. 
Per capita expenditures for males are considerably higher than for 
females. Among children there is no significant difference between males and females. Among adults, however, between the ages of lo and 6I4., expenditures 
for males are significantly higher than for females. For adults 65 and 
over there is a lesser difference, although per capita expenditures for 
males are higher. Among the general population of the U. S. there are no 
consistent differences in medical expenditures of males and females; in 
adult groups, however, expenditures for women are substantially higher than 
for men. l/ The high expenditures for men in the public assistance case 
load are probably accounted for by the selective nature of the case load 
which tends to draw men with physical handicaps and by efforts at reha- 
bilitation of families in need because of physical disability of the male 
breadwinner. That these are factors is evident since per capita expend- 
itures for males are significantly higher than for females only for the 
wage-earning years, 18-6L;.. 
Data on average expenditure per person eligible for care (Table 15) 
are incomplete in the sense that they include only expenditures from the 
three sources under study. The additional amount from other sources is 
unknown and cannot be accurately estimated, A considerable portion of this 
additional medical care was undoubtedly received in the form of clinic 
visits and office or home visits by physicians, average charges for which 
are generally low. Furthermore, the number receiving care from other 
sources was fewer than those receiving care from the three DPW sources under 
study (see Table 6). It seems probable, therefore, that the monetary value 
of such services was much less than that supplied from the three DPW 
sources under study. Assuming, however, for purposes of comparison that 
the average value per case of other care received was equal to that paid 
for by the DPW, and adjusting the six-month expenditures for an annual 
period, we can estimate the average value of medical care received by 
public assistance recipients at less than $13 per person annually. 
A study made by the committee on costs of medical care (1928-1931) 
produced the following estimates of average annual expenditure per person 
for medical care for persons in towns of less than 5*000 and rural areas: 2/ 
Average 
Income Group 
Per Person 
I/s .0. q "hVifir) !$] } POO f . ........ 
$ Q.5i. 
$1,200 - 1 ',999 
13.90 
2,000 - 2,999 
3,000 - 1*,999 
5,000 - 9,999 
1*2. oU 
It appears that expenditures in the public assistance case load may 
not be materially less than for the lower income groups of the country as 
a whole, but that they'are considerably below those for the middle and 
higher income groups who are able to purchase needed medical care. Since 
studies show that medical needs of low income families are higher than for 
the general population ,it can safely be said that average expenditures per 
person were below a desirable minimum. . . 
Method of Payment 
One of the problems arising in administration of a public assistance 
medical care program concerns method of payment for services rendered. 
l/ Hollingsworth, Helen, and Klem, Margaret C., op. cit.'* p. 18. 
1?/ Hollingsworth, Helen, and Klem, Margaret C,, op. cit., p. ?U* Two methods were in use at the time of the study: 1) through the assistance 
grant (cash payment from OAA, ADC or ANB fund), and 2) through general assis- 
tance or medical care project funds, with payment directly to the vendor. In 
the first of these methods the Federal Government matches .State funds to cover 
medical and other needs, within maximum limits for individual payments, subject 
to the provision that the client cannot be conditioned in the expenditure of 
his assistance payment. Though the budget is planned to cover specific items, 
there is no check on the client's actual use of the money. From the viewpoint 
of the medical practitioner the method of payment through the assistance grant 
is relatively less satisfactory, since amounts budgeted or ’’allowed" for 
medical items do not always reach the doctor, dentist, druggist, etc., when 
services have been rendered to the client and obligations incurred. Physicians 
sometimes lower their scale of fees when direct payment is assured, in recogni- 
tion of the lessened financial risk involved. 
From the viewpoint of the agency, provision of care through the assis- 
tance payment is unsatisfactory because it produces poor relations with 
physicians. They often expect the Department to assume responsibility for 
payment if the patient is a DRW client, but the Department, under the law, is 
not permitted to do this. Furthermore, the Department is relatively limited 
in any attempt to improve standards of medical service, and the administration 
of the program becomes relatively more complex, since two different methods of 
payment are in use. 
In tabulating the data of the present study this problem was considered. 
Both GA and MCP expenditures are "direct payment," in contrast with the method 
of payment through the assistance grant. Table 16 gives the relative expend- 
itures by the two methods, and the corresponding percentage distribution of 
persons receiving care. 
TABLE 16. PERCENTAGE DISTRIBUTION OF EXPENDITURES FOR MEDICAL CARE 
(3 DRW FUNDS) AND OF PERSONS RECEIVING CARE, BY CATEGORY AND 
METHOD OF PAYMENT 
Method of Payment 
Total 
0AA 
ADC 
ANB 
GA 
NA 
Expenditures 
Total ........... 
100.0 
100.0 
100.0 
100.0 
100.0 
100.0 
In Grant 
39.8 
<$.3 
22.7 
I4JU.6 
- 
- 
Direct Payment a/ 
60.2 
30.7 
77.3 
55-it 
100.0 
100.0 
Persons 
Total 
100.0 
100.0 
100.0 
100.0 
100.0 
100.0 
In Grant 
37.8 
6I4.. U 
21.5 
60.8 
- 
- 
Direct Payment a/ ... 4.. 
55.7 
27.0 
71.7 
27.4 
100.0 
100.0 
Both 
6,5 
8.6 
6.8 
11.8 
- 
- 
a/ Direct payments by the DPW to 
medical practitioners, etc. From the data of Table 16, it is evident that in Old Age Assistance 
cases the main dependence has been on medical payments through grant only, 
while among those families receiving Aid to Dependent Children over three- 
fourths of the total amount was spent by direct payment. 
One explanation of the tendency to use direct payment more often in 
ADC cases than in the OAA group is the fact that maximum grants (for 
Federal matching) are lower for the former category (ADC), and agency 
policy does not permit "overgrants” for medical care. Instead, GA or MCP 
funds have been utilized, when available, to meet medical needs, 
supplementing the assistance grant. It is also true that persons in ADC 
families are on the whole younger and likely to have illnesses or disabling 
conditions which can be completely cured or greatly improved by adequate 
treatment, which is often not possible within the limitations of the assis- 
tance grant. In such cases this may mean the rehabilitation of the family, 
through improved health of the chief wage earner. Persons in OAA oases, on 
the other hand, are older and more often suffer from chronic conditions 
which can be alleviated but seldom cured. 
An evaluation of the relative merits of the two methods of payments is 
not possible with the tabulations presented in this survey. Table 17, 
however, permits comparison of the outcome of treatment for the two methods 
of payment. Where payment was made through the assistance payment only, 
12.9 per cent of persons treated were cured or received maximum benefits; 
where direct payments to vendors were made, per cent were cured or 
received maximum benefit. This large variation, no doubt, results primarily 
from the fact that direct payment was the major method of payment for ADC 
cases and the only method for GA. In these categories the patients were 
younger and the prognosis better, whereas the assistance payment was the 
primary method of payment in the OAA category where chronic conditions 
connected with advanced age are more prevalent. 
TABLE 17. PERCENTAGE DISTRIBUTION OF PERSONS RECEIVING MEDICAL 
CARE, a/ BY STATUS OF TREATMENT AND METHOD OF PAYMENT 
All 
Assistance 
Direct 
Both 
Status of Treatment 
Methods 
Payment 
Payment 
Methods 
Only 
Only 
Xoi3Q.X •••••••••«••#•• 
Treatment not begun 
100.0 
100.0 
100.0 
100.0 
5.0 
3.0 
7.0 
1.9 
Now under treatment 
1*2.5 
70.0 
20.5 
55.2 
Treatment suspended or discon- 
3.9 
l+.i 
3.6 
5.0 
tinned 
Treatment completed .. ., * 
1+7.2 
22.U 
66.8 
37.9 
Patient cured or maximum 
benefit received * 
31.1+ 
12.9 
U6.U 
21.6 
Condit ion improved .,.*....* 
11.7 
6.5 
15.1+ 
12. k 
Other .. ..t- * 
U-l 
3.0 
5.0 
3-9 
Unknown * 
i-h 
0.5 
2.1 
0 
a/ Persons in cases open March 31 > who had received medical examination 
— or treatment in the preceding 6 months. The hypothesis that patients receive better and more adequate care when 
direct payment is made can only be tested by controlling for age, sex, type of 
disability and other factors. Unfortunately the number of cases in any one 
group, when necessary factors were controlled, was so small as to permit 
statistical analysis of variations only in 3 groups - females, 6-17* with 
defective vision, and males and females, 6-17, with defective tonsils. As 
would be expected for these disabilities, there was no statistically signifi- 
cant difference in the outcome of treatment under the two methods of payment, 
since favorable outcome occurred in practically every case. 
Object of Expenditure 
The total medical expenditures are broken down in Table 18 according to 
the object of expenditure - i.e., physicians’ services, hospital care, drugs, 
special diet, etc. Table 20 shows the corresponding number of persons 
receiving each type of care. This is unavoidably a multiple count, since one 
person may have received hospital and dental care, home nursing, housekeeping 
service, etc., or any similar combination of more than 20 items listed. For 
comparative purposes, two averages are presented: the average payment per 
person treated (Table 21), and the per capita expenditure per person in the 
eligible population (Table 22). 
The major medical expenditures were for physicians' services, hospi- 
talization, drugs and dentist fees, listed in their order of importance. 
This roughly corresponds with the experience of the general population. 
There is considerable variation in the distribution of expenditures 
between payments included in the assistance grant and direct payments. Items 
with high unit costs such as hospital care tend to be handled by direct pay- 
ment to the vendor. Items of low cost required over a long period such as 
drugs tend to be included in the assistance grant. In view of restrictions 
which prevent inclusion of large items in the assistance payment, it would be 
almost impossible to operate a well-balanced medical care program using this 
method of payment only. 
Table 20 indicates that under the present system of free choice of 
physicians, a relatively small part of funds expended goes to non-medical 
practitioners. The extent to which specialists were used in providing treat- 
ment is not known. 
The most costly items of expenditure in terms of average per patient are 
for care of patients outside of hospitals including convalescent care, board 
and care, nursing care and housekeeping service, the range being from $121.90 
for convalescent care to $I|.0.37 for housekeeping service. These figures 
represent average costs during a six-month period. The average cost of hospi- 
tal care was $14.1,83* Dental services ran fairly high at $31*52 per patient 
treated. This high average probably resulted from the fact that only the 
more serious conditions were treated and that the cost of dentures was included. 
Physicians’ services averaged $16.92. Average charge per patient treated for 
medical doctors and doctors of osteopathy was close to this figure. The 
average charge by doctors of chiropracty was almost twice as much ($30*20), 
However, since only 15 patients were treated by. chiropractors, this average 
may not be reliable. TA3LE IS. EXPENDITURES FOR E 1 CAL CARE (3 OP17 FUNDS), 
CY OBJECT OF EXPENDITURE AND ETISOD OF PAYMENT 
OCTOBER I, 1942 - MARCH 3l, 1943 
Object or Expenditure 
Expenditures by method of payment 
Total 
Assistance 
Grant 
Direct 
payment 
Total 
$84,749.18 
$33,698.32 
551,050.06 
PHYSICIANS* SERVICES 
25,895.06 
£,222,53 
17,672.53 
MEDICAL DOCTOR 
22,964.49 
7,073.42 
15,491.07 
DOCTOR OF OSTEOPATHY * 
2,809.57 
032.61 
1,976.36 
DOCTOR OF CH1ROPRACTY 
453.00 
285.00 
168.00 
OTHER 
62,00 
31.50 
30.50 
Type unknown 
6,00 
- 
6.00 
HOSPITAL CARE 
14,430.33 
1,901.63 
12,528.70 
PHYSICIANS* SERVICES AND HOSPITALIZATION t! , ,, 
4,798.09 
996.05 
3,802.04 
DRUGS 
13,396.92 
1 1,5l0,54 
1,886,38 
DENTIST SERVICES (INCLUDING DENTURES) 
8,730.51 
905.50 
7,325.01 
NURSING SERVICES 
2,480.89 
i,798.79 
688,10 
REGISTERED 
129.20 
95.20 
34,00 
PRACTICAL 
2,357.69 
1,703.59 
654.10 
MIDWIFE SERVICES 
63.00 
“ 
63.OO 
Refraction and glasses (to physicians) 
2,472.05 
313.25 
2,158,80 
Eyeglasses (not to physicians) 
567.70 
162.55 
405.15 
Appliances (other than dentures and glasses) . 
1,314.97 
98.35 
I,210,62 
X-rays 
80,00 
36.00 
44,00 
Convalescent care 
1,828.50 
965.00 
863.50 
Board and care 
3,047.90 
2,151,00 
890,90 
HOUSEKEEPING SERVICE 
1,493.60 
1,116,50 
377.10 
FOSTER CARE (OF CHILDREN) 
237,00 
151.50 
85.50 
Speci al diet , 
872.64 
680,81 
191.83 
Transportation 
705.53 
382.39 
323.14 
MISCELLANEOUS 
67. 06 
46,50 
20.56 
Division of funds unknown 
2,26l.43 
2,259.43 
2.00 
a/ hospitals operated 3Y physician - division of 
FUNDS UNKNOWN, TABLE 19. PERCENTAGE DISTRIBUTION OF EXPENDITURES FOR LED 1 CAL CARE 
(3 DRW FUNDS), BY OBJECT OF EXPENDITURE AND METHOD OF PAYMENT 
OCTOBER I, !942 - MARCH 3l, 1943 
Object of Expenditure 
METHOD OF PAYMENT 
Total 
ASS I STANCE 
Grant 
DIRECT 
P AY.MEN T 
Total 
100.0 
100,0 
100.0 
PHYSIC! ANS 1 SERVICES 
30.6 
24.4 
34.6 
medical doctor 
26,6 
2l,0 
30.3 
Doctor of osteopathy 
3.3 
2.5 
3.9 
DOCTOR OF CHIROPRACTY 
o,6 
0.8 
0.3 
OTHER 
0.1 
0. 1 
0, 1 
Type unknown 
- 
- 
HOSPITAL CARE 
17.o 
5.6 
24,6 
PHYSICIANS* SERVICES AND HOSPITALIZATION -/, 
5.7 
3.o 
7.4 
DRUGS . 
15.8 
34.2 
3.7 
DENTIST SERVICES (INCLUDING DENTURES) 
io,3 
2.7 
i5.3 
NURSING SERVICES 
2.9 
5.4 
1.4 
REGISTERED 
0.2 
o.3 
0.1 
PRACTICAL , 
2.7 
5.i 
1.3 
MIDWIFE SERVICES * 
0.1 
- 
0.1 
Refraction and glasses (to physicians) 
2.9 
0.9 
4.2 
Eyeglasses (not to physicians) 
0.7 
o.5 
0.3 
Appliances (other than glasses) 
1.5 
o.3 
2.4 
X-rays 
0.1 
o.i 
0.1 
Convalescent care , 
2.1 
2.9 
1.7 
Board and care ,,, ; 
3.6 
6,4 
1.8 
HOUSEKEEPING SERVICE 
1.8 
3.3 
o.7 
Foster care (of children) 
o.3 ' 
0,4 
0.2 
Speci al DIET ...... , 
1.0 
2,0 
0.4 
Transportation , 
0.8 
1.1 
0,6 
M | SCELL ANEOUS 
0.1 
o,i 
__ 
Division of funds unknown 
2.7 
6.7 
- 
A/ HOSPITALS OPERATED BY PHYSICIAN - DIVISION OF FUNDS UNKNOWN, TABLE 20. PERSONS RECEIVING f/.EDI CAL CARE (3 DRW FUNDS), 
BY OBJECT OF EXPENDITURE AND METHOD OF PAYMENT 
OCTOBER I, 1942 - MARCH 3l, I943 
method of payment 
Object of Expenditure 
Total 
ASS1 STANCE 
Grant 
Direct 
Payment 
, all Expenditures 
2.538 V 
I,125 V 
i 
1,5/8 t! 
PHYSICIANS* SERVICES , . 
1,530 
-493 
1,037 
• MEDICAL DOCTOR ,* , 
. U328 
43l 
897 
DOCTOR OF OSTEOPATHY 
177 
53 
124 
• DOCTOR OF CHIROPRACTY 
15 
7 
8 
OTHER 
2 
6 
TYPE UNKNOWN 
2 
- 
2 
HOSPITAL CARE 
345 
47 
298 
PHYSICIANS* SERVICES AND HOSPITALIZATION ®/, 
57 
13 
44 
DRUGS 
930 
565 
365 
DENTIST SERVICES (INCLUDING DENTURES) 
277 
43 
234 
NURSING SERVICES 
49 
34 
15 
Registered 
6 
4 
2 
PRACTICAL 
43 
30 
13 
MIDWIFE SERVICES 
5 
- 
5 
Refraction and glasses (to physicians) 
• 1 173 
21 
152 
Eyeglasses (not to p.hys i ci ans), ,.. 
7o 
22 
48 
Appliances (other than dentures and glasses). 
37 
1 1 
26 
6 
I 
5 
Convalescent care 
i5 
7 
8 
Board and care 
*.■ - 3i 
15 
l6 
Housekeeping service 
37 
25 
12 
Foster care (of children) 
■..-6 ■ 
2 
4 
■ 
Special diet 
56 
42 
14 
Transportation *. 
82 
32 
50 
MISCELLANEOUS 
',■10 
4 
6 
Division of funds unknown * 
s. 
73 
1 
A/ unduplicated count of persons receiving medical care, 
b/ hospital operated by physician -division of funds unknown. TABLE 21, AVERAGE EXPENDITURE PER PERSON RECEIVING SPECIFIED TYPES OF MEDICAL 
CARE {3 DPW FUNDS), BY OBJECT OF EXPENDITURE AND METHOD OF PAYMENT 
October \, i942 - March 31, 1943 
Object of expenditure 
* , 
Method of Payment 
Total 
Assistance 
Grant 
DIRECT 
Payment 
All Expenditures 
> 33.39 . 
...i 29.95 
3 32.35 
Physicians* services ,.... 
16,92 
tj. 
... 16,68 
' 
I 7.04 
medical doctor 
i6.99 
• 16,41 
17.27 
Doctor of osteopathy 
15.87 
15.70 
15.94 
DOCTOR OF CH1ROPRACTY 
30,20 
40.7l 
21,00 
OTHER 
•1. 
15.75 
5.08 
Type unknown 
3.oo 
- 
4 
3.00 
HOSPITAL CARE 
41.83 
40.46 
42,04 
PHYSICIANS* SERVICES AND HOSPITALIZATION i/.... 
84.18 
76,62 
86. 41 
DRUGS 
14.40 
20.37 
5.i7 
Dentist services (including dentures) 
31.52 
21.06 
33.44 
NURSING CARE 
50.75 
52.90 
45.87 
Registered 
2i.53 
23.80 
17.00 
practical 
54.83 
56.79 
50.32 
MIDWIFE services 
ro 
a 
G\ 
O 
- 
12.60 
Refraction and glasses (to physicians) 
14.29 
14.92 
14.20 
Eyeglasses (not to physicians) 
8, I 1 
7.39 
8,44 
Appliances (other than dentures and glasses) ,, 
35.54 
8.94 
46.79 
X-rays 
- 13.33 
36,00 
. 
8,80 
Convalescent care 
121.90 
137.86 
* 
107.94 
Board and care 
98.32 
. .1.43,40 
56.06 
housekeeping service 
40.37 
44,66 
31 .42 
Foster care (of children) 
39.50 
75.75 
21.38 
Special diet 
15.58 • 
.16,21 
13.70 
Transportation 
8,o0 
n.95 
6.46 
miscellaneous 
• .6.71 
11,62 
3.43 
Division of funds unknown 
, i 
30.56 , 
30.95 
2.00 
A/ HOSPITAL OPERATED BY PHYSICIAN - DIVISION OF FUNDS UNKNOWN, TABLE 22. PER CAPITA EXPENDITURES FOR ME DI C A L C..RE (3 DP (I FUNDS), 
BY OBJECT OF EXPENDITURE ,.NO DIET HOD OF PAYMENT 
OCTOBER I, 1942 - MARCH 3l, 1943 
METHOD OF PAYMENT 
Object of Expenditure 
Total 
Assistance 
grant 
Direct 
Payment 
All Expenditures 
£3.60 
, 
•$1.43 
1 32.17 
PHYSICIANS* SERVICES 
l .10 
.35 
.75 
MEDICAL DOCTOR 
.96 
.30 
.66 
DOCTOR OF OSTEOPATHY 
.12 
.04 
.08 
DOCTOR OF CH|ROPRACTY 
.02 
.01 
.01 
OTHER 
£ 
£ 
b/ 
2/ 
Type unknown 
y 
i/ 
HOSPITAL CARE 
.61 
.08 
.53 
PHYSICIANS* SERVICES AND HOSPITALIZATION V. . , 
•20 
.04 
. 16 
DRUGS 
.57 
• 49 
.08 
Dentist services (including dentures) 
.37 
.04 
.33 
NURSING SERVICES 
. 11 
.07 
.04 
Registered 
b/ 
3/ 
2/ 
PRACTICAL 
. 11 
.07 
.04 
MIDWIFE SERVICES 
£/ 
l/ 
2/ 
Refraction and glasses (to physicians) 
.10 
,01 
.09 
Eyeglasses (not to physicians) 
.03 
.01 
.02 
Appliances (other than dentures and glasses) . 
.05 
B/ 
.05 
X-RAYS 
2/ 
b/ 
?/ 
CONVALESCENT CARE 
.08 
.04 
.04 
Bo ARD and CARE 
.13 
.09 
.04 
HOUSEKEEPING SERVICE 
.07 
.05 
.02 
FOSTER care (of children) 
.01 
.01 
b/ 
Special diet 
.04 
.03 
.01 
TRANSPORTATION 
.03 
.02 
.01 
MISCELLANEOUS 
1/ 
.10 
b/ 
b/ 
Division of funds unknown 
— 
... 
— 
a/ HOSPITAL OPERATED BY PHYSICIAN - DIVISION OF FUNDS UNKNOWN. 
b/ LESS THAN ONE-HALF CENT, Data on per capita expenditures for various objects of expenditure give 
one basis for appraising the adequacy of remuneration given physicians, 
dentists, hospitals, etc. Louis Reed and Dean Clark make the following 
suggestion: 
.....One basis of judging the fairness of remuneration 
afforded, say, to physicians is to inquire what would be the 
gross income of all the physicians in the community if, as a 
group, they derived the same per capita income from the 
general population as they derived from those on relief, l/ 
Upon application of this principle to remuneration paid medical practi- 
tioners in New Mexico; we find that the hypothetical annual average income 
per physician would be slightly under $I|.,000 annually, which may be less than 
the actual income of many practicing physicians but would not indicate that 
the average fees paid were inadequate. 
Volume and Cost of Hospitalization 
Data on hospital care were more adequately reported than on other types 
of medical services. Therefore, it is possible to present a more detailed 
analysis of this one type of service. Among 2,538 persons receiving medical 
care there were i;68 persons who received hospitalization from some source, 
either DRW funds or other funds. 2/ The percentage distribution of these per- 
sons according to type of care is~”shown in Table 23 below: 
TABLE 23. PERCENTAGE DISTRIBUTION OF PERSONS RECEIVING 
HOSPITAL CARE, BY ASSISTANCE PROGRAM AND TYRE OF 
SERVICE a/ 
~ 
Type of Care 
All 
Programs 
OAA 
ADC 
GA 
NA 
All Types .... 
100.0 
100.0 
100.0 
100.0 
100.0 
Major surgery 
27.9 
31.1 
2k-3 
35.0 
21.9 
Minor surgery ......... 
3U.6 
13.2 
1+7.6 
22.7 
58.6 
Non-surgical 
57.5 
55.7 
28.1 
1*2.3 
19.5 
a/ Based on data for persons receiving medical care from 3 DPW funds under 
study. ANB excluded because of small number of cases included in totals. 
However, percentages based on data excluding 9 cases for whom type of care 
was unknown. 
Non-surgical care predominates (37*5 per cent) although persons hospitalized 
were fairly evenly distributed between major surgery, minor surgery and non- 
surgical care. These data, however, indicate that quite different types of 
care predominated for the assistance programs - non-surgical for OAA and GA 
and minor surgery for ADC and NA, The predominance of minor surgery for these 
two categories results from a substantial number of tonsillectomies provided 
for children. In fact, many of the non-assistance cases during the survey 
period were opened specifically to provide tonsillectomies and other minor 
surgery for children in families otherwise self-supporting, "the medically 
needy, " 
Clark, Dean; and Reed, Louis; "Appraising Public Medical Services," in 
American Journal of Public Health, Vol. XXXL No, 5 (May, 19Ul)* 
2/ Note from Table 20 that 345 persons received hospital care from DPW funds. A study of the Medical Care Program of the Welfare Board of Freeborn 
Couriy, Minnesota (made under the auspices of the U. S. Public Health Service), 
found that approximately 25 per cent of admissions were non-surgical. 
Dean A. Clark, author of the study, makes the following comment: 
This accords with most surveys on hospitals located in 
predominantly rural communities. Nevertheless, it probably 
indicates that non-surgical cases were not admitted as 
frequently as would be professionally desirable. 1/ 
The relatively higher percentage of non-surgical admissions to New 
Mexico hospitals (37.5 per cent) suggests that more persons in public assis- 
tance families receive needed medical care at a relatively early stage of 
illness, where surgical intervention is not required. However, the 
concentration of these persons in the OAA and GA groups, where the incidence 
of chronic illnesses is relatively high, may indicate that lack of nursing 
care facilities for chronic cases would account for the high proportion of 
non-surgical cases. In this connection, note that for persons in ADC cases, 
28.1 per cent were given non-surgical care, which conforms closely to the 
Freeborn County experience for all categories combined. 
The average cost per patient for major surgery was $69.23 as compared 
with $13.15 for minor surgery and $46.55 for non-surgical patients (see 
Table 24). These figures represent obligations incurred for care received 
during the six months under study rather than average cost for each illness 
treated. 
The average cost per day of care was $3.20 for major surgery, $4.35 for 
minor surgery and $2.10 for non-surgical care. The relatively high cost for 
minor surgery results from medicines, laboratory fees, etc., included in the 
hospital bill. The effect of inclusion of those items in the hospital bill 
is to increase cost per day for fewer days’ treatment. 
TABLE 2k. HOSPITAL CARE: AVERAGE COST PER PATIENT, AVERAGE COST PER 
DAY AND AVERAGE DaYS PER PATIENT, BY ASSISTANCE PROGRAM AND TYPE OF 
SURGERY a/ 
Assistance 
.average Cost 
Per Patient 
Average Cost 
Per Day 
Average Days 
Per Patient 
Program 
Major 
Surgery 
Minor 
Surgery 
Non-Sun 
gical 
Major 
Surgery 
Minor 
Surgery 
Non-Sur- 
gical 
Major 
Surgery 
Minor 
Surgery 
Non-Sur- 
gical 
All Programs 
$69.23 
$13.15 
$46.55 
$3.20 
$4.35 
$2.10 
21.6 
3.0 
22.1 
Old Age iissis- 
tance ....... 
66.65 
21.46 
44.39 
2.88 
3.86 
1.84 
23.1 
5.5 
24.1 
Aid to Dep. 
Children .... 
57.16 
11.75 
30.30 
4.27 
5.70 
3.19 
13.4 
2.1 
9.5 
General Ass?t. 
94.85 
17,98 
67.00 
2.66 
3.03 
2.17 
35.5 
5.9 
30.9 
Non-assis tance 
72.76 
8.21 
32.36 
4.34 
4.11 
3.29 
16.7 
2.0 
9.8 
jy ANB excluded because of small number of cases; included in totals, however; 
averages based on 275 patients receiving care from DPW funds for whom 
complete information was available as to number of days in hospital and 
amount paid. 
jyClark, Dean, The Medical Care Program of the Welfare Board of Freeborn County, 
Minnesota, U. S. Public health Scrvice"7~p. 47~ Contrasting average cost per day irom this study with the average cost 
per day of the Freeborn County study, we note that the average for major 
surgery is 38 cents more and for minor surgery $1.55 more than in New Mexico, 
.average cost per day for all types of hospital care varies considerably 
among the assistance programs(see Table 24). For major surgery, the range 
is from $4.34 for NA cases to $2.66 for GA cases. The variation in average 
cost per day appears to result largely from variation in average days per 
patient. In general, it appears that the longer the stay, the less the cost 
per day, although this relationship is not absolute. For minor surgery the 
range is from $5,70 per day for ADC to $3.03 per day for GA, the average 
days per patient being 2,1 and 5.9, respectively. For non-surgical patients 
the range is from $3,29 for NA cases to $1.84 for OAn., the average days per 
patient being 9.8 and 24.1, respectively. VII. EXTENT TO MICH RECOMMENDED CARE WAS RECEIVED 
For each of the cases which received medical care from the 3 DRW funds 
the schedule showed the original recommendations for treatment made by the 
examining physician. Table 25, below, summarizes the extent to which 
recommendations were carried out. "All recommendations carried out" signi- 
fies that among one or more recommendations made by the examining physician 
all the types of recommendations were carried out. For example, if 
medication and X-rays were recommended and the client received both he would 
be classified under "all recommendations carried out" even though the number 
of X-ray treatments or the amount of medication did not meet desirable 
standards. If medication and X-rays were recommended and only medication 
was received the case was classified under "part, but not all recommen- 
dations carried out." In short, the scope of treatment, rather than the 
quantity or quality was considered. Care received included that from 
sources other than the 3 DPW funds. 
TABLE 25. PERSONS RECEIVING MEDICaL CARE (3 DPW FUNDS) BY EXTENT 
TO WHICH RECOMMENDED TREATMENT YvAS RECEIVED AND ASSIS- 
TANCE PROGRAM 
Persons 
Receiving Medical Care 
Item 
~xn— 
Programs 
OAA 
ADC 
ANB 
GA 
NA 
Total 
2,538 
1,167 
833 
51 
402 
85 
All recommendations carried 
out 
2,080 
977 
675 
47 
311 
70 
Part, but not all recom- 
mendations carried out 
304 
131 
105 
3 
55 
10 
No recommendation carried out 
70 
23 
23 
0 
20 
4 
No treatment recommended .... 
35 
18 
6 
1 
9 
1 
Unknown .. 
49 
18 
24 
0 
7 
0 
k Percentage Distribution 
Total ..,. 
100.0 
100.0 
100.0 
100.0 
100.0 
100.0 
a11 recommendations carried 
out 
81.9 
83.8 
81.0 
92.2 
77.4 
82.4 
Part, but not all recom- 
mendations carried out ..... 
12.0 
11.2 
12.6 
5.9 
13.7 
11.8 
No recommendation carried out 
2.8 
2.0 
2.8 
- 
5.0 
4.7 
No treatment recommended ..«. 
1.4 
1.5 
0.7 
1.9 
2.2 
1.1 
Unknown 
1.9 
1.5 
2.9 
- 
1.7 
- In all programs taken together, over 80 per cent of the persons examined 
or treated received the care recommended. An additional 12 per cent received 
the recommendations in part. Fewer than 3 per cent received none of the care 
recommended. This indicates a good record in carrying through recommendations 
Table 26 gives some indication of points which need strengthening in 
planning for the future. Lack of facilities near at hand and transportation 
difficulties explain some instances, such as failure to secure X-ray exam- 
inations or the advice of specialists. Where a recommended operation is not 
performed, the reason in most cases is "client or parent refuses." On the 
other hand failure to provide a special diet on physician's recommendation 
may indicate either lack of funds or underestimation of the importance of 
diet in the treatment plan. The highest percentages of recommendations not 
received are in ADC and GA families. 
What failure to provide recommended care may mean in extreme cases is 
seen in the following summary of a case record: 
Tomas S., age 1+6, the family head, was ill with jaundice and anemia. 
The physician recommended medication, blood count and periodic re- 
examination, and special diet. Only medication was provided, at a 
cost of $9»6l from GA funds, Mr. S. died of jaundice and anemia. 
This man should have started treatments a long time before he did. 
Lack of funds prevented this ... Mrs. S. is now ill and in need of 
treatment. 
In another county one of the home visitors added the following comment 
on the medical care survey schedule: 
Patient has been examined by several doctors 
Since payments for medical care would constitute an overgrant, no 
plans for treatment have been made. Two other members of this house- 
hold apparently need physical examinations. 
The patient referred to was diagnosed in 1936 and 1937 as "suffering 
from a very bad heart and kidney lesion ... and in a very critical condi- 
tion," In January 191+2, a third physician diagnosed his condition as 
"cardiac dropsy and asthma. Prognosis unfavorable. Special diet elimi- 
nating meats recommended." Later in 191+2 the same doctor recommended ex- 
traction of the patient’s teeth, "as they are infected badly," 
A similar situation is described by a home visitor in Bernalillo County: 
This family has been on relief for ten years, and has had medical 
problems of all kinds - three T.B., including family head; two 
pellagra; and one crippled child. Limited funds have made adequate 
diet impossible in a case where diet is most important for the 
diseases present. 
The extent to which different types of recommendations were carried out 
varied from 97•! per cent for medication to 28.6 per cent for psychiatric 
treatment (see Table 26), The majority, however, were more than 80 per cent. 
The following types of care were reported "not received" in a relatively 
high percentage of cases: 
Re c online ndat i ons 
Percentage of Times 
Not Received 
Psychiatric treatment . 
71.1+ 
X-ray for diagnosis .., 
37.2 
Special diet 
36.0 
X-ray for treatment ... 
26.? 
Physiotherapy 
26.7 RECOMMENDATION 
PERSONS RECEIVING 
Medical Care 
All Programs &/ 
OAA 
ADC 
GA 
Total b/ 
Recom- 
menda- 
tion 
Received 
Recommen- 
dation 
not 
RECEIVED 
TOTAL 8/ 
RECOM- 
MENDA- 
TION 
RECEIVED 
RECOMMEN- 
DATION 
NOT 
RECEIVED 
TOTAL B/ 
recom- 
menda- 
tion 
RECEIVED 
recommen- 
dation 
not 
RECEIVED 
TOTAL B/ 
recom- 
menda- 
tion 
received 
RECOMMEN- 
OATION 
NOT 
RECE1VED 
Medication 
1,402 
1,3^2 
32 
796 
783 
12 
334 
315 
13 
222 
2 14 
7 
OPERATION (DEFINITE) 
400 
350 
48 
75 
57 
18 
2 12 
194 
i7 
65 
59 
5 
HOSPITALIZATION 
357 
336 
14 
102 
98 
3 
134 
122 
8 
90 
85 
3 
Eyeglasses 
276 
265 
8 
115 
113 
2 
119 
1 12 
6 
29 
28 
0 
Special diet 
27? 
i7i 
98 
138 
87 
50 
81 
52 
28 
44 
25 
18 
Dental extractions .. 
21 1 
184 
25 
64 
54 
10 
102 
91 
9 
38 
32 
6 
X-RAYS (DIAGNOSIS)... 
148 
89 
55 
35 
19 
15 
66 
36 
28 
40 
29 
1 1 
DENTURES 
•39 
123 
16 
66 
63 
3 
46 
37 
9 
22 
1 8 
4 
Dental Treatment .... 
96 
80 
14 
'7 
10 
7 
57 
52 
3 
12 
8 
4 
OTHER APPLIANCES .... 
74 
65 
8 
37 
35 
1 
28 
23 
5 
8 
6 
2 
X-RAYS (TREATMENT)... 
30 
22 
8 
i7 
12 
5 
8 
6 
2 
3 
3 
0 
PHYSIOTHERAPY 
15 
11 
4 
7 
7 
0 
4 
2 
2 
4 
2 
2 
PSYCHIATRIC TREATMENT 
7 
2 
5 
2 
2 
0 
1 
0 
1 
3 
0 
3 
OTHER 
192 
316 
68 
159 
129 
28 
132 
105 
24 
76 
60 
|6 
PERCENTAGE DISTRIBUTION 
MEDICATION 
100.0 
97.1 
2.3 
100.0 
98.4 
t.5 
100.0 
94.3 
3- 9 
100.0 
96.4 
3.2 
OPERATION (DEFINITE) 
100.0 
87.5 
12.0 
100.0 
76.0 
24.0 
100.0 
91.5 
8.0 
100.0 
90.8 
7.7 
HOSPITALIZATION 
100.0 
94.1 
3*5 
100.0 
96.1 
2.9 
100.0 
91.0 
6.0 
100.0 
94.4 
30 
EYEGLASSES 
100.0 
96.0 
2.9 
100.0 
98.3 
1.7 
100.0 
94. 1 
5.0 
100.0 
96.6 
0 
Spec i ai diet 
100.0 
62.9 
36.0 
100.0 
63.0 
36.2 
100.0 
64.2 
34.6 
100.0 
56.8 
40.9 
DENTAL EXTRACTIONS .. 
100.0 
87.2 
1 1.8 
100.0 
84.4 
15.6 
100.0 
89.2 
8.8 
100.0 
84.2 
15.8 
X-RAYS (DIAGNOSIS)... 
100.0 
60. 1 
37.2 
100.0 
54.3 
42.9 
100.0 
54.5 
42.4 
ICO.O 
72.5 
27.5 
Dentures 
100.0 
88.5 
11.5 
ICO.O 
95.5 
4.5 
100.0 
80.4 
19.6 
100.0 
8 1.8 
18.2 
Dental Treatment .... 
100.0 
83-3 
14.6 
100.0 
58.8 
4 1.2 
100.0 
91.2 
5.3 
IOO.C 
66.7 
33.3 
other appliances .... 
ioo.n 
87.8 
10.8 
100.0 
94.6 
2.7 
IOO.C 
82. 1 
17.9 
IOO.C 
75.0 
25.0 
X-RAYS (treatment)... 
lon.o 
7 3.3 
26.7 
100.0 
70.6 
29.4 
IOO.C 
75.0 
25.0 
100.0 
ICO.O 
0 
PHYSIOTHERAPY 
100.0 
73.3 
26.7 
IOO.C 
100.0 
0 
IOO.C 
50.0 
50.0 
100.0 
50.0 
50.c 
PSYCHIATRIC TREATMENT 
100.n 
28.6 
71.4 
ICO.O 
100.0 
0 
100.0 
0 
ICO.O 
IOO.C 
0 
I0C.0 
Other 
I0C.0 
80.6 
17.3 
IPG.O 
8 1.1 
17.6 
ICO.O 
79.5 
18.2 
100.0 
78.9 
2 1.1 
A/ ANB AND NA,CASES INCLUDED IN TOTAL, ALTHOUGH DATA FOR THESE PROGRAMS IS NOT SHOWN SEPARATELY, 
6/ Total includes some cases for whom it was not known whether recommended treatment was received. 
TABLE 26. NUMBER '>ND PERCENTAGE DISTRIBUTION OF PERSONS RECEIVING MEDICAL CARE (3 DPW FUNDS) BY TYPE OF RECOMMENDATION, 
ASSISTANCE PROGRAM AND WHETHER OR NOT RECOMMENDED TREATMENT WAS RECEIVED VIII. OUTCOME OF TREATMENT 
Status of Treatment, March 31, 19U3 
Among 8,857 cases open on March 31# there were 1,578 which had 
received medical care from DPW funds at some time during the six preceding 
months. In these families there were 2,275 persons who received medical 
examination or treatment. This section deals with the status of treatment 
of these persons as of March 31, (see Tables 27 and 28). 
There were 115 persons who were examined but not treated. The most 
usual reason for not beginning treatment was that treatment was not recom- 
mended by the examining physician persons). Next in importance was 
refusal by the client to accept treatment after it was recommended; this 
occurred in 36 cases. Combining these cases with i_j.5 in which the client 
discontinued treatment because of discouragement and with 91 cases in which 
the client refused original examination although apparently in need of 
medical care, it appears that client attitudes on medical care are an 
important factor in the administration of the program, and that there is a 
large field for family counselling on health care. 
Treatment was suspended or discontinued for only 88 persons. The 
most usual reason for suspension was discouragement on the part of the 
client. The doctor shortage, transportation difficulties and lack of 
funds accounted for only a small number of suspensions of treatment. It 
seems probable, however, that these factors were more important in 
preventing original examinations, since they would be considered by workers 
before attempting to provide medical care. 
A large percentage of persons (14.2.5 per cent) were under treatment as 
of March 31, 19lj-3» The range among assistance programs was from 56.3 per 
cent for Old Age Assistance to 20.0 for non-assistance cases. The high 
percentage for Old Age Assistance is accounted for by the prevalence of 
chronic conditions requiring continued treatment, and the small percentage 
in the non-assistance group is accounted for by the fact that these persons 
generally receive medical care to tide them over a period of temporary need 
because of accident or illness. The high percentage of persons "under 
treatment” indicates considerable need for family services in ’’following 
through” on treatment begun. 
Treatment had been completed for almost half of persons who received 
care during the six survey months. The large majority of these persons 
(713) received maximum benefit or were cured. This appears to be an 
excellent record for the first six months of the medical care program. 
The data in Tables 27 and 28 on "patient cured or maximum benefit 
received” do not give a complete picture of favorable results of medical 
treatment, since the cases which had been closed as a result of medical 
treatment or for other reasons are not included. 
The condition of 267 persons was improved by treatment, but the 
persons were not cured. Only 29 persons showed no improvement as a result 
of treatment. 
Cases Closed as a Result of Treatment 
One of the most dramatic results of medical care, is return of the 
family to self-supporting status. This study would indicate that such 
effects cannot be expected (in so short a period as six months) among a 
large proportion of cases. Forty-nine cases were closed as a result of TABLE 27. PERSONS RECEIVING MEDICAL CARE a/, ACCORDING TO STATUS OF 
TREATMENT, BY ASSISTANCE PROGRAM, MARCH 3l, 1943 
Persons Receiving Medical Care 
oTATUo Or IRLATMt.NT 
ALL 
Programs 
OA A 
ADC • 
ANB 
GA 
NA 
Total 
2,275 
1,098 
777 
47 
323 
30 
Treatment not begun 
1.15 
40 
39 
3 
32 
1 
NO TREATMENT RECOMMENDED.. 
44 
21 
10 
2 
1 I 
0 
Lack of time; etc 
■ 5 
3 
6 
1 
5 
0 
Lack of funds; etc 
8 
3 
1 
0 
4 
0 
Client or parent refuses.. 
3 6 
10 
16 
0 
9 
1 
Other 
12 
3 
6 
0 
3 
0 
NOW UNDER treatment 
9 67 
618 
203 
24 
116 
6 
Treatment suspended or disc. 
88 
44 
24 
I 
17 
2 
Pending change in condition 
»7 
9 
6 
0 
1 
I 
Lack of funds 
5 
i 
2 
0 
2 
0 
Client discouraged; etc. .. 
45 
23 
9 
0 
12 
I 
Doctor left community 
5 
3 
1 
I 
0 
0 
Transportation Difficulties 
5 
i 
4 
0 
0 
0 
Other 
10 
7 
1 
0 
2 
0 
Reason Unknown 
i 
0 
1 
,0 
0 
0 
Treatment completed 
1,074 
386 
498 
19 
• 5* 
20 
Patient cured or maximum 
BENEFIT RECEIVED 
3 
223 
00 
CA 
11 
CD 
14 
Condition improved 
267 
119 
96 
7 
41 
4 
Condition not improved .... 
29 
■ 5 
8 
0 
6 
0 
Death 
44 
20 
»2 
0 
1° 
2 
Miscellaneous 
21 
9 
4 
1 
7 
0 
Unknown 
3i 
(0 
>3 
0 
7 
l 
a/ Persons in cases open 
March 3i, 
1943 WHO HAD received medical 
examination or 
TREATMENT IN THE PRECEDING 6 MONTHS. TABLE 28. PERCENTAGE DISTRIBUTION OF PERSONS RECEIVING MEDICAL CARE a/, 
ACCORDING TO STATUS OF TREATMENT, BY ASSISTANCE PROGRAM, MARCH 31, 1943 
PERCENTAGE OF PERSONS RECEIVING MEDICAL CARE 
Status or Treatment 
All 
PROGRAMS 
OAA 
ADC 
ANB 
GA 
NA 
Total •«•••••••#•••*••••••••• 
100.0 
o 
o 
o 
100.0 
100.0 
100,0 
100.0 
Treatment Not Begun 
5.0 
3.6 
5.Q 
6.4 
9.9 
3.3 
NO treatment recommended 
i.9 
l .8 
1 *3 
4.3 
3.5 
0 
Lack of time 
o,6 
o.3 
0.8 
2.1 
i.5 
0 
Lack of funds 
0.4 
o.3 
0.1 
0 
1.2 
0 
CLIENT OR PARENT REFUSES 
».6 
o.9 
2.0 
0 
2.8 
3.3 
OTHER 
o.5 
o.3 
0.8 
0 
0.9 
0 
NOW UNDER TREATMENT 
42.5 
56.3 
26.1 
51.1 
35.9 
20,0 
Treatment suspended or discontinued 
3.9 
4.0 
3.1 
2.1 
5.3 
PENDING CHANGE IN CONDITION ..... 
0.8 
0.8 
0,8 
0 
0.3 
3.4 
Lack of funds 
0.2 
0.1 
o.3 
0 
0.6 
0 
CLIENT DISCOURAGED ,, 
2.1 
2.1 
1.2 
0 
3.3 
3.3 
Doctor left community 
0.2 
0.3 
0.1 
2.1 
0 
0 
Transportation difficulties 
0.2 
0.1 
0.5 
0 
0 
0 
OTHER 
0.4 
0.6 
0.1 
0 
0.6 
0 
Reason unknown 
y 
0 
0.1 
0 
0 
0 
Treatment completed 
47.2 
35.. 2 
64,1 
40.4 
46.7 
(£.r 
Patient cured or maximum benefit 
received 
31.4 
20.4 
48.7 
23.3 
26.8 
46.7 
Condition improved , ,, , 
m.7 
10.8 
12.4 
45.0 
• 
CM 
13.3 
Condition not improved 
1.3 
1.4 
1.0 
0 
1.9 
0 
Death 
i.9 
1.8 
1.5 
0 
3.1 
6.7 
miscellaneous 
0.9 
• 
0.8 
0.5 
2,1 
2.2 
0 
Unknown 
1.4 
0.9 
i.7 
0 
2.2 
3.3 
A/ PERSONS IN CASES OPEN MARCH 3l, 1943 WHO HAD RECEIVED ME D 1C AL EXAMINATION OR TREATMENT 
IN THE PRECEDING 6 MONTHS. 
B/ LESS THAN 0,05 PER CENT. medical treatment. These cases were distributed among the assistance programs 
as follows: 
Old Age Assistance 0 
Aid to Dependent Children 3 
Aid to Needy Blind 0 
General Assistance 21 
Non-assistance 25 
The relatively large number of closures for general assistance and non- 
assistance cases no doubt results from the fact that many such cases are 
opened only to assist the family in receiving medical care or to assist the 
family while medical care is received. With the disability removed in such 
cases there is no further need of assistance. 
Considering the fact that almost half the cases were still under treat- 
ment it is not surprising that the number of closures because of treatment 
is low. Many of the conditions treated are of long duration and cannot be 
immediately cured, and a substantial proportion of persons treated are those 
of advanced age and the very young who are not of employable age. The child 
who receives a tonsillectomy does not thereby become self-supporting. The 
value of the treatment, however, is no less real in terms of preventing 
future dependency. The twenty-five closures of non-assistance cases because 
of medical treatment may also be considered as preventing dependency, for if 
medical care had not been available some of these cases would undoubtedly have 
become dependent upon the Department for assistance other than medical needs. 
Favorable Changes in the Family Situation as a Result of Treatment 
Although immediate closure of a case as a result of medical treatment 
cannot often be expected, many other favorable changes occur in the family 
situation. The workers preparing the survey schedules were asked to specify 
favorable changes in family situations resulting from medical care. This 
was done in 68 cases. Favorable changes include improved work in school, 
ability of a mother to care better for her family, or of any person in the 
home to assume increased responsibility, participate more extensively in 
community activities, etc. Illustrations from the survey schedules follow: 
"Margarita now in good health and able to attend school regularly.” 
"Catarina now able to work and support herself as well as assist 
her mother." 
"Mrs. 0. now able to do her own housework." 
"Patient had spent entire savings for treatment before coming to us. 
(Toxic tyroid, man age 32 - ADC family head). Has apparently made 
complete recovery and is looking forward to being self-supporting 
again." 
(Mother 30; 2 children under 6; endocrine unbalance and arthritis) 
"Mother now more able to care for children." 
The intangible factors of personal satisfaction and happiness derived 
from good health cannot be measured; they are inter-related with many of the 
situations described above. Their importance, however, is above question, 
and they perhaps are primary considerations in the accepted goal of providing 
adequate medical care for persons dependent upon public aid.