Committee Recommends Free Health Service

WITH the objective of unifying Dartmouth's various health services and making them more generally available to undergraduates, the Health Survey Committee has recommended to President Hopkins the establishment of an inclusive College Health Council and the provision of free medical care to be financed partly by general College funds and partly by an increase in tuition.

The Committee, which based its report on a survey conducted during the past five months under the chairmanship of Dean Robert C. Strong '24, has also recommended that the Board of Trustees author- ize a contractual agreement with the Hitchcock Clinic to provide for the complete medical care of the student body, and that some change be made in the faculty ruling on medical excuses in order to eliminate the hazard of students continuing with their work when in need of medical care.

Confining itself to general recommendations, the Health Survey Committee neither suggested the details of organization for its plan nor estimated the cost of providing medical care for the entire student body. The specific measures involved in such a plan are now being worked out by a special committee appointed by President Hopkins in accordance with the recent vote of the Board of Trustees. This special committee, under the chairmanship of Professor Francis J. Neef, director of personnel research, is expected to submit its report to the Trustees at the June meeting of the Board.

ORGANIZATION LACKING

In making its report to President Hopkins, the Health Survey Gommittee praised the facilities and personnel of the various health agencies in Hanover, but found that the present lack of organization makes impossible the maximum use of these assets. Referring to the basic health obligations of every college, as outlined at the 1931 national college hygiene conference, the report states:

"To a large extent we believe that Dartmouth has been discharging the obligations mentioned above in providing the personnel and facilities for proper health education, physical examinations, protection of the environment, and care and treatment of the sick. However, we are forced to the conclusion that under our present form of organization, many students are not receiving the medical care that they need and are, therefore, not learning sound health habits and are not receiving as complete protection as is desired. Furthermore, we believe that it should be possible for Dartmouth to have a health service second to none and that such service could be developed without difficulty and within reasonable limits as far as cost is concerned. We therefore make the following general recommendations for your consideration:

"I. That the Board of Trustees establish a College Health Council, made up of representatives from the several departments now concerned with the health pro- gram; that this council be given power to supervise the health service of the College, including health education, sanitary control, physical examinations, and care of the sick both by out-patient service and hospitalization. Such council would be responsible to the Board of Trustees through the President.

"2. That the Board of Trustees authorize a contractual agreement with the Hitchcock Clinic to provide for the complete medical care of the student body, including physical examinations.

"3. That the cost of the health service be apportioned between the students and the college and that the charge to students be included in tuition. In order that medical care and hospitalization shall be made available to all students and so far as possible be dissociated from immediate expense, we believe that an increase in tuition is preferable to a special health fee.

"4. That some change be made in the faculty ruling concerning medical excuses for absences from class in order to eliminate the hazard of students continuing with their work when in need of medical care for fear of the penalty of overcuts."

FULL COMMITTEE APPROVES

These recommendations were endorsed by the full committee, which included Dean Strong, chairman, formerly liaison officer between the President's Office and Dick's House; Dean Neidlinger; Dean Gray of Tuck School, a trustee of Mary Hitchcock Memorial Hospital: Dr. Howard N. Kingsford, medical director of the College; Halsey C. Edgerton, treasurer of the College and of the Hospital; Max A. Norton, bursar of the College and president of the Hospital; Professor Robert J. Delehanty, chairman of the Department of Physical Education; Dr. John P. Bowler and Dr. John F. Gile, representing the Hitchcock Clinic; and four undergraduate representatives, Dean R. Gidney '36, Robert H. Shertz '36, Gordon P. Bennett '37, and Frederick K. Castle '37. The Committee was appointed by President Hopkins on November 6, 1935, in response to a petition from Palaeopitus.

The major portion of the full report is devoted to a study of the present health service of the College and to a study of the health organizations at a dozen other colleges and universities, including Harvard, Yale, Princeton, Cornell, Pennsylvania, Amherst, Illinois, Michigan, Minnesota, California, Oregon State Agricultural College, and Wesleyan University of Wisconsin. The present set-up at Dartmouth, the Committee found, consists of six virtually independent administrative units: the Medical Director's office, the Department of Physical Education, the Dartmouth Medical School, Dick Hall's House, the Mary Hitchcock Memorial Hospital, and the Hitchcock Clinic.

"Few colleges, if any," the report declares, "can lay claim to as fine a personnel or as complete a plant as exists at Dartmouth, and yet our investigations have shown us that by comparison with other colleges we seem to be sadly lacking in the organization of our work. If it were not for the fact that all the various branches of the health service have been only too willing to cooperate on a voluntary basis, it seems certain that the College would not have been discharging its responsibility at many vital points. Although the service as it is now organized has doubtless resulted in some duplication of effort and, at times, some friction, we wish to emphasize that the devotion of all parties concerned to the common good has given us a health service of excellent quality as well as extensive in its scope."

DARTMOUTH SECOND HIGHEST

Operating costs of the present health service place Dartmouth as the second highest in the group studied by the Committee. The estimate prepared shows an annual expenditure of $32,000 by students for professional fees and hospitalization, and an expenditure by the College of $28,- 000 for salaries, Dick's House deficit, and physical examinations, and of an additional $26,500 in connection with buildings and equipment. The first two amounts, totaling $60,000, average approximately $25 per student enrolled, of which the College at present pays $11.67.

"It is apparent," the report states, "that the share of expense now met from College funds is greater than that at other institutions. The Committee does not believe that the College can reasonably be expected to meet the expenses of an expanded health service from general funds but must provide some means of distributing the students' share of expense over the entire undergraduate body."

Undergraduate use of the present medical service was investigated by means of a questionnaire mailed to the entire student body. Some 1500 blanks were returned to the Committee, disclosing that only 282 students were in the habit of consulting a doctor promptly when ill, while 806 were not. The reasons for not seeking immediate medical attention were given as the expense of consultation in 394 cases, the expense of hospitalization in 624 cases, and the fear of missing work and incurring overcuts in 54 cases. The questionnaire also disclosed that 380 men consult doctors less promptly than they did before entering Dartmouth. Although no question was asked with regard to health insurance, 343 men voluntarily expressed themselves in favor of a health tax.

In abstracting some 500 comments made by students in filling out the questionnaires, the Committee came to three general conclusions: one, that a large majority of the student body have but little knowledge of the facilities of the present health service and have no appreciation of the extremely high quality of the medical service provided in the community; two, that there is a desire on the part of a considerable portion of the undergraduate body for greater health protection through some form of compulsory tax; and three, that the weaknesses existent in the present health service relate directly to the fact that the student must incur a charge whenever he seeks medical advice at Dick's House or at the Hitchcock Clinic.