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I For many decades, various groups in this country have been seeking a solution to the several economic problems of medical care. But it is only in the past few years that people have been faced with a situation where the costs of illness can vary excessively. This problem of varying costs of illness arose as a result of the explosive expansion of medical science. Beginning more than 50 years ago and continuing to the present time, this proceeded without regard for the economic consequences. The development of medical institutions and equipment, the differentiation of medical knowledge into myriad fields of specialization, has been haphazard. This has resulted in numerous new services, charges for which are now found in the medical bill. Where in the i88o's the doctor received almost ioo per cent of the expenditures for medical care, he now receives approximately 40 per cent1 and this is divided between the general practitioner and a corps of specialists. But the doctors are not receiving less; the patients are paying more. When today's patient makes his first visit in any illness to the office of the doctor, he can have no idea what the ultimate cost to him will be. He knows that the visit will cost $2, $3 or $5. But he cannot foretell whether the doctor will call for laboratory tests, x-rays or special diagnostic work. He does not know whether the physician will recommend hospitalization and surgery. For each of these he must pay. The bill for medical care, composed of items for many different kinds of services, may total hundreds of dollars. Experience has indicated that the burden of these varying costs can be met by spreading them over a large group of people, each person paying his proportional share, in other words, by insurance. It is the cost problem that most of our current experimentation is designed to meet. * This paper is devoted to a consideration of voluntary medical service plans. Its scope does not include consideration of the numerous experiments under governmental auspices or group hospitalization plans. While the latter are significant as illustrating a partial solution to present problems and have a definite place in the scene of American Experimentation, it has been left for following articles on these plans to develop. t B.A., I934, LL.B., I936, Columbia University. General Secretary, Bureau of Cooperative Medicine; Executive Secretary, Association of Medical Cooperatives; Vice-President, Group Health Association of New York; Editor, COOPERATIVE HEALTH; Co-author of The Changing Scene of American Medicine (1939) MEDICINE TODAY & TOMORROW, and articles on group medicine. ' FALK, KLEM & SINAI: THE INCIDENCE OF ILLNESS AND THE RECEIPT AND COSTS OF MEDICAL CARE AMONG REPRESENTATIVE FAMILY GROUPS (1933) PUBLICATION OF THE COMMITTEE ON THE COSTS OF MEDICAL CARE, No. 26, 151, table 30.

American Experimentation in Meeting Medical Needs by Voluntary Action