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Medicare, 1968 



Publications in this annual statistical series are : 

Section 1 — SUMMARY (in preparation) 

Section 2— ENROLLMENT (in preparation) 

Section 3— PARTICIPATING PROVIDERS 

3.1: Participating Hospitals (in preparation) 

3.2: Participating Home Health Agencies (published September 1971) 
3.3: Participating Independent Laboratories (published September 1971) 
3.4: Participating Extended Care Facilities (published September 1971) 

Section 4— INPATIENT CARE (in preparation) 
4.1 : Short-stay Hospital Utilization 
4,2: Short-stay Hospitals — Diagnoses and Procedures 
4.3: Psychiatric Hospital Utilization 
4.4: Long-stay Hospital Utilization 
4.5 : Extended Care Facility Utilization 

Section 5— OUTPATIENT HOSPITAL SERVICES (in preparation) 

Section 6— HOME HEALTH SERVICES (in preparation) 

Section 7— PHYSICIANS' AND OTHER MEDICAL SERVICES (in preparation) 

Persons on the ORS health insurance mailing list will be notified when the various sec- 
tions are available for purchase through the Superintendent of Documents, U.S. Govern- 
ment Printing Ofllce. 






Medicare 

Health Insurance for the Aged, 1968 
Section 3.3: Participating Independent Laboratories 



l^'iarvienci 21244 



U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 

SOCIAL SECURITY ADMINISTRATION • OFFICE OF RESEARCH AND STATISTICS 

i' Ci'isTibrary f 

C2-07-13 \ 

7500 Security B5vd. 



Library of Congress Catalog Card Number HEW 66-36 



SUGGESTED CITATION 



U.S. Social Security Administration, Office of Re- 
search and Statistics, Medicare: Health Insurance 
for the Aged 1968, Section 3.3: Participating Inde- 
pendent Laboratories. Washington, D.C. 1971. 



United States 

Government Printing Office 

Washington: 1972 



F'or .sale by tiie Su])erintendeiit of Documents, U.S. Government Printing Officx^ 

Washington, D.C. 20402— Price 40 cents 

Stock Number 1770-0176 



Foreword 



With the enactment of the health insurance pro- 
gram for the aged (Medicare), it became possible to 
organize a continuing information system to report 
the use of health care services by older Americans. 
Since Medicare began, one of the basic tasks has been 
to process and pay claims for covered medical serv- 
ices submitted by or on behalf of the almost 19.8 
million persons entitled to hospital insurance benefits 
and the 18.8 million persons enrolled for supplemen- 
tary medical insurance benefits. From this operation 
come data on the amount, the kind, and the cost of 
such services used by the aged. 

This report is one in a series of publications de- 
signed to disseminate such data on a regular basis. 
It provides detailed statistical information on inde- 
pendent laboratories participating under Medicare. 
Other reports in the series will present the number 
and characteristics of participating hospitals, home 
health agencies, extended care facilities, of the in- 
sured population, and the utilization of medical care 
services. The reports are intended to give a compre- 
hensive account of the amounts reimbursed under the 
program, the kinds of services paid for, and the varia- 
tions in utilization and reimbursement by age, race, 
and sex of the beneficiary, as well as his place of 



geographic residence. Such data can provide new 
insights into the patterns of medical care for persons 
aged 65 and over. A fuller understanding of present 
practice can contribute to improved health services 
not only for the aged but for the general population 
of the United States as well. 

Many individuals in the Social Security Adminis- 
tration have assisted with the development of this 
series. The preparation of these reports is a major 
function of the ORS Division of Health Insurance 
Studies under the supervision of Howard West, direc- 
tor, and Aaron Krute, deputy director, and involving 
a majority of its staff. Important contributions for 
the tabulation and presentation of the statistical con- 
tent of this report were made by Frank L. Kirby, 
Charles G. Scott, and Harvey L. Engbretson of the 
Statistical Processing and Procedures Branch of that 
division. Text preparation was the responsibility of 
Wayne Callahan of the Provider Statistics Branch. 
Special acknowledgments for publication services are 
made to the Division of Operating Facilities in the 
Office of Administration, and for tabulating services 
to the Division of Health Insurance Statistical Data 
of the Bureau of Data Processing. 



September, 1971 



Ida C. Merriam, 
Assistant Commissioner for Research and Statistics. 



Ill 



Contents 

Page 

Foreword iii 

The Statistical System of the Medicare Program vi 

Independent Laboratories Participating in the Program ix 

Characteristics of the Independent Laboratories ix 

Conditions of Participation xii 

Source of the Data xv 

Provisions of the Law xvii 

Hospital Insurance Program xvii 

Supplementary Medical Insurance Program xviii 

Eligibility xix 

Financing the Program xix 

Administration of the Program xx 



GENERAL TABLES 

Notes 3.3-1 

3.3.1 Number of independent laboratories, by training of laboratory 

director, and technical staff, region, division, and State 3,3-2 

3.3.2 Number of independent laboratories, by type of procedure approved, 
training of laboratory director, and technical staff, region, division, 

and State 3.3-3 



The Statistical System 



This publication is a section of a statistical report 
series produced from Medicare program records. Pre- 
sented on a calendar year basis, describing services 
rendered in the year, the series includes sections on 
enrollment, characteristics of providers, inpatient 
care in hospitals and extended care facilities, outpa- 
tient hospital services, home health services, physi- 
cians' and other medical services, and overall summa- 
ries. 

The primary objective of these reports is to provide 
data required to measure and evaluate program oper- 
ation and effectiveness. Benefit payment operations 
furnish information about the amount and kind of 
hospital and medical care services used by persons 
aged 65 and over, as well as the expenditures for such 
services. The applications by hospitals, extended care 
facilities, home health agencies, and independent labo- 
ratories to participate in the program provide data on 
the characteristics of such providers of services. The 
claim number assigned to each individual serves as 
the link between the program services utilized and the 
demographic characteristics of each individual re- 
corded in the health insurance entitlement master file. 

The data-collection system has two inherent charac- 
teristics that determine the scope, detail, and flexibil- 
ity of the available data. First, data are collected and 
maintained on an individual basis so that the benefici- 
ary and his medical experience under the program 
form the basic unit. Second, records for each bill paid 
under the program and, for a sample of beneficiaries, 
records of diagnoses and surgical procedures are 
maintained on a centralized basis. Except for inter- 
mediary operating statistics such as those relating to 
workloads, costs, and the like, all program statistics 
are centrally prepared. 

THE BASIC RECORDS 

The statistical system is based on five related com- 
puter-tape records : the health insurance entitlement 
master file, provider record, hospital insurance (Part 
A) utilization record, medical insurance (Part B) 
payment record, and the record containing informa- 
tion from medical insurance bills for a 5-percent sam- 
ple of supplementary medical insurance enrollees. 

THE HEALTH INSURANCE ENTITLEMENT MASTER FILE 

The health insurance entitlement master file identi- 
fies each aged person eligible for health insurance 
benefits and indicates whether he is entitled to hospi- 
tal benefits, to supplementary medical insurance bene- 
fits, or to both of these benefits. 



This record is used to create a health insurance 
card that is sent to each insured person. The card 
contains the individual's claim number (the number 
used for OASDI or railroad retirement programs). It 
indicates the entitlement of the individual for the two 
parts of the Medicare program. 

The entitlement record provides the population 
data for each part of the program and therefore 
serves as the base for the computation of a variety of 
utilization rates, limited only by its demographic con- 
tent. 



PROVIDER RECORD 

Every hospital, home health agency, extended care 
facility, and independent laboratory must apply for 
participation in the hospital insurance program in 
order to be reimbursed for services provided. Data 
included on the application forms have been recorded 
in the central provider record and are updated as 
facilities are recertified periodically, as new ones 
apply for participation, or as some leave the program. 
When the information in this provider file is com- 
bined with utilization data, it serves to relate the 
characteristics of facilities and agencies that provide 
care to the kinds and amounts of service used by 
persons insured under Medicare. 

UTILIZATION RECORD FOR HOSPITAL INSURANCE 

The administration of the hospital insurance pro- 
gram requires that two items of information be 
known about each person at the time of his admission 
to a hospital — his entitlement under the program and 
the extent to which he has used the benefits available 
to him under the "benefit period" concept. 

When the patient is admitted to a hospital, the ad- 
mission section of the inpatient hospital admission 
and billing form is completed by the hospital and 
forwarded through its intermediary to the Social Se- 
curity Administration for recording in the central 
record. As soon as the record is checked, normally in 
less than 24 hours, the intermediary is informed of 
the patient's benefit status and of the number of days 
remaining during the "benefit period." 

This information is then forwarded to the hospital. 
At discharge, the hospital completes the billing sec- 
tion of the form and sends it to the intermediary for 
payment. When approval for payment has been made, 
the intermediary forwards the claim to the Social Se- 



VI 



of the Medicare Program 



curity Administration for inclusion in the central rec- 
ord. 

As part of this process, information on diagnoses 
and surgical procedures are coded for a 20-percent 
sample of beneficiaries based on specific combinations 
of digits in the health insurance claim number. Copies 
of admission and billing forms are handled in a com- 
parable manner by home health agencies and ex- 
tended care facilities. The outpatient billing form is 
also transmitted to the Social Security Administra- 
tion for recording in the central record after the bill 
is approved for payment by the intermediary. 

All the information on utilization experience in 
hospital and extended care facilities that is needed to 
administer the "benefit period" provision is recorded 
in the central record. This information includes stays 
in certain nonparticipating institutions that meet the 
definition of a hospital or extended care facility under 
the law, and days of care not covered or reimbursable 
under the program. 

Each admission and billing form contains both the 
beneficiary's claim number and the provider's identi- 
fication number. The resulting tape record can be 
readily matched to the beneficiary files and the provi- 
der files. By this process, a statistical tape record is 
created for the sample of insured persons that con- 
tains all the available information needed for tabula- 
tion from the three files related to Part A utilization. 

PAYMENT FOR MEDICAL INSURANCE 

Payment or reimbursement under the SMI pro- 
gram is made only after receipt by the carriers (in- 
termediaries involved in Part B of the Medicare pro- 
gram) of bills having allovi^ed charges exceeding $50 
during a calendar year period. 

For the insured population, carriers need to know 
from a central source that the deductible has been 
met; thereafter, during the remainder of the calendar 
year, the only additional information required from 
the Social Security Administration for reimburse- 
ment or payment purposes is whether the person is 
still enrolled under the SMI program. 

For administration and operation of the program, 
the Social Security Administration must have accu- 
rate and complete information on the amounts paid 
by the carriers for physician services and for other 
services and supplies under this part of the program. 
To meet these needs, carriers furnish a payment rec- 
ord consisting of tape, punched card, or other ma- 
chine-readable record of each bill paid. A "bill" is 
defined as a request for payment from or on behalf of 
a beneficiary as the result of services provided by a 



single physician or supplier. 

The payment record also contains selected items of 
information needed to supply an efficient basis for 
drawing samples of the bills. These items provide a 
sampling frame that may be used to draw additional 
samples designed to obtain specific information not 
furnished reliably by the basic sample of enrolled per- 
sons under the medical insurance program. 

THE MEDICAL INSURANCE SAMPLE 

Although the payment record provides a rapid 
method for summarizing payment data and a sam- 
pling frame for efficiently drawing additional samples 
of bills, it does not provide specific data on diagnoses, 
procedures, and related charges. 

Basic statistics on the utilization of physician and 
other services covered under the supplementary medi- 
cal insurance program are derived from bills paid by 
intermediaries to or on behalf of a continuous 5-per- 
cent sample of all enrolled persons. Intermediaries 
have been given specific combinations of digits of the 
health insurance claim number to be used in selecting 
the 5-percent sample, which is a sub-sample of the 
20-percent sample used for hospital insurance pro- 
gram data. 

Bills are submitted either directly on an SSA re- 
quest for payment form, or on the SSA form in com- 
bination with the physician's billing form. Both meth- 
ods are designed to provide information on the date 
and place of each service, the procedure carried out or 
service provided, the condition treated (diagnosis), 
and the physician's or supplier's charge for the spe- 
cific service. 

All of the bills of persons in the 5-percent sample to 
or for whom payment is made under the program, 
including those used to meet the annual $50 deducti- 
ble, are included in the sample and coded. However, 
data are not available through these procedures for 
persons in the sample who do not meet the $50 de- 
ductible. Such data are collected by means of the Cur- 
rent Medicare Survey, with data made available in a 
separate report series.^ 

For hospital-based physicians who have authorized 
the provider to collect the fee for their services, the 
provider billing for patient services by physicians 
form is used. This form is completed for each patient. 
It includes descriptive information on the date and 
place of each service, the diagnoses, procedures, and 
the charges. These bills are received centrally for the 
5-percent sample of persons enrolled for supplemen- 
tary medical insurance. 



^ Jack Scharff, "Current Medicare Survey: The Medical 
Insurance Sample," Social Security Bulletin, April 1967. 



Vll 



Independent Laboratories 
Participating in the Program 



Title XVIII of the Social Security Act, introduced 
as part of the 1965 amendments, provides health in- 
surance protection for the aged. To implement the 
law, two separate but complementary programs were 
established. The first of these, the hospital insurance 
(HI) program, provides protection against the cost 
of hospital and related post-hospital care. The second, 
termed supplementary medical insurance (SMI) pro- 
vides coverage of physicians' services and a number 
of other health items and services not included under 
the HI program. Among the major benefits provided 
under the SMI program are reimbursement for diag- 
nostic laboratory tests performed in an independent 
clinical laboratory. 

A laboratory operating under the direction of a 
physician primarily for the performance of diagnostic 
laboratory services for other physicians is considered 
to be an independent laboratory. An independent 
laboratory must also be independent both oi an at- 
tending physician's office and of a hospital that par- 
ticipates in the Medicare program. However, a 
laboratory maintained by a physician for performing 
diagnostic tests in connection with his own practice is 
not considered to be an independent laboratory. 

In order to participate in the Medicare program, 
a laboratory must be approved by the Secretary of 
Health, Education, and Welfare as meeting the spe- 
cific requirements for participation under the pro- 
gram.^ Section 1861(a) of the Social Security Act 
stipulates that, where State or local laws provide for 
licensing laboratories, the laboratory be licensed in 
accordance with such law or be approved by the 
agency of the State or locality responsible for such 
licensure. 



Characteristics of the Independent Laboratories 
GEOGRAPHIC DISTRIBUTION OF LABORATORIES 

There were 2,714 independent laboratories ap- 
proved for participation under Medicare during cal- 
endar year 1968, a net gain of 45 over the number 
that participated in 1967. ^ The number of approved 
laboratories varied considerably by region and State 
(table A). Forty-six percent of the approved labora- 
tories were concentrated in two geographic areas : 
723 or 27 percent were in the Pacific States, and 513 
or 19 percent were in the Middle Atlantic States. 
The East North Central States had 394 (15 percent 
of the total) while the remaining two-fifths were scat- 
tered throughout the country. 

California with 609 approved laboratories (22 per- 
cent) had the largest number of any State, followed 
by New York with 257 (9 percent). Other States 
with more than 100 approved laboratories included 
Florida, Illinois, New Jersey, Ohio, Pennsylvania, and 
Texas. These eight States accounted for 1,693, or 62 
percent of all approved laboratories. Idaho and New 
Hampshire, on the other hand, each had only one 
approved independent laboratory. 

TRAINING OF LABORATORY DIRECTORS 

Physicians who were pathologists served as direc- 
tors in 36 percent of the approved laboratories ; physi- 
cians who were not pathologists served as directors 
in 26 percent; while nonphysicians directed 38 per- 
cent (table A). 



1 "Conditions for Coverage of Services of Independent Labo- 
ratories" (HIR-13), Social Security Administration. 



2 Medicare: Health Insurance for the Aged, 1967 : Section 3 J 
Participating Independent Laboratories, Social Security Ad- 
ministration Office of Research and Statistics (Washington, 
D.C.: U.S. Government Printing Office, 1971) 



IX 



Table A. — Number and percent of approved independent labo- 
ratories by training of laboratory director, division, and State. 
1968 



All T> n, 1 • * Other Non- 

Division an d State laboratories Pathologist ^^^^.^.^^ p^^^^.^.^^ 

Percent of total 

All areas... 2,714 36 26 38 

United States 2,660 37 26 37 

New England 166 16 14 69 

Maine.... 2 — 50 50 

New Hampshire 1 _ — 100 

Vermont 4 — 50 50 

Massachusetts 91 21 18 62 

Rhode Island 17 6 12 82 

Connecticut 51 14 6 80 

Middle Atlantic 513 28 13 58 

New York 257 33 14 53 

New Jersey 129 19 16 65 

Pennsylvania 127 28 10 61 

East North Central 394 30 25 45 

Ohio 106 26 28 45 

Indiana 32 59 16 25 

Illinois 159 20 30 50 

Michigan 79 34 18 48 

Wisconsin-.. 18 78 6 17 

West North Central 145 63 18 19 

Minnesota 12 75 25 

Iowa ---- 16 75 13 13 

Missouri 59 59 14 27 

North Dakota. 10 60 40 — 

South Dakota. 4 100 — — 

Nebraska. 19 79 11 11 

Kansas 25 44 28 28 

South Atlantic 222 42 23 35 

Delaware 4 75 25 

Maryland 33 48 27 24 

District of Columbia 6 83 17 

Virginia 23 78 — 22 

West Virginia 8 13 38 50 

North Carolina 11 55 45 — 

South Carolina 6 83 17 

Georgia 20 85 15 — 

Florida .- m 20 26 54 

East South Central 80 49 31 20 

Kentucky 32 34 56 9 

Tennessee-. - 27 44 15 41 

Alabama 12 92 8 — 

Mississippi 9 56 22 22 

West South Central 268 41 35 24 

Arkansas 14 57 43 — 

Louisiana .- 20 50 45 5 

Oklahoma 39 36 28 36 

Texas 195 39 35 25 

Mountain 149 44 21 36 

Montana 8 50 25 25 

Idaho.. - 1 100 — — 

Wyoming 3 100 — — 

Colorado 34 38 9 53 

New Mexico 23 30 40 30 

Arizona 54 44 20 35 

Utah - 13 38 15 46 

Nevada -- 13 62 31 8 

Pacific- - - 723 39 38 23 

Washington..- 65 58 18 23 

Oregon 31 65 6 29 

California.. 609 35 42 23 

Alaska. 2 50 50 — 

Hawaii 16 50 44 6 

Outlying areas. 54 11 20 69 

Guam — "~ "T 

Puerto Rico- 53 9 21 70 

Virgin Islands 1 100 — — 

Other outlying areas. — 

Among the States there is considerable variation 

in the professional training of laboratory directors. 

In the West North Central States, 63 percent of the 
approved laboratories had pathologists serving as 
their directors. Forty-nine percent of the directors in 
the East South Central States were pathologists. New 
England and the Middle Atlantic States, on the other 

hand, had only 16 and 28 percent, respectively, di- 
rected by pathologists. 



The proportion of laboratories directed by non- 
physicians also varies considerably on a geographic 
basis. In New England, for example, 69 percent were 
directed by nonphysicians, as were 58 percent in the 
Middle Atlantic States. In contrast, only about one- 
fifth of the directors in the West North Central States 
and the East South Central States were not physi- 
cians.3 



APPROVED REIMBURSABLE TESTS OR PROCEDURES 

Laboratories are certified to be reimbursed only for 
those laboratory tests and procedures within the spe- 
cialties or subspecialties which the laboratory direc- 
tor or supervisors are qualified to perform. Thus, not 
all approved laboratories may perform all of the tests 
in Medicare's seven categories of reimbursable 
tests and procedures. Table B shows that 27 percent 
of the 2,714 laboratories were approved for all seven 
types. More than nine out of every 10 laboratories 
were approved for clinical chemistry and hematology. 
Tissue pathology and exfoliative cytology were ap- 
proved for the fewest laboratories — 32 percent and 
35 percent, respectively. 

Over two-thirds (68 percent) of the laboratories 
directed by pathologists were approved under the 
program to perform all seven diagnostic procedures. 
Only 7 percent of the laboratories with directors who 
were physicians but not pathologists, and 2 percent 
of the nonphysician-directed laboratories were ap- 
proved for the performance of all these procedures. 

The specific kind of procedures that laboratories 
are approved to perform also varied with the profes- 
sional training of their directors. A large percentage 
of the pathologist-directed laboratories were ap- 
proved for tissue pathology — 79 percent, compared 
with only 8 percent of the laboratories directed by 
physicians not pathologists, and 3 percent of those 
directed by nonphysicians. Approximately the same 
ratios existed for laboratories approved for exfolia- 
tive cytology. 

There is also geographic variation in the propor- 
tion of laboratories approved for various procedures 
(table C). Over 60 percent of all participating labora- 
tories in the West North Central States were ap- 
proved for all seven types of tests, compared to less 
than 20 percent in the New England and Middle At- 
lantic States. The proportion of laboratories approved 
for all clinical tests among the various geographic 
divisions followed closely that proportion of labora- 
tories whose directors were pathologists. 



3 Nonphysician laboratory directors may include persons 
holding doctoral degrees from accredited institutions with a 
major in clinical, physical, or biological science together with 
either certification by a national accrediting board in one of 
the laboratory specialties, or 4 or more years of general clinical 
laboratory training and experience after graduation. For a 
detailed description of these requirements and certain permis- 
sible exceptions, see Social Security Administration, "Condi- 
tions for Coverage . . .," ibid., section 405.1312. 



Table B. — Number and percent of approved independent laboratories, by training of laboratory director and type of procedu 
approved, 1968 



re 



Type of procedure approved 



All laboratories 



Pathologist 



Other physician 



Nonphysician 



Number 



Percent 
of total 



Number 



Percent 
of total 



Number 



Percent 
of total 



Number 



Percent 
of total 



All laboratories - 

Microbiology 

Serology 

Clinical chemistry _ . 
Hematology 

Immunohematology_ 

Tissue pathology 

Exfoliative cytology- 
All procedures 



100 



977 



100 



100 



1,032 



100 



2,157 


80 


807 


83 


553 


78 


797 


77 


1,742 


64 


775 


79 


357 


51 


610 


59 


2,502 


92 


862 


88 


661 


94 


979 


95 


2,513 


93 


874 


89 


657 


93 


982 


95 


1,455 


54 


788 


81 


382 


54 


285 


28 


859 


32 


775 


79 


58 


8 


26 


3 


989 


35 


820 


84 


84 


12 


35 


3 


734 


27 


667 


68 


47 


7 


20 


2 



Table C. — Number and percent of approved independent laboratories, by type of procedure approved and division, 1968 



Division 



All 
laboratories 



Micro- 
biology 



Serology 



Clinical 

chemistry 



Hema- 
tology 



Iramuno- 
hematology 



Tissue 
pathology 



Exfoliative 
cytology 



All 
procedures 



All areas 2,714 

New England 

Middle Atlantic 

East North Central 

West North Central .._ 

South Atlantic 

East South Central 

West South Central 

Mountain 

Pacific __ _ 

Outlying areas 54 



80 



166 


67 


513 


68 


394 


70 


145 


88 


222 


81 


80 


80 


268 


92 


149 


81 


723 


87 



87 



Percent of total 



64 



92 



93 



54 



58 
68 
84 
72 
46 

65 
52 
58 
66 

13 



96 
90 
92 
94 
91 



95 
89 
94 

91 



96 
91 
93 
93 
92 

90 
96 
90 
94 

83 



46 
38 
49 
73 
47 

48 
65 
55 
66 



32 



10 
23 
30 
64 
37 

48 
45 
39 
29 

11 



35 



16 
26 
34 
67 
43 

50 
47 
40 
31 

13 



27 



16 
26 
61 
33 

41 
43 
36 
24 



NUMBER OF TECHNICAL STAFF 

Medicare regulations for independent laboratory- 
certification also define the duties and qualifications 
of a technical laboratory staff (other than those of 
the director)/ Each laboratory submits an applica- 
tion form "Request for Approval" (Form SSA-1517, 
see figure 1) requesting approval to participate in 
Medicare, The application provides information on 
the number of technical personnel (expressed in full- 
time equivalents), which information can be used as 
a relative indicator of the size of the laboratory.^ 
Such "size" information, relating the number of 
technical staff to the number of approved laboratories 
in each State, is shown in the general tables. 

Nationally, approved laboratories employed almost 
12,000 technical personnel (full-time equivalents), 
with an average of 4.4 for each approved laboratory 
(table D). The technical staffs for all laboratories 
averaged about one physician to every five nonphysi- 
cians. Almost two-thirds (62 percent) of the physi- 
cians were employed in laboratories directed by 
pathologists. Although these laboratories comprised 



** Social Security Administration, "Conditions for Cover- 
age . . .," ibid., section 405.1315. 

5 To arrive at full-time equivalents, divide the total number 
of hours worked by all employees in each classification in the 
week prior to the week of filing the request by the number of 
hours in the standard work week. 



only 36 percent of all the approved laboratories, they 
employed 57 percent of the technical staff. 

Table D. — Number and percentage distribution of approved 
independent laboratories by number of technical staff, and 
training of laboratory director, 1968 

Technical staff ' 

Training of laboratory All ' — 

director laboratories ^otal Physician ,^°": 

physician 

Number 

All areas 2,714 11,987.0 2,027.3 9,959.7 

Pathologist 977 6,874.4 1,257.0 5,617.5 

Other physician 705 2,808.8 599.0 2,209.8 

Nonphysician 1,032 2,303.8 171.4 2,132.4 

Percentage distribution 

All areas 100 100 100 100 

Pathologist 36 57 62 56 

Other physician 26 23 30 22 

Nonphysician 38 19 8 21 

1 Includes all technical personnel other than directors. Expressed in full-time 
equivalents. 

The State distribution shows that the average num- 
ber of technical staff per laboratory exceeded 10 only 
in Alabama, Alaska, the District of Columbia, 
Nebraska, North Dakota, and South Carolina. At the 
other extreme, Maine, New Jersey, Vermont, and 
West Virginia averaged two technical employees per 
laboratory. 

The continental regions with the smallest number 
of laboratories approved (the North Central States 
and the South) had the largest number of technical 
employees per laboratory. 



XI 



Table E. — Number of approved independent laboratories, by training of laboratory director, number of technical staff, and level 
of certification, by division, 1968 



Level of certification and division 



All 
laboratories 


Training of laboratory 


director 




Technical staff i 




Pathologist 


Other 
physician 


Non- 
physician 


Number 


Average per 
laboratory 


Physician 


Non- 
physician 


2,714 


977 


705 


1,032 


11,987.0 


4.4 


2,027.3 


9,959.7 


2,278 
436 

166 

114 

52 

513 
394 
119 

394 

356 

38 

145 

137 

8 

222 

202 

20 


865 
112 

27 
17 
10 

146 

123 

23 

120 

110 

10 

92 

91 

1 

93 
82 
11 

39 

36 

3 

109 

101 

8 

65 

61 

4 

280 

238 

42 

6 
6 


585 
120 

24 
17 

7 

69 
53 
16 

98 
87 
11 

26 

23 

3 

51 

46 
5 

25 
25 

95 

84 
11 

31 

25 

6 

275 

215 

60 

11 
10 

1 


828 
204 

115 
80 
35 

298 

218 
80 

176 

159 

17 

27 
23 

4 

78 

74 

4 

16 

13 

3 

64 

59 

5 

53 

51 

2 

168 

114 

54 

37 

37 


10,287.7 
1,699.3 

559.3 
448.5 
110.7 

1,975.5 

1,563.9 

411.6 

1,550.5 

1,375.2 

175.3 

1,064.8 

1,044.3 

20.5 

1,315.3 

1,252.0 

63.3 

431.6 

395.6 

36.0 

1,441.6 

1,343.6 

98.0 

560.5 

523.0 

37.5 

2,943.1 

2,197.7 

745.4 

144.9 

143.9 

1.0 


4.5 
3.9 

3.4 
3.9 
2.1 

3.9 
4.0 
3.5 

3.9 
3.9 
4.6 

7.3 
7.6 
2.6 

5.9 
6.2 
3.2 

5.4 
5.3 
6.0 

5.4 
5.5 
4.1 

3.8 
3.8 
3.1 

4.1 
3.9 
4.8 

2.7 
2.7 
1.0 


1,776.4 
250.9 

97.0 
86.0 
11.0 

162.6 
127.6 
35.0 

193.9 

162.2 

31.8 

233.0 

224.0 

9.0 

248.3 

235.0 

13.3 

78.0 

75.0 

3.0 

318.6 

293.6 

25.0 

117.0 

104.0 

13.0 

550.0 
440.1 
109.9 

29.0 
29.0 


8,511.3 
1,448.4 

462.3 

362.6 

99.7 

1,812.9 

1,436.3 

376.6 

1,356.6 

1,213.1 

143.5 

831.8 

820.3 

11.5 

1,067.0 

1,017.0 

50.0 


80 


353.6 


74 


320.6 


6 


33.0 


268 
244 


1,123.0 
1,050.0 


24 


73.0 


149 


443.5 


137 


419.0 


12 


24.5 


723 


2,393.2 


567 


1,757.6 


156 


635.6 


54 


115.9 


53 


114.9 


1 


1.0 



All areas 

No significant deficiencies 

With correctible deficiencies 

New England 

No significant deficiencies 

With correctible deficiencies 

Middle Atlantic 

No significant deficiencies 

With correctible deficiencies 

East North Central 

No significant deficiencies 

With correctible deficiencies 

West North Central 

No significant deficiencies 

With correctible deficiencies 

South Atlantic 

No significant deficiencies 

With correctible deficiencies 

East South Central 

No significant deficiencies 

With correctible deficiencies 

West South Central 

No significant deficiencies 

With correctible deficiencies 

Mountain 

No significant deficiencies 

With correctible deficiencies 

Pacific 

No significant deficiencies 

With correctible deficiencies 

Outlying areas 

No significant deficiencies. 

With correctible deficiencies 

' Includes all technical personnel other than directors. Expressed in full-time equivalents. 



LEVEL OF CERTIFICATION 

Independent laboratories must meet specific re- 
quirements in order for their services to qualify for 
reimbursement under the program. Established in 
the interest of health and safety, these requirements 
are essential to maintaining quality care and pro- 
viding adequate services and facilities. The test is 
whether there is substantial compliance with each of 
the Medicare conditions for participation.'' 

Under these conditions, independent laboratories 
can be approved for participation in the program at 
the following levels of certification: 

1. With no significant deficiencies 

2. With correctible deficiencies 

Of the 2,714 laboratories approved in 1968, 2,278 
or 84 percent were found to have no significant de- 
ficiencies (table E). Of the 436 laboratories approved 
with correctible deficiencies, 275 or 63 percent were 
located in the Middle Atlantic and Pacific States, the 
two geographical divisions with the largest number 
of certified laboratories. In six of the nine divisions 
shown in table E, 10 percent or less of the certified 
laboratories had correctible deficiencies. The excep- 



* Social Security Administration, "Conditions for Cover- 
age . . .," ibid., section 405.1305. 



tions were New England, the Middle Atlantic States, 
and the Pacific States where the proportion of labora- 
tories with deficiencies ranged from 22 to 31 percent 
of those certified. Approximately nine out of every 
10 staff" members or 86 percent were employed in 
laboratories found to have no significant deficiencies. 

Conditions of Participation 

The following material is from the Code of Federal 
Regulations, Title 20, Chapter III, Part 405, "Con- 
ditions for Coverage of Services of Independent 
Laboratories" (HIR-13), Social Security Adminis- 
tration. 

Definition of an independent laboratory. — As noted 
earlier, an independent laboratory performing diag- 
nostic tests is one which is independent both of the 
attending physician's office and of a hospital that 
participates in the program. A facility is not an 
independent laboratory if it is located in a hospital 
participating in the Medicare program or, if out- 
side such a hospital, it is operated by the hos- 
pital or its medical staff and serves the hospital's 
patients. A laboratory directed by a physician and 
located outside of a hospital is considered to meet 
the definition when the facility is operated pri- 



Xll 



DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 
SOCIAL SECURITY ADMINISTRATION 



Figure 1. 




Form Approved 

Budget Bureau No. 72-R731 



REQUEST FOR APPROVAL OF INDEPENDENT LABORATORY 
UNDER THE HEALTH INSURANCE FOR THE AGED PROGRAM 

All independent laboratories desiring to establish the coverage of their services under 
the Health Insurance Program should complete this form and return it to the State 
agency that is handling the certification process. If a return envelope is not provided, 
the name and address of the State agency may be obtained from the nearest Social 
Security Administration district office. 

The following laboratories should not file this form: 

Laboratories in participating hospitals or those operated by or under the supervision of 
a participating hospital or its organized medical staff; laboratories maintained by phy- 
sicians in connection with their individual or group practice, except where the physi- 
cian(s) holds himself out to the general public, and/or other physicians as being avail- 
able primarily for the performance of diagnostic x-ray and/or other laboratory services. 



Identifying 
Information 



II. 

Licensure 



NAME OF LABORATORY 



CITY. COUNTY, AND STATE 



NAME OF DIRECTOR 



A. I I LICENSED, APPROVED, OR REGISTERED AS A LAB- 
ORATORY BY A STATE OR LOCAL GOVERNMENT 
AGENCY. (Name of Agency) 



DO NOT WRITE IN THIS SPACE 



DATE C ERTI Fl ED 



C ER Tl Fl C A TION 



STREET ADDRESS 



Zl P CODE 



TELEPHONE NUMBER (Including area 
code) 



PROFESSIONAL QUALIFICATIONS (See instructions) 

1. Q] PATHOLOGIST 3. | | MP (other) 

2. [^RADIOLOGIST 4. [ | OTHER (Attach description 

of cpjalifications) 



LICENSE EFFECTIVE 



BEGINNING DATE THRU DATE 



NO LICENSE 
APPROVAL OR 
REGISTRATION 
REQUIRED 



III. 

Laboratory 

Tests or 
Procedures 
(Check all 
applicable) 



A. CLINICAL TESTS OR PROCEDURES 

1 I I Microbiology 7 | | Exfoliative Cytology 

2 □ Serology g □ Electrocardiograph 

3 I I Clinical Chemistry , , 

^ ^l^ 9 □ Basal Metabolic Rate 

4 I I Hematology 

5 □ Immunohematology ^0 □ Electroencephalograph 

6 [^ Tissue Pathology 11 [^ Other (Specify) 



B. RADIOLOGY PROCEDURES 

1 I I X-Ray, Diagnostic 

2 I I X-Ray, Therapeutic 

3 I I Radioisotope 

4 □ Other (Specify) 



IV. 

Type of 
Ownership 
or Control 
(Check one) 



1 [^ Private 

2 □ State 



3 □ City 

4 I I County 



5 I I City— County 

6 □ Other (Specify) 



A. NUMBER OF PHYSICIANS AND/OR SUPERVISORS (Do not include director) 



1. PATHOLOGISTS 



CLINICAL ANATOMICAL 



V. 

Number of 

Personnel 

(Ful 1-Time 

Equivalents) 



2. RADIOLOGISTS 



6. M.S./M. A. 



3. OTHER M.D.'S 



7. B.S./B.A. 



B. NUMBER OF TECHNOLOGISTS (Exclude director and supervisors) 



1. CLINICAL 



B.S./B.A. (or higher) 



2. RADIOLOGIC 



B.S./B.A. (or higher) 



3. NUCLEAR MEDICAL 



B.S./B.A. (or higher) 



C. NUMBER OF CLINICAL LABORATORY TECHNICIANS 




SIGNATURE OF AUTHORIZED OFFICIAL 



<:o«K, SSA-1517 i^- 



Oo) 



xni 



Figure 2, 




OEPARTUENT or HEALTH. EOUCATIOH, AHO WELFARE 
50CIAL SECURITY ADMINISTRATION 



Form Approved. 

Budget Bureau No. 72 — R725 



CERTIFICATION AND TRANSMITTAL 



TO BE COMPLETED BY STATE AGENCY 



1. NAME AND ADDRESS OF FACILITY 


2. TYPE OF FACILITY 




(^>nios'p-,ar^^^' (^)n^^'^ 




(''^□Sn'ela.^Hospital (0 □ HHA 




(c) □ Psych. Hospital (g) Q HHA (Psych.) 




(d) □ TB Hospital (h) □ Independent Lab. 


"TO: 

BHI Regional Representative 


4. DATE OF 

APPLICATION 


5. CERTIFICATION 
1 1 INITIAL 


6. STATE 


Regional Office, 




1 1 RECERTIFI- 

' ' CATION 





7. PURSUANT TO PROVISIONS OF SEC. 1864 OF THE SOCIAL SECURITY ACT. AND UPON CONSIDERATION OF ALL FACTS, THE 
FACILITY IS CERTIFIED AS: 



(a)0 



In substantial compliance with the conditions of 
participation (with no significant deficiencies) 

In substantial compliance with the conditions of 
participation (with correctable deficiencies) 



(d)n 



Not (or no longer) in compliance with conditions 
of participation 



. . I 1 Meeting the conditions for special certification 

' ' (limited access) 



9. 

JCAH 
I I ACCREDITA- 
TION 
VERIFIED 



1 0. RECOMM. IRE- 
SURVEY DATE 



8. SUPPLEMENTAL INFORMATION ON HOSPITALS AND ECF'S NOT 
IN COMPLIANCE 



Facility is in conformance with 186l (e) (1) 

(Definition of hospital) 

. . I 1 Facility is in conformance with 1861 (j) (1) 

^ '^ '(Definition of ECF) 

Hospital is in conformance with 1861 (e) (1 — 5) and (7) 

(Eli gible for emergency services) 



(«)□ 

(on 



1 1 . CONDITIONS OF PARTICIPATION WITH MAJOR DEFICIENCIES (CircteJ 

(Complete when items 7b, 7c, or 7d are checked) 

I II III IV V VI VII VIII IX X XI XII 



XVI 



XVII 



V 
XVIII 



XIX 



XX 



XXI 



XXII 



XXIII 



XIII XIV XV 
XXIV XXV 



12. EVIDENCE AND R^ASoniNG (Include results of consultation) 









r~l CONT. ON ATTACHED SHEET 


13. PREPARED BY 


14. DATE 


15. REVIEWED BY 


16. DATE 


TITLE 




TITLE 



TO BE COMPLETED BY REGIONAL OFFICE 



17. DETERMINATION OF ELIGIBILITY 

(a) I I Facility is eligible to participate (b) | | Facility is not eligible to participate 



(J-^ FACILITY IS IN COMPLIAN 
I 1 TITLE VI OF CIVIL RIGHT! 



CE WITH 
S ACT 



19. REGIONAL OFFICE REVIEW ACTION 

Approved SA Certification 



MUD 



No change 



Following consultation with SA, 
(b) I I original certification of compli- 
ance changed to non-compliance 



Following consultation with SA, 
(c) I I original certification of non- 
compliance changed to compliance 



20. REMARKS 



21. PHS REVIEWER CiiiAerc applicable) 



22. DATE 



23. DETERMINATION APPROVED 



24. DATE 



TO: BHI 

Division of Methods and Procedures 
Baltimore, Maryland 21233 



FORM SSA-1539 (2-66) 



XIV 



marily for the performance of diagnostic tests for 
other physicians. A laboratory maintained by a physi- 
cian for performing diagnostic tests primarily for his 
own patients would be exempt from the conditions, 
even if the laboratory does diagnostic tests on referral 
from other physicians. Diagnostic tests furnished by 
physicians working outside of a hospital and whose 
primary practice is directly attending patients, even 
though conducted partly through diagnostic proce- 
dures, are considered physicians' services rather than 
clinical laboratory services. 

Certification of independent laboratories. — Inde- 
pendent laboratories that wish to participate under 
the supplementary medical insurance part of the 
Medicare program must apply for and establish their 
eligibility to do so. The independent laboratory must 
demonstrate that it meets the specific statutory re- 
quirements. As a further condition, the statute re- 
quires that the independent laboratory meet such 
standards as the Secretary finds necessary to assure 
the health and safety of individuals for whom these 
tests are performed. 

The law makes provision for designated State 
health agencies, or other State agencies, to assist the 
Secretary in determining compliance with the condi- 
tions for coverage of services of independent labora- 
tories. The designated State agencies certify to the 
Secretary those laboratories which they find meet the 
conditions. Services provided in a laboratory that is 
determined by the Secretary to be in substantial 
compliance with the conditions relating to health and 
safety and which meet the statutory licensure re- 
quirement would be reimbursable under the medical 
insurance program. 

Initial certification by a State agency that an 
independent laboratory is in compliance with the 
conditions of participation is good for a period of 
1 year from the date of certification. The certi- 
fication remains in effect until such time as notice of 
revision is given. State agencies may resurvey labora- 
tories to ascertain continued compliance and may, 
at any time, certify to the Secretary of Health, 
Education, and Welfare that a laboratory is no 
longer in compliance. 



Source of the Data 

Each independent laboratory desiring to establish 
coverage of its services under Medicare submits 
a completed "Request for Approval" (Form SSA- 
1517, figure 1) through the State certification agency 
and the regional oflfice of the Social Security Admin- 
istration to the central office. The data on this form, 
and that on the "Certification and Transmittal" 
(Form SSA-1539, figure 2) , are the sources of the in- 
formation shown in the general taoies. The types of 
clinical tests or procedures that each laboratory is 



approved to perform are noted by the State agency 
surveyor in item 12 of the Certification and Trans- 
mittal form. 

Upon receipt of these forms in the central office, 
the information describing the characteristics of the 
independent laboratory is entered into a master pro- 
vider of services file for storage and retrieval pur- 
poses. The detailed information about each laboratory 
recorded in the statistical tapes includes such items 
as the State and county in which the laboratory is 
located, professional qualification of the director, 
types of clinical tests that each laboratory is approved 
to perform, and the number of technical personnel 
employed. This record is updated as laboratories are 
periodically recertified, or as new laboratories apply 
and are approved for participation, or as some leave 
the program. In addition, laboratories can request 
that they be certified eligible to perform additional 
tests at any time; conversely, laboratories can be 
found ineligible to perform tests for which they had 
earlier been found eligible. 

Independent laboratories may perform other clin- 
ical or radiological procedures (item III, Form SSA- 
1517, figure 1) not included as covered services of 
independent laboratories under the Medicare pro- 
gram. This information was requested for program 
evaluation purposes only and is not shown in this 
report. 



Reimbursable Test 



Procedures 



Payment can be made for the seven classes of 
laboratory tests and procedures listed below: 

Microbiology. — Identification of micro-organisms 
that cause disease in human beings. 

Serology. — Examination of the sera (liquid) com- 
ponent of blood, to determine whether antibodies of 
certain diseases identifiable through blood analysis 
are present. 

Clinical chemistry. — Examination of the chemical 
properties of specimens (usually blood) to determine 
the presence of abnormal substances or to determine 
pathological amounts of "normal" components of the 
human organism. 

Hematology. — Examination of the cellular struc- 
tures of the blood and bone marrow to identify and 
classify such diseases as anemias, leukemias, and 
blood-clotting disorders. 

Immunohematology. — Examination of immune bod- 
ies in blood by (a) blood group typing, (b) Rh 
studies, and (c) cross-matching of blood for trans- 
fusions. 

Tissue pathology. — Examination of abnormal char- 
acteristics of human tissue ; for example, detection of 
cancer by the use of biopsy, etc. Tissue is analyzed 
using both gross and microscopic procedures. 

Exfoliative cytology. — Examination of cells which 
detach themselves from the linings of passages in the 
body. 



XV 



Provisions of the Low 



The health insurance program for the aged, com- 
monly called Medicare, was enacted on July 30, 1965, 
as Title XVIII of the Social Security Act, and be- 
came effective on July 1, 1966. The program, a part 
of the 1965 amendments (Public Law 89-97), makes 
available two separate but coordinated insurance 
coverages — ^hospital insurance, covering nearly all 
persons aged 65 and over, and supplementary med- 
ical insurance, covering those persons in this age 
group who enroll voluntarily and pay the premium. 
Changes in the program, effective in 1968, were in- 
corporated in the 1967 amendments to the Social 
Security Act (Public Law 90-248) enacted on Janu- 
ary 2, 1968. 

Hospital Insurance Program 

The hospital insurance program (Part A of Medi- 
care) pays for a large portion of the costs of hospital 
and related post-hospital services. It is financed on 
a self-supporting basis through a tax on a portion of 
current earnings, paid by employees, employers, and 
self-employed persons. The proceeds of this tax are 
placed in the Hospital Insurance Trust Fund, from 
which reimbursements for benefits and administra- 
tive expenses incurred under the program are paid. 
The trust fund is reimbursed from general tax 
revenues for the costs of providing coverages for 
persons who qualify for hospital insurance but who 
are not eligible for monthly social security or rail- 
road retirement benefits. 



BENEFITS 

Inpatient hospital benefits. — The program covers 
the cost of covered services in a participating hospital 
for up to 90 days in a "benefit period" ( a period be- 
ginning with the first day of hospitalization and end- 
ing 60 days after discharge from a hospital or a 
skilled nursing home). Full payment is made for the 
first 60 days of hospitalization after a deductible of 
$40 has been paid. For each of the remaining 30 days 
in the benefit period, the patient pays a coinsurance 
amount of $10 a day. Each hospital insurance bene- 
ficiary also has a "lifetime reserve" of 60 additional 
days, subject to a copayment of $20 a dav. These 
additional days can be used at the patient's option 



whenever the 90 days covered in a benefit period are 
exhausted. The program also provides benefits for 
emergency services rendered in a nonparticipating 
hospital. Each nonparticipating hospital providing 
emergency services elects whether to bill the program 
or to charge its patients directly. If they bill the pro- 
gram, they are reimbursed on the basis of reasonable 
costs of covered services rendered. If they bill the 
patient, he pays the bill and submits the item^'zed bill 
to SSA for reimbursement. The reimbursement paid 
is 60 percent of reasonable charges for room and 
board and 80 percent of the charges for ancillary 
services. 

Inpatient tuberculosis and psychiatric hospital serv- 
ices are also covered. However, there is a lifetime 
limit of 190 days of care in a psychiatric hospital. 
Where an individual is a patient in a participating 
psychiatric hospital at the time he becomes entitled 
to hospital insurance, the number of days he was such 
an inpatient in the 150-day period immediately prior 
to his eligibility are deducted from his days of entitle- 
ment in that benefit period, but not from the lifetime 
limitation. 

Covered hospital services include hospital room and 
board in accommodations containing from two to four 
beds, nursing services except for private-duty nurs- 
ing, drugs and biologicals, and all those services 
ordinarily furnished by a hospital to its inpatients. 
Coverage under the hospital insurance program does 
not include the services of physicians (including 
radiologists, anesthesiologists, pathologists, and phys- 
iatrists) except for those services provided by in- 
terns or residents in training under approved teach- 
ing programs in a hospital. 

The cost of the first three pints of blood (or equi- 
valent amounts of packed red blood cells) furnished 
a patient during a benefit period is a deductible 
amount unless the patient arranges for replacement. 
Charges for any additional blood are covered under 
the program. 

Outpatient hospital diagnostic benefits. — These 
benefits cover the costs of tests and related services 
that are ordinarily furnished by a participating hos- 
pital to its outpatients for the purpose of diagnostic 
study. Such services are covered subject to a $20 de- 
ductible and 20-percent coinsurance for services fur- 
nished the beneficiary by the same hospital during a 



xvu 



20-day period. Beginning April 1, 1968, all outpatient 
hospital benefits are covered by the Supplementary 
Medical Insurance program and are no longer sub- 
ject to these limitations. 

Post-hospital home health care benefits. — These 
benefits cover the cost of visiting nurse services and 
related home health services for as many as 100 visits 
for up to a year following the patient's most recent 
discharge from a hospital or participating extended 
care facility, provided he has been confined for at 
least 3 consecutive days in a hospital. A home health 
plan must be developed by a physician and imple- 
mented within 14 days after the patient's discharge 
from the hospital or extended care facility. The home 
health care must be for further treatment of a condi- 
tion for which he received services as an inpatient in 
the hospital or extended care facility. 

Post-hospital extended care facility benefits. — The 
program pays for the reasonable cost of all covered 
inpatient services in participating extended care fa- 
cilities for up to 100 days of such care in any 
benefit period, following discharge from a hospital 
after a stay of 3 consecutive days or more, and ad- 
mission to an extended care facility within 14 days of 
discharge. Full payment is made for the first 20 days. 
For each of the remaining 80 days, the patient pays a 
coinsurance amount of $5 a day. 



Supplementary Medical Insurance Program 

The supplementary medical insurance program 
(Part B of Medicare) provides coverage of physi- 
cians' services, outpatient hospital services (begin- 
ning April 1, 1968), additional home health services, 
other medical services and supplies, and outpatient 
physical therapy services furnished by qualified pro- 
viders (beginning July 1, 1968). Individuals 65 years 
of age and over may enroll in the program regardless 
of whether they are eligible for social security retire- 
ment benefits. Monthly premiums paid by the indi- 
vidual are matched by the Federal Government and 
paid into the Supplementary Medical Insurance Trust 
Fund, which reimburses carriers for benefits and ad- 
ministrative expenses incurred under the program. 



charges can be reimbursed tlie effective maximum 
becomes $250. 

To preclude the possibility of having to meet a de- 
ductible twice in a short period of time, a "carry- 
over" provision is applied. Accordingly, covered ex- 
penses that are incurred in the last quarter of the 
year and counted toward the deductible in that year 
are also credited toward the deductible for the fol- 
lowing year. However, after March 31, 1968, the 
provisions concerning the deductible and the coin- 
surance do not apply to the services of radiologists 
and pathologists furnished to hospital inpatients. 

Covered under the program are such benefits as 
physicians' services, including home, hospital and 
office visits; services and supplies, including drugs 
and biologicals that cannot be self-administered, that 
are furnished as a part of a physician's professional 
service, most commonly in his office, and either ren- 
dered without charge or included in the physician's 
bills; diagnostic X-ray tests, diagnostic laboratory 
tests, and other diagnostic tests; X-ray; radium, and 
radioactive isotope therapy, including materials and 
the services of technicians; surgical dressings, 
splints, casts, and other devices used for reduction 
of fractures and dislocations; purchase or rental of 
durable medical equipment, including iron lungs, oxy- 
gen tents, hospital beds, and wheelchairs used in the 
patient's home (including an institution used as his 
home) ; ambulance service in cases where the use of 
other methods of transportat'on is contraindicated 
by the individual's condition; prosthetic devices 
(other than dental) that replace all or part of an in- 
ternal organ, including replacement of such devices; 
leg, arm, back, and neck braces, and artificial legs, 
arms, eyes, including replacement if required because 
of a change in the patient's physical condition; and 
100 home health visits during a calendar year — ^these 
visits being independent of those provided under the 
hospital insurance program. 

Also covered are hospital services, incident to 
physicians' services rendered to outpatients, includ- 
ing services beginning April 1, 1968 which were 
previously covered under the hospital insurance pro- 
gram, and outpatient physical therapy services be- 
ginning July 1, 1968. 



BENEFITS 

The SMI program pays for 80 percent of the al- 
lowed charges for covered physician services and 
other medical services (or 80 percent of reasonable 
cost) after the patient has met a deductible of $50 
during a calendar year. However, payment for out- 
patient psychiatric physician services is. limited to 
the le.sser of $250 or 50 percent of the allowed 
charges in any year after the $50 deductible has been 
met. The sum and percentage are derived from the 
statutory provision which permits an incurred ex- 
pense for out-of-hospital treatment of mental illness 
of only $312.50 or 62.5 percent of actual expenses in 
a calendar year. Since only 80 percent of allowed 



Eligibility 

The hospital insurance program. — Almost all per- 
sons aged 65 and over are eligible for benefits under 
the hospital insurance program. Included are those 
persons in this age group who are entitled to monthly 
social security cash benefits or payments from the 
railroad retirement system,^ regardless of whether 
they have applied for these cash benefits. During the 
period under consideration, a person could apply for 
hospital insurance protection even though he did not 
qualify for either social security cash benefits or a 
railroad retirement annuity if he had attained age 
65 before 1968, or after 1967 with not less than 3 



xvm 



quarters of social security coverage, whenever ac- 
quired, for each calendar year elapsing after 1966 
and before the year in which he had attained age 65. 
However, hospital insurance could not go into effect 
until the individual attained age 65. These classes 
of individuals were "deemed insured" under a special 
transitional provision. 

Federal employees who retired from the Federal 
service after July 1, 1960, and who had the oppor- 
tunity to be covered under the Federal Employees 
Health Benefits act of 1959, are ineligible for hos- 
pital insurance benefits under the transitional provi- 
sions. Also ineligible are aliens with less than 5 years 
of continuous residence in the United States, and 
those convicted of crimes against the security of the 
United States. 

Hospital insurance protection can be retroactive 
for as many as 12 months before the month an indi- 
vidual files his application for entitlement. For exam- 
ple, an individual may apply 11 months after he 
attains age 65 and still be entitled to benefits from 
the month he attained age 65. 

Supplementary medical insurance. — Persons en- 
titled to benefits under the hospital insurance pro- 
gram (Part A), retired Federal employees, and 
persons not eligible for hospital insurance under the 
transitional provisions may voluntarily participate 
in the SMI program. 

Enrollment. — Individuals may enroll in the SMI 
program only during specified periods — the initial 
and the general enrollment periods. The initial en- 
rollment period begins with the third month preced- 
ing the one in which an individual attains age 65 and 
ends 3 months after the month of attainment, a total 
period of 7 months. If he enrolls during the 3 months 
prior to the month in which he attains age 65, his 
coverage is effective with the month in which he at- 
tains age 65 ; if he enroPs during the month he attains 
age 65, his coverage begins the following month; if 
he enrolls in any of the 3 months after he attains age 
65, his coverage begins from 2 to 3 months after en- 
rollment, depending on how long he waited before 
enrolling. 

A general enrollment period was set between Octo- 
ber 1, 1967 and March 31, 1968 for those who did 
not enroll in the initial enrollment period. A person 
who enrolls during a general enrollment period may 
receive benefits starting on the first of July following 
the general enrollment period. An eligible individual 
must enroll within 3 years after the close of his ini- 
tial enrollment period or within 3 years after termi- 
nation of prior enrollment. 

An initial general enrollment period was set up at 
the beginning of the program for people who had at- 
tained age 65 before March 1, 1966. This enrollment 
period began September 1, 1965, and ended on May 
31, 1966, for coverage to begin on July 1, 1966. 

A State may enroll otherwise eligible individuals 
who receive cash payments under public assistance 
programs if the State requests such a State-Federal 



enrollment agreement to be established and pays the 
ncessary premiums. 

Enrollment terminates with the beginning of the 
month following the month of death. Up to April 1, 
1968, railroad retirement beneficiaries and individ- 
uals entitled to monthly cash social security benefits 
could terminate their enrollment voluntarily by noti- 
fying the Social Security Administration in writing 
during a general enrollment period of the desire to 
withdraw from the program. Under the 1967 amend- 
ments effective April 1, 1968, beneficiaries may give 
notice of withdrawal at any time and their coverage 
will be terminated at the close of the following 
calendar quarter. Other enrolled persons may termi- 
nate their coverage by withholding payment of pre- 
miums or by notifying the Social Security Adminis- 
tration in writing of the desire to withdraw from the 
program. The enrollee is provided a 90-day grace 
period for the payment of overdue premiums after 
which coverage is automatically terminated. An in- 
dividual who previously has terminated his enroll- 
ment may re-enroll only in a general enrollment 
period beginning within 3 years of the date his pre- 
vious enrollment had terminated. Re-enrollment, 
however, is allowed only once. 

Financing the Program 

Hospital Insurance. — The hospital insurance pro- 
gram is financed on a long-range, self-supporting 
basis through a separate schedule of increasing tax 
rates on the first $7,800 of earnings in employment 
covered under the Social Security Act. The same tax 
rate applies to employees, employers, and self-employed 
persons. This rate was 0.35 percent in 1966, 0.50 per- 
cent for 1967, O.eO for 1968-1972, and is scheduled to 
increase until it is 0.90 percent in 1987 and there- 
after. The proceeds of this tax and that collected 
from the railroad retirement system are placed in a 
Hospital Insurance Trust Fund from which reim- 
bursements for all benefits and administrative ex- 
penses incurred under the hospital insurance program 
are paid. The Hospital Insurance Trust Fund is reim- 
bursed from general tax revenues for the cost of 
providing coverage for the almost 21/4 million persons 
who qualify for hospital insurance but who are not 
entitled to monthly social security or railroad retire- 
ment benefits, that is, those "deemed insured." 

Supplementary Medical Insurance. — Premiums are 
paid into the Federal Supplementary Medical Insur- 
ance Trust Fund by those persons enrolled for supple- 
mentary medical insurance, (or on their behalf) and 
a matching amount is paid from general revenues by 
the Federal government. 

The premiums of persons receiving social security 
cash benefits, railroad retirement, or Federal civil 
service annuities are deducted from their monthly 
benefit checks. Persons not receiving monthly benefits 
are billed quarterly for premiums by the Social 



XIX 



Security Administration or Railroad Retirement 
Board and have a 90-day grace period in which to 
make payment. Premiums may be paid for as long 
as a year in advance, and for individuals financially 
unable to make quarterly payments, arrangements 
can be made for monthly payments. 

The premium rate of the supplementary medical in- 
surance program may be adjusted annually if med- 
ical costs rise. The law requires that the rate be set 
at an amount that will generate income to the fund 
sufficient to cover benefit payments and administra- 
tive costs incurred during the year. The monthly 
premium was $3 for each month beginning with July 
1966 and ending with March 1968; and $4 a month 
beginning April 1968. 

Under the 1967 amendments. States are permitted 
to enter into agreements with the Secretary, based on 
a request made before January 1, 1970, to buy in — 
that is, to pay the medical insurance premiums — for 
public assistance recipients aged 65 or over who were 
receiving money payments under an approved public 
assistance plan and for all aged persons eligible to 
receive medical assistance under an approved Title 
XIX plan. 

Administration of the Program 

Hospital Insurance. — Under the hospital insurance 
plan, groups or associations of providers, on behalf 
of their members, may nominate a national. State, 
or other public or private agency or organization to 
serve as intermediary in the claims process. A mem- 
ber of an association is free, however to receive pay- 
ment from an approved intermediary other than its 
association's nominee, if approved by the Secretary 
and agreeable to the intermediary selected. In addi- 
tion, a provider may deal directly with the Social 
Security Administration. 

The Secretary may enter into an agreement with 
a nominated organization if he finds this to be con- 
sistent with effective and efficient administration of 
the hospital insurance program. The intermediary 
makes payments to providers for covered items and 
services on the basis of reasonable cost determina- 
tions and assists in the application of safeguards 
against unnecessary utilization of covered services. 
The agreement may also call for (1) furnishing con- 
sultative services to assist providers to establish and 
maintain necessary fiscal records and otherwise 
qualify as providers of services, (2) serving as a 
center for communicating with providers, and (3) 
making audits of provider records. Generally speak- 
ing, the Social Security Administration utilizes the 
services of the hospital insurance intermediary in 
making payments for home health and outpatient hos- 
pital services covered under medical insurance. 

Payment may be made for a beneficiary for covered 
emergency inpatient hospital services or covered 
emergency outpatient hospital services where the 
hospital is not a participating facility and agrees not 



to charge the beneficiary for covered services. Such 
a hospital may be outside the United States if it is 
more accessible than the nearest hospital in the 
United States adequately equipped to treat the pa- 
tient. 

Requests for payment for covered services must be 
signed by the beneficiary (or someone for him, if he 
is unable to do so). Payments are made on the basis 
of reasonable costs for these services to participating 
providers of services, that is, hospitals, extended-care 
facilities, and home health agencies, v/ho have been 
certified for participation. 

In some instances, hospitals may bill for physician 
services rendered to inpatients. In these cases, in- 
terim payment is made by the Part A intermediary. 
Depending on the nature of the billing, funds are 
transferred from the SMI trust fund to the HI trust 
fund to cover the cost of these services, or funds are 
paid directly from the SMI trust fund. 

The intermediary selected by the provider reviews 
the claims for payment and pays the provider. Actual 
payment is made on the basis of an interim rate 
established between the provider and the intermedi- 
ary. Final settlement based on each provider's op- 
erating year is made on the basis of a cost report 
submitted by the provider, and subject to an inde- 
pendent audit. 

No payments can be made to Federal providers of 
services except for emergency services, unless this 
provider serves as a community institution. In addi- 
tion, payment cannot be made to a provider for those 
services it is obligated to render at public expense 
under Federal law or contract. 

Supplementary Medical Insurance. — Under the 
medical insurance program, the Secretary of Health, 
Education, and Welfare may enter into contracts 
with carriers for the performance of specified admin- 
istrative functions. The carriers' principal function is 
to determine whether charges are allowable (reason- 
able) and to make payment. 

The carrier selected by the Secretary of Health, 
Education, and Welfare to serve as an intermediary 
determines the allowed charges for bills submitted 
for each medical care service covered by the program 
and pays 80 percent of this amount after the $50 de- 
ductible has been met. 

The allowed charge for the service may be paid 
to the patient, or the patient may assign the bill for 
collection to the physician or other supplier of the 
service, if he is willing to accept assignment. In the 
former situation, the patient submits an itemized 
bill to the carrier and is reimbursed ; in the latter, the 
physician or other supplier submits the bill and is 
reimbursed. When the payment is made directly to 
the physician (or supplier) on assignment, the al- 
lowed or reasonable charge determined by the carrier 
is the total charge. In both situations, the patient is 
responsible for the first $50 of the charges for cov- 
ered services he receives during the year and the 
amount of the bill over 80 percent of the allowed 
charges. 



XX 



The law instructs the carrier to consider the fol- 
lowing criteria in determining the "allowed" charge : 

(1) the customary charge for the service generally- 
made by the physician or other person fur- 
nishing such services ; and 

(2) the prevailing charge in the locality by other 
physicians and suppliers for similar services. 

The law also specifies that the "allowed" charge can- 
not be higher than the charge applicable for the 
similar service rendered under comparable circum- 
stances to the carriers' own policy holders or sub- 
scribers. 

Carriers also have the authority and responsibility 
to determine, in a given case, whether a claim is for 
a covered service and to deny claims for noncovered 
or excluded items or services. In addition, carriers 
are to assist in the application of safeguards against 
unnecessary utilization of services furnished eligible 
individuals. 

Most services covered by the medical insurance 
program are rendered on a fee-for-service basis. 



However, services furnished under group practice 
prepayment plans are normally rendered in return 
for predetermined premium payments. In recognition 
of the need for special adaptation of the Medicare 
payment procedure for services rendered by group 
practice prepayment plans, the law provides that an 
organization which furnishes medical and other 
health services (or arranges for their availability) 
on a prepayment basis, may elect to be paid 80 per- 
cent of the reasonable cost of services in lieu of 80 
percent of the allowed charge for such services. 

The 1967 amendments to the Social Security Act 
introduced a time limit on filing of claims. For bills 
incurred in the supplementary medical insurance por- 
tion of the program after March 1968, claims must be 
filed no later than the close of the calendar year fol- 
lowing the year in which the services are furnished. 
For services provided during the last 3 months of the 
calendar year, bills may be submitted through the 
end of the second year following. 



XXI 



General Tables 



Notes 



Independent laboratory. — See page ix. 

Type of procedure. — See page x . 

Technical staff. — Includes all technical personnel 
other than laboratory directors. Figures are ex- 
pressed in full-time equivalents. 

Geographic classifications. — Based on the address of 
the laboratory. 

All areas: Consists of the United States, Guam, 
Puerto Rico, Virgin Islands, and other outlying 
areas. 



United States: Consists of the 50 States, and the 
District of Columbia. 

Other outlying areas: Consists of American Samoa, 
the Canal Zone, Canton Island, Caroline Islands, 
Mariana Islands, Marshall Islands, Midway Is- 
lands, and Wake Island. 



Symbols 

Quantity zero — 

Quantity more than but less than 0.05 0.0 



3.3-1 



Health Insurance 1968: Participating Independent Laboratories 

Table 3.3.1 NUMBER OF INDEPENDENT UBORATORIES, BY TRAINING OF LABORATORY DIRECTOR, AND TECHNICAL STAFF, REGION, 
DIVISION, AND STATE 

[See NOTES preceding General Tables] 





Total laboratories 


Training of laboratory director 


Technical staff 


Region, di\-i.sion, and State 


Number 


Percent 


Pathologist 


Other physician 


Non-physician 


Total 
number ' 


Average per 
laboratory 


Physician 


Non-physician 


Total 


2 71<. 


100.0 


977 


705 


1 032 


11 987.0 


4.4 


2 027.3 


9 959.7 


United States . . 


2 660 


98.0 


971 


694 


99 5 


11 842.1 


4.5 


1 998.3 


9 843.8 


REGIONS 




















Northeastern States - 


679 


25.0 


173 


93 


413 


2 534.7 


3.7 


259.5 


2 275.2 


North Central States _ . , . 


539 


19.9 


212 


124 


203 


2 615.3 


4.9 


426.9 


2 188.4 


South - - . - 


570 


21.0 


241 


171 


158 


3 188.5 


5.6 


644.9 


2 543.5 


West 


872 


32.1 


345 


306 


221 


3 503.6 


4.0 


657.0 


2 835.7 


DIVISIONS 




















The Northeastern States: 




















New England 


166 


6.1 


27 


24 


115 


559.3 


3.4 


97.0 


462.3 


Middle Atlantic _ ,_ 


513 


18.9 


146 


69 


298 


1 975.5 


3.9 


162.6 


1 812.9 


The North Central States: 




















East North Central . .. 


394 


14.5 


120 


98 


176 


1 550.5 


3.9 


193.9 


1 356.6 


West North Central 


I'iS 


5.3 


92 


26 


27 


1 064.8 


7.3 


233.0 


831.8 


The South : 




















South Atlantic 


222 


8.2 


93 


51 


78 


1 315.3 


5.9 


248.3 


I 067.0 


East South Central 


80 


2.9 


39 


25 


16 


431.6 


5.4 


78.0 


353.5 


West South Central 


268 


9.9 


109 


95 


64 


1 441.6 


5.4 


318.6 


1 123.0 


The West: 




















Mountain 


1*9 
723 


5.5 
26.6 


65 

280 


31 
275 


53 

168 


560.5 
2 943.1 


3.8 
4.1 


117.0 
550.0 


443.5 


Pacific . - 


2 393.2 


STATES 




















New England : 




















Maine _ 


2 


0.1 


- 


1 


1 


4.0 


2.0 


- 


4.0 


New Hampshire - . 


1 


0.0 


- 




1 


5.0 


5.0 


1.0 


4.0 


Vermont 


4 


O.l 


- 


2 


2 


8.0 


2.0 


3.0 


5.0 


Massachusetts _ 


91 


3.4 


19 


16 


56 


258.2 


2.8 


37.0 


221.3 


Rhode Island 


17 


0.6 


1 


2 


14 


46.2 


2.7 


4.0 


42.2 


Connecticut _ -_ 


51 


1.9 


7 


3 


41 


237.9 


4.7 


52.0 


185.9 


Middle Atlantic : 




















New York 


257 
129 


9.5 
4.8 


85 
25 


36 

20 


136 
84 


1 302.1 
263.4 


5.1 
2.0 


113.3 
20.3 


1 188.8 


New Jersey - - - - 


243.1 


Pennsylvania - - -- 


127 


4.7 


36 


13 


78 


410.0 


3.2 


29.0 


381.0 


East North Central : 




















Ohio 


106 
32 


3.9 
1.2 


28 
19 


30 

5 


48 
8 


355.9 
157.0 


3.4 
4.9 


22.0 
5.0 


333.9 


Indiana ._ 


152.0 


Illinois 


159 


5.9 


32 


46 


79 


513.5 


3.2 


79.8 


433.8 


Michigan ^ - 


79 


2.9 


27 


14 


38 


364.1 


4.6 


47.2 


317.0 


Wisconsin _. _ 


18 


0.7 


14 


1 


3 


160.0 


8.9 


40.0 


120.0 


West North Central : 




















Minnesota _ . 


12 


0.4 


9 


3 


- 


87.0 


7.3 


40.0 


47.0 


Iowa 


16 


0.6 


12 


2 


2 


115.5 


7.2 


19.0 


95.5 


Missouri -. . - 


59 
10 


2.2 
0.4 


35 
6 


8 
4 


16 


376.5 
110.0 


6.4 
11.0 


64.8 
32.0 


311.8 


North Dakota 


78.0 


South Dakota - 


* 


0.1 


4 


- 


- 


35.0 


8.8 


8.0 


27.0 


Nebraska - 


19 


0,7 


15 


2 


2 


226.5 


11.9 


48.0 


178.5 


Kansas 


25 


0.9 


11 


7 


7 


114.3 


4.6 


21.3 


93.0 


South Atlantic : 




















Delaware _- _ _ 


i, 


0.1 


3 




1 


34.5 


8.6 


23.0 


11.5 


Maryland _ - 


33 


1.2 


16 


9 


8 


201.2 


6.1 


27.5 


173.7 


District of Columbia - 


6 


0.2 


5 


1 


- 


100.0 


16.7 


12.0 


88.0 


Virginia _ 


23 


0.8 


18 


- 


5 


112.7 


4.9 


22.0 


90.7 


West Virginia 


8 


0.3 


1 


3 


4 


15.2 


1.9 


2.3 


12.9 


North Carolina 


11 


0.4 


6 


5 


- 


40.3 


3.7 


3.0 


37.3 


South Carolina - — 


6 


0.2 


5 


1 


- 


132.0 


22.0 


35.0 


97.0 


Georgia - - - - 


20 


0.7 


17 


3 


- 


182.3 


9.1 


18.0 


154.3 


Florida 


111 


4.1 


22 


29 


60 


497.1 


4.5 


105.5 


391.6 


East South Central : 




















Kentucky _ __ 


32 


1.2 


11 


18 


3 


98.6 


3.1 


27.0 


71.5 


Tennessee - - 


27 


1.0 


12 


4 


11 


135.5 


5.0 


17.0 


118.5 


Alabama 


12 


0.4 


11 


1 


- 


147.0 


12.3 


27.0 


120.0 


Mississippi - — 


9 


0.3 


5 


2 


2 


50.5 


5.6 


7.0 


43.5 


West South Central ; 




















Arkansas — - __ 


1« 


0.5 


8 


6 


- 


125.0 


8.9 


30.0 


95.0 


Louisiana - - - 


20 


0.7 


10 


9 


1 


138.0 


6.9 


29.0 


109.0 


Oklahoma . 


39 


1.4 


14 


11 


14 


218.5 


5.6 


63.0 


155.5 


Texas -- - 


195 


7.2 


77 


69 


49 


960.1 


4.9 


196.6 


753.5 


Mountain: 




















Montana 


8 


0.3 


4 


2 


2 


34.6 


4.3 


2.0 


32.5 


Idaho 


1 


0.0 


1 


_ 


- 


9.0 


9.0 


4.0 


5.0 


Wyoming _ 


3 


0.1 


3 


- 


- 


20.0 


5.7 


8.0 


12.0 


Colorado 


■i'l 


1.3 


13 


3 


18 


130.4 


3.8 


24.0 


105.4 


New Mexico _ : 


23 


O.B 


7 


9 


7 


79.5 


3.5 


7.0 


72.5 


Arizona 


54 


2.0 


24 


11 


19 


203.0 


3.8 


47.0 


156.0 


Utah 


13 


0.5 


5 


2 


6 


43.0 


3.3 


9.0 


34.0 


Nevada - 


13 


0.5 


8 


4 


1 


41.0 


3.2 


15.0 


25.0 


Pacific : 




















Washington 


65 


2.4 


38 


12 


IS 


277.0 


4.3 


30.0 


247.0 


Oregon 


31 


1.1 


20 


2 


9 


220.5 


7.1 


15.0 


205.5 


California 


609 


22.4 


213 


253 


143 


2 349.1 


3.9 


485.0 


1 854.2 


Alaska 


2 


0.1 


1 


1 


- 


21.0 


10.5 


3.0 


18.0 


Hawaii 


16 


0.6 


8 


7 


1 


75.5 


4.7 


17.0 


58.5 


Outlying areas: 




















Guam 


53 


2.0 


5 


11 


37 


142.9 


2.7 


28.0 


— 


Puerto Rico 


114.9 


Virgin Islands 


1 


0.0 


1 




- 


2.0 


2.0 


1.0 


1.0 


Other outlying areas -__ - _ ^ 








- 


- 


- 


- 


~ 


~ 



' Includes all technical personnel other than directors-expressed in full-time equivalents. 



3.3-2 



Health Insurance 1968: 

Table 3.3.2 NUMBER OF INDEPENDENT LABORATORIES, BY TYPE OF PROCEDURE APPROVED, 
RECTOR AND TECHNICAL STAFF, REGION, DIVISION, AND STATE 

[See NOTES preceding General Tables] 



Participating Independent Laboratories 
TRAINING OF LABORATORY Dl- 



Region, division, State, and 
tjTJe of procedure 



Total laboratories 



Number 



Percent 



Training of laboratory director 



Pathologist Other physician Non-physician 



Technical staff 



Total 
number I 



Average per 
laboratory 



Physician 



Non-physician 



ALL AREAS 

All laboratories 

Microbiology 

Serologj' 

Clinical chemistry 

Hematology. __ 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures ._ 

UNITED STATES 

All laboratories 

Microbiology 

Serology - 

Clinical chemistry 

Hematology _ 

Immunohematology 

Tissue pathology 

Exfoliative cytology. 

All procedures 

NORTHEASTERN STATES 

All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 

NORTH CENTRAL STATES 

All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology- 

Tissue pathology 

Exfoliative cytology 

All procedures 

SOUTH 

All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 

WEST 

All laboratories 

Microbiology 

Serology _ 

Clinical chemistry- 

Hematology 

Immunohematology 

Tissue pathology _ 

Exfoliative cytology. 

All procedures 

NEW ENGLAND 

All laboratories 

Microbiology _ 

Serology 

Clinical chemistry 

Hematology--. 

Immunohematology- 

Tissue pathology 

Exfoliative cytology 

All procedures 

MIDDLE ATLANTIC 

All laboratories 

Microbiology 

Serology 

Clinical chemistry- 

Hematology 

Immunohematology _ 

Tissue pathology 

Exfoliative cytology. 

All procedures 



2 714 

2 157 

1 742 

2 502 
2 513 
1 455 

859 
939 
734 



110 
735 
453 
468 
450 
853 
932 
733 



679 

462 
444 
618 
624 
273 
136 
160 
96 



539 

404 
434 
497 
500 
299 
211 
231 
191 



570 

491 
294 
529 
534 
316 
241 
260 
221 



872 

753 
563 
809 
810 
562 
265 
281 
225 



166 

111 
97 
159 
159 
76 
17 
27 
14 



513 

351 
347 
459 
465 
197 
119 
133 
82 



100.0 

79.5 
64.2 
92.2 
92.6 
53.6 
31.7 
34.6 
27.0 



100.0 

79.3 
65.2 
92.2 
92.8 
54.5 
32.1 
35.0 
27.6 



100.0 

68.0 
65.4 
91.0 
91.9 
40.2 
20.0 
23.6 
14.1 



100.0 

75.0 
80.5 
92.2 
92.8 
55.5 
39.1 
42.9 
35.4 



100.0 

86.1 
51.6 
92.8 
93.7 
55.4 
42.3 
45.6 
38.8 



100.0 

86.4 
64.6 
92.8 
92.9 
64.4 
30.4 
32.2 
25.8 



100.0 

66.9 
58.4 
95.8 
95.8 
45.8 
10.2 
16.3 
8.4 



100.0 

68.4 
67.6 
89.5 
90.6 
38.4 
23.2 
25.9 
16.0 



977 

807 
775 
862 
874 
788 
775 
820 
667 



971 

806 
774 
861 
873 
787 
769 
814 
666 



173 

127 
123 
141 
146 
117 
124 
138 
90 



212 

187 
193 
196 
198 
193 
195 
204 
179 



241 

212 
203 
217 
221 
212 
206 
221 
192 



345 

280 
255 
307 
308 
265 
244 
251 
205 



19 
18 
24 
25 
20 
16 
20 
13 



146 

108 
105 
117 
121 

97 
108 
118 

77 



705 

553 

357 

661 

657 

382 

58 

84 

47 



694 

542 

356 

650 

647 

378 

58 

84 

47 



55 
44 

85 
83 
37 

6 
10 

2 



124 

69 

81 

115 

113 

62 

10 

18 

8 



171 

147 
52 
159 
160 
75 
27 
32 
23 



306 

271 

179 

291 

291 

204 

15 

24 

14 



12 
8 
23 
22 
11 



43 

36 

62 

61 

26 

6 

9 

2 



032 


11 


987.0 


797 


10 


470.9 


610 


8 


821.7 


979 


11 


365.5 


982 


11 


338.0 


285 


8 


551.2 


26 


6 


287.5 


35 


6 


593.7 


20 


5 


827.2 


995 


11 


842.1 


762 


10 


333.5 


605 


8 


811.7 


942 


11 


228.1 


948 


11 


208.6 


285 


8 


526.2 


26 


6 


278.0 


34 


6 


577.2 


20 


5 


825.2 



280 


2 


068.4 


277 


1 


835.8 


392 


2 


317.6 


395 


2 


310.2 


119 


1 


443.9 


6 


1 


071.6 


12 


1 


127.1 


4 




851.4 



148 


2 


232.5 


160 


2 


341.1 


186 


2 


513.3 


189 




520.8 


44 




984.6 


6 




702.3 


9 




770.6 


4 




606.8 



132 


2 940.9 


39 


2 221.3 


153 


3 072.0 


153 


3 084.2 


29 


2 432.7 


8 


2 074.9 


7 


2 154.4 


6 


2 018.7 



221 

202 

129 

211 

211 

93 

6 

6 

6 



115 

80 

71 

112 

112 

45 

1 

6 

1 



298 

200 

206 

280 

283 

74 

5 

6 

3 



3 503.6 



3 091.7 

2 413.5 

3 325.2 
3 293.3 
2 665.0 
1 429.2 
1 525.2 
1 348.3 



559.3 

456.8 
398.7 
546.3 
540.3 
353.6 
204.5 
241.0 
194.5 



611.7 
437.1 
771.4 
770.0 
090.4 
867.1 
886.1 
657.0 



4.4 

4.9 
5.1 
4.5 
4.5 
5.9 
7.3 
7.0 
7.9 



4.5 

4.9 
5.1 
4.6 
4.5 
5.9 
7.4 
7.1 
7.9 



3.7 

4.5 
4.1 

3.8 
3.7 
5.3 
7.9 
7.0 
8.9 



4.9 

5.5 

5.4 
5.1 
5.0 
6.6 
8.1 
7.7 
8.4 



5.6 

6.0 
7.6 
5.8 
5.8 



4.0 

4.1 
4.3 
4.1 
4.1 
4.7 
5.4 
5.4 
6.0 



4.1 
4.1 
3.4 
3.4 
4.7 

12.0 
8.9 

13.9 



3.9 

4.6 
4.1 
3.9 
3.8 
5.5 
7.3 
6.7 
8.0 





778.2 


8 


692.7 




469.2 


7 


352.6 




906.1 


9 


459.4 




906.3 


9 


431.7 




482.6 


7 


068.7 




110.5 


5 


177.1 




177.7 


5 


416.0 




035.5 


4 


791.7 



752.2 
468.2 
880.1 
880.3 
475.6 
106.5 
170.7 
034.5 



259.5 

193.8 
185.2 
231.5 
230.5 
162.8 
142.5 
161.5 
118.5 



425.9 

349.3 
359.4 
402.4 
401.4 
320.0 
256.0 
268.7 
233.0 



644.9 

599.9 
460.8 
619.9 
624.9 
505.4 
432.8 
452.4 
421.8 



97.0 

76.3 
74.0 
91.0 
92.0 
70.3 
56.3 
64.3 
52.3 



162.6 

117.6 

111.3 

140.6 

138.6 

92.6 

86.3 

97.3 

66.3 



9 843.8 



8 581.3 
7 343.6 

9 348.0 
9 328.3 
7 050.7 
5 171.6 
5 406.5 
4 790.7 



2 275.2 



874.6 
550.6 
086.1 
079.7 
281.1 
929.1 
965.5 
732.9 



2 188.4 

1 883. 2 

1 981.7 

2 110.9 
2 119.4 
1 564.6 
1 445.3 
1 501.9 
1 373.8 



341.0 
760.6 
452.1 
459.4 
927.3 
642.2 
702.0 
596.9 



509.2 


2 


482.5 


462.7 


1 


950.7 


626.2 


2 


599.0 


623.5 


2 


659.9 


487.3 


2 


177.7 


275.2 


1 


154.0 


288.2 


1 


237.0 


261.2 


1 


08T.1 



452.3 

380.5 
324.8 
455.3 
448.3 
283.3 
148.2 
176.7 
142.2 



494.1 
325.8 
630.8 
631.4 
997.8 
780.9 
788.9 
590.7 



' Includes all technical personnel other than directors-expressed in full-time equivalents. 



3.3-3 



Health Insurance 1968: Participating Independent Laboratories 



Table 3.3.2 NUMBER OF INDEPENDENT LABORATORIES, BY TYPE OF PROCEDURE APPROVED, 
RECTOR AND TECHNICAL STAFF, REGION, DIVISION, AND STATE— Con. 

[See NOTES preceding General Tables] 



TRAINING OF LABORATORY Dl- 



Region, division, State, and 
type of procedure 



Total laboratories 



Percent 



Training of laboratory director 



Pathologist Other physician Non-physician 



Technical staff 



Total 
number' 



Average per 
laboratory 



Physician 



Non-physician 



EAST NORTH CENTRAL 
All laboratories 



Microbiology 

Serology 

Clinical chemistry __. 

Hematology 

Immunohematology _ 

Tissue pathology 

ExfoUative cytology. 
All procedures 



WEST NORTH CENTRAL 
All laboratories 



Microbiology ..- 

Serology 

Clinical chemistry __. 

Hematology 

Immunohematology _ 

Tissue pathology 

Exfoliative cytology- 
All procedures 



SOUTH ATLANTIC 
All laboratories 



Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology _ 

Tissue pathology 

Exfoliative cytology.. 
All procedures 



EAST SOUTH CENTRAL 
All laboratories 



Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology _ 

Tissue pathology 

ExfoUative cytology- 
All procedures 



WEST SOUTH CENTRAL 
All laboratories 



Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology _ 

Tissue pathology 

Exfoliative cytology- 
All procedures 



MOUNTAIN 
All laboratories. -- 



Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology _ 

Tissue pathology 

Exfoliative cytology,. 
All procedures 



PACIFIC 
All laboratories- 



Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology . 

Tissue pathology 

Exfoliative cytology.. 
All procedures 



ALABAMA 
All laboratories... 



Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology . 

Tissue pathology 

Exfoliative cytology- 
All procedures 



394 

277 
329 
361 
365 
193 
118 
13'i 
102 



145 

127 

105 

136 

135 

106 

93 

97 

89 



222 

180 

103 

203 

204 

105 

83 

95 

74 



64 
52 
71 
72 
38 
38 
40 
33 



268 

247 
139 
255 
258 
173 
120 
125 
114 



149 

121 

87 
132 
134 
82 
58 
60 
54 



723 

632 
476 
677 
676 
480 
207 
221 
171 



100.0 

70.3 
83.5 
91.6 
92.6 
49.0 
29.9 
34.0 
25.9 



87.6 
72.4 
93.8 
93.1 
73.1 
64.1 
66.9 
61.4 



100.0 

81.1 
46.4 
91.4 
91.9 
47.3 
37.4 
42.8 
33.3 



100.0 

80.0 
65.0 
86.8 
90.0 
47.5 
47.5 
50.0 
41.3 



100.0 

92.2 
51.9 
95.1 
96.3 
64.6 
44.8 
46.6 
42.5 



100.0 

81.2 
58.4 
88.6 
89.9 
55.0 
38.9 
40.3 
36.2 



100.0 

87.4 
65.8 
93.6 
93.5 
66.4 
28.6 
30.6 
23.7 



11 


91.7 


10 


10 


83.3 


10 


11 


91.7 


10 


12 


100.0 


11 


10 


83.3 


10 


11 


91.7 


11 


11 


91.7 


11 


10 


83.3 


10 



120 

100 
105 
107 
108 
104 
104 
113 
92 



87 
88 
89 
90 
89 
91 
91 
87 



77 
75 
82 
83 
78 
73 
85 
68 



32 
32 
32 
34 
33 
34 
36 
30 



109 

103 

96 

103 

104 

101 

99 

100 

94 



55 
52 
58 
58 
55 
53 
54 
49 



280 

225 
203 
249 
250 
210 
191 
197 
156 



51 
73 
93 
93 
50 

8 
13 

6 



18 

8 

22 

20 

12 

2 

5 

2 



38 

14 

45 

46 

13 

5 

6 

3 



21 
6 
23 
23 
3 
3 
3 
2 



88 
32 
91 
91 
59 
19 
23 
18 



21 

15 

29 

28 

13 

3 

4 

3 



275 

250 

164 

262 

263 

191 

12 

20 

11 



126 




257.7 


151 




403.4 


161 




471.0 


164 




496.0 


39 




046.8 


6 




818.1 


8 




877.8 


4 




738.6 



22 

9 

25 

25 

5 



65 
14 
76 
75 
14 
5 



11 

14 

16 

15 

2 

1 

1 

1 



56 

11 

61 

63 

13 

2 

2 

2 



45 

20 

45 

48 

14 

2 

2 

2 



974.8 
937.8 
042.3 
024.8 
937.8 
884.3 
892.8 
868.3 



1 315.3 

1 171.3 
874.9 
1 274.1 
1 280.1 
951.0 
820.7 
866.0 
804.7 



431.6 

369.6 
335.6 
383.6 
384.6 
320.6 
334.6 
348.6 
304.6 



1 441.6 

1 400.0 

1 010.8 

1 414.3 

1 419.6 

I 161.1 

919.6 

939.7 

909.3 



560.5 

485.6 
434.9 
513.1 
515.1 
439.9 
367.3 
380.8 
358.9 



157 


2 


606.1 


109 


1 


978.6 


166 


2 


812.1 


163 


2 


778.2 


79 


2 


225.1 


4 


1 


061.9 


4 


1 


144.4 


4 




989.4 



147.0 

144.0 
143.0 
144.0 
147.0 
143.0 
146.0 
146.0 
143.0 



5 
3 
1 
1 
4 
9 
6.6 
7.2 



7.3 

7.7 
8.9 
7.7 
7.6 
8.8 
9.5 
9.2 
9.8 



5.9 

6.5 
8.5 
6.3 
6.3 
9.1 
9.9 
9.1 
10.9 



5.4 

5.8 
6.5 
5.4 
5.3 
8.4 
8.6 
8.7 
9.2 



5.4 

5.7 
7.3 
5.5 
5.5 
6.7 
7.7 
7.5 
8.0 



3.8 

4.0 
5.0 
3.9 
3.8 
5.4 
6.3 
6.3 
6.6 



4.1 
4.2 
4.2 
4.1 
4.6 
5.1 
5.2 
5.8 



14.3 
13.3 
13.3 
14.3 



193.9 

153.3 

164.4 

175.4 

176.4 

130.0 

82.0 

95.7 

66.0 



233.0 

196.0 
195.0 
227.0 
223.0 
190.0 
174.0 
173.0 
167.0 



248.3 

224.3 
186.8 
241.3 
243.3 
195.6 
177.6 
189.8 
174.8 



78.0 

68.0 
54.0 
66.0 
69.0 
54.0 
55.0 
60.0 
50.0 



318.6 



307.6 
220.0 
310.6 
312.6 
255.6 
200.0 
202.6 
197.0 



117.0 

94.0 
88.0 
98.0 
99.0 
91.0 
77.0 
82.0 
75.0 



27.0 

26.0 
26.0 
26.0 
27.0 
26.0 
27.0 
27.0 
26.0 



104.4 
239.0 
295.6 
317.6 
916.8 
736.1 
782.2 
672.6 



831.6 

778.8 
742.8 
815.3 
801.8 
747.8 
710.3 
719.6 
701.3 



947.0 
688.1 
032.8 
036.6 
755.2 
642.9 
676.3 
629.9 



353.6 

301.6 
281.6 
315.6 
315.6 
266.6 
279.6 
288.6 
254.6 



092.4 
790.8 
103.7 
107.0 
905.5 
719.6 
737.1 
712.3 



443.5 

391.6 
346.9 
415.1 
416.1 
348.9 
290.3 
298.8 
283.9 



515.2 


2 


090.9 


374.7 


1 


603.6 


528.2 


2 


283.9 


524.5 


2 


253.8 


396.3 


I 


628.8 


196.2 




863.7 


206.2 




938.2 


166.2 




603.2 



120.0 

118. 
117.0 
118.0 
120.0 
117.0 
119.0 
119.0 
117.0 



' Includes all technical personnel other than directors-expressed in full-time equivalents. 



3.3-4 



Health Insurance 1968: 

Table 3.3.2 NUMBER OF INDEPENDENT LABORATORIES, BY TYPE OF PROCEDURE APPROVED, 
RECTOR AND TECHNICAL STAFF, REGION, DIVISION, AND STATE— Con. 

[See NOTES preceding General Tables] 



Participating Independent Laboratories 
TRAINING OF LABORATORY Dl- 



Region, division. State, and 
type of procedure 



Total laboratories 



Number 



Percent 



Training of laboratory director 



Pathologist Other physician Non-physician 



Technical staff 



Total 
number ' 



Average per 
laboratory 



Physician 



Non-physician 



ALASKA 
All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology- 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures _ 

ARIZONA 

All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology __ 

Exfoliative cytology. 

All procedures 

ARKANSAS 
All laboratories 

Microbiology _ 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology. 

All procedures ._ 

CALIFORNIA 

All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 

COLORADO 

All laboratories.. 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology. 

All procedures 

CONNECTICUT 
All laboratories 

Microbiology 

Serology 

Clinical chemistry. 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 

DELAWARE 
All laboratories 

Microbiology 

Serology 

Clinical chemistry _ 

Hematology _ . 

Immunohematology _ 

Tissue pathology 

Exfoliative cytology. 

All procedures 

DISTRICT OF COLUMBIA 

All laboratories 

Microbiology 

Serology 

Clinical chemistry- 

Hematology.. 

Immunohematology 

Tissue pathology 

Exfoliative cytology. 

All procedures 



2 


100.0 


2 


100.0 


2 


100.0 


2 


100. 


2 


100.0 


2 


100.0 


2 


100.0 


2 


100.0 



48 
51 
50 
35 
21 
22 
20 



609 

542 

391 
574 
569 
409 
154 
163 
128 



100.0 



88.9 
88.9 
94.4 
92.6 
64.8 
38.9 
40.7 
37.0 



14 


100.0 


14 


100.0 


14 


100.0 


13 


92.9 


12 


85.7 


12 


85.7 


12 


85.7 


12 


85.7 



100. 

89.0 
64.2 
94.3 
93.4 
67.2 
25.3 
26.8 
21.0 



39 


76.5 


47 


92.2 


51 


100.0 


51 


100.0 


9 


17.6 


3 


5.9 


8 


15.7 


2 


3.9 



4 


100.0 


4 


100.0 


4 


100. 


4 


100.0 


4 


100. 


3 


75.0 


3 


75.0 


3 


75.0 



5 


83.3 


5 


83.3 


5 


83.3 


5 


83.3 


5 


83.3 


5 


83.3 


6 


100.0 


5 


83.3 



23 
22 
22 
22 
21 
20 
21 
19 



213 

173 
151 
190 
188 
162 
141 
144 
116 



30 


88.2 


12 


12 


35.3 


12 


29 


85.3 


12 


30 


88.2 


12 


14 


41.2 


12 


13 


38.2 


13 


13 


38.2 


13 


12 


35.3 


12 



8 
10 
11 
11 

7 
1 
1 
1 



253 

233 

152 

242 

243 

179 

10 

16 

9 



17 
16 
18 
17 

7 



30 
39 
41 
41 



21.0 

21.0 
21.0 
21.0 
21.0 
21.0 
21.0 
21.0 
21.0 



203.0 

189.0 
193.0 
195.0 
195.0 
165.0 
130.0 
137.0 
127.0 



125.0 

125.0 
125.0 
125.0 
117.0 
114.0 
114.0 
114.0 
114.0 



136 


2 


183.1 


88 


1 


531.1 


142 


2 


270.1 


138 


2 


249.2 


68 


1 


799.6 


3 




792.4 


3 




813.9 


3 




746.9 


18 




130.4 


17 




120.0 


- 




94.3 


14 




121.0 


16 




121.0 


1 




97.8 



96.7 
96.7 
94.3 



237.9 

222.9 
231.9 
237.9 
237.9 
147.5 
127.0 
150.5 
126.0 



34.5 

34.5 
34.5 
34.5 
34.5 
34.5 
33.0 
33.0 
33.0 



100.0 

96.0 
96.0 
96.0 
96.0 
96.0 
96.0 
100.0 
96.0 



10.5 

10.5 
10.5 
10.5 
10.5 
10.5 
10.5 
10.5 
10.5 



3.8 

3.9 
4.0 
3.8 
3.9 
4.7 
6.2 
5.2 
6.4 



8.9 

8.9 
8.9 
8.9 
9.0 
9.5 
9.5 
9.5 
9.5 



3.9 

4.0 
3.9 
4.0 
4.0 
4.4 
5.1 
5.0 
5.8 



3.8 

4.0 
7.9 
4.2 
4.0 
7.0 
7.4 
7.4 
7.9 



4.7 

5.7 

4.9 

4.7 

4.7 

16.4 

42.3 

18.8 

63.0 



8.6 

8.6 

8.6 

8.6 

8.6 

8.6 

11.0 

11.0 

11.0 



16.7 

19.2 
19.2 
19.2 
19.2 
19.2 
19.2 
16.7 
19.2 



3.0 

3.0 
3.0 
3.0 
3.0 
3.0 
3.0 
3.0 
3.0 



47.0 

45.0 
44.0 
43.0 
43.0 
37.0 
35.0 
36.0 
33.0 



30.0 

30.0 
30.0 
30.0 
27.0 
27.0 
27.0 
27.0 
27.0 



485.0 

461.2 
324.7 
465.2 
463.5 
356.3 
160.2 
167.2 
152.2 



24.0 

23.0 
20.0 
23.0 
23.0 
22.0 
20.0 
20.0 
20.0 



52.0 

50.0 
51.0 
52.0 
52.0 
47.0 
44.0 
47.0 
44.0 



23.0 

23.0 
23.0 
23.0 
23.0 
23.0 
23.0 
23.0 
23.0 



12.0 

12.0 
12.0 
12.0 
12.0 
12.0 
12.0 
12.0 
12.0 



18.0 

18.0 
18.0 
18.0 
18.0 
18.0 
18.0 
18.0 
18.0 



156.0 



144. 
149. 
152. 
152. 
128. 

95. 
101.0 

94.0 



95.0 

95.0 
95.0 
95.0 
90.0 
87.0 
87.0 
87.0 
87. 



721.9 
206.3 
804.9 
785.8 
443.3 
632.2 
646.7 
594.7 



106.4 

97.0 
74.3 
98.0 
98.0 
75.8 
76.7 
76.7 
74.3 



185.9 

172.9 
180.9 
185.9 
185.9 
100.5 

83.0 
103.5 

82.0 



11.5 

11.5 
11.5 
11.5 
11.5 
11.5 
10.0 
10.0 
10.0 



' Include.s all technical personnel other than directors-expressed in full-time equivalents. 



3.3 5 



Health Insurance 1968: Participating Independent Laboratories 



Table 3.3.2 NUMBER OF INDEPENDENT LABORATORIES, BY TYPE OF PROCEDURE APPROVED, TRAINING OF LABORATORY DI- 
RECTOR AND TECHNICAL STAFF, REGION, DIVISION, AND STATE— Con. 

[See NOTES preceding General Tables] 



Region, division, State, and 
type of procedure 



Total laboratories 



Number 



Percent 



Training of laboratory director 



Pathologist Other physician Non-physician 



Technical staff 



Total 
number I 



Average per 
laboratory 



Physician 



Non-physician 



FLORIDA 
All laboratories _ _ 

Microbiology .__ 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 

GEORGIA 

All laboratories -- 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 

HAWAII 

All laboratories.- 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 

IDAHO 
AH laboratories. - 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 

ILLINOIS 

All laboratories.. 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 

INDIANA 

All laboratories.. 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology. 

All procedures 

IOWA 

All laboratories. - 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 

KANSAS 

All laboratories.. 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 



111 

96 
25 
108 
107 
21 
22 
20 
19 



159 

107 

123 

142 

145 

78 

30 

37 

26 



100.0 

86.5 
22.5 
97.3 
96.4 
18.9 
19.8 
18.0 
17.1 



10 


62.5 


13 


81.3 


16 


100.0 


16 


100.0 


6 


37.5 


3 


18.8 


5 


31.3 


3 


18.8 



100.0 

67.3 
77.4 
89.3 
91.2 
49.1 
18.9 
23.3 
16.4 



21 
18 
22 
22 
19 
17 
18 
17 



18 


90.0 


15 


15 


75.0 


14 


18 


90.0 


15 


18 


90.0 


15 


18 


90.0 


15 


16 


80.0 


15 


18 


90.0 


17 


15 


75.0 


14 



27 
26 
27 
28 
24 
25 
29 
22 



24 


75.0 


18 


31 


96.9 


18 


31 


96.9 


18 


31 


96.9 


18 


29 


90.6 


18 


21 


65.6 


19 


22 


68.8 


19 


20 


62.5 


18 



15 


93.8 


12 


12 


75.0 


12 


16 


100.0 


12 


15 


93.8 


12 


14 


87.5 


12 


12 


75.0 


12 


12 


75.0 


12 


12 


75.0 


12 



23 


92.0 




12 


48.0 




22 


88.0 




24 


96.0 




13 


52.0 




12 


48.0 




12 


48.0 




12 


48.0 





23 
3 
27 
27 
1 
3 
1 
1 



23 

28 

45 

46 

27 

3 

5 

2 



59 
58 
1 
2 
1 
1 



57 

69 

70 

71 

27 

2 

3 

2 



497.1 

466.6 
207.8 
492.1 
492.1 
208.8 
206.8 
206.4 
200.8 



182.3 

177.3 
170.0 
177.3 
177.3 
177.3 
173.0 
177.0 
170.0 



75.5 

52.5 
66.5 
75.5 
75.5 
41.5 
33.5 
36.5 
33.5 



513.5 

380.4 
429.6 
475.5 
501.5 
317.5 
167.5 
188.1 
157.5 



157.0 

152.0 
157.0 
157.0 
157.0 
153.0 
149.0 
149.0 
149.0 



115.5 

111.5 
101.0 
115.5 
111.5 
110.5 
101.0 
101.0 
101.0 



114.3 

111.3 
95.3 
110.3 
111.3 
99.3 
95.3 
95.3 
95.3 



4.5 

4.9 
8.3 
4.6 
4.6 
9.9 
9.4 
10.3 
10.6 



9.1 

9.9 

11.3 

9.9 

9.9 

9.9 

10.8 

9.8 

11.3 



4.7 

5.3 
5.1 
4.7 
4.7 
6.9 

11.2 
7.3 

11.2 



3.2 

3.6 
3.5 
3.3 
3.5 
4.1 
5.6 
5.1 
6.1 



4.9 

6.3 
5.1 
5.1 
5.1 
5.3 
7,1 
6.8 
7.5 



7.2 

7.4 
8.4 
7.2 
7.4 
7.9 
8.4 
8.4 



4.6 

4.8 
7.9 
5.0 
4.6 
7.6 
7.9 
7.9 
7.9 



105.5 

97.5 
60.0 
103.5 
103.5 
61.0 
60.0 
61.0 
58.0 



18.0 

18.0 
18.0 
18.0 
18.0 
18.0 
18.0 
18.0 
18.0 



17.0 

11.0 

15.0 

17.0 

17.0 

6.0 

4.0 

5.0 

4.0 



79.8 

64.8 
67.8 
74.8 
77.8 
44.0 
13.0 
16.0 
10.0 



5.0 

5.0 
5.0 
5.0 
5.0 
5.0 
5.0 
5.0 
5.0 



19.0 

19.0 
17.0 
19.0 
19.0 
19.0 
17.0 
17.0 
17.0 



21.3 

21.3 
18.3 
21.3 
21.3 
21.3 
18.3 
18.3 
18.3 



391.6 

369.1 
147.8 
388.6 
388.6 
147.8 
146.8 
145.4 
142.8 



164.3 

159.3 
152.0 
159.3 
159.3 
159.3 
155.0 
159.0 
152.0 



58.5 

41.5 
51.5 
58.5 
58.5 
35.5 
29.5 
31.5 
29.5 



433.8 

315.7 
361.9 
400.8 
423.8 
273.5 
154.5 
172.1 
147.5 



152.0 

147.0 
152.0 
152.0 
152.0 
148.0 
144.0 
144.0 
144.0 



96.5 

92.5 
84.0 
96.5 
92.5 
91.5 
84.0 
84.0 
84.0 



93.0 

90.0 
77.0 
89.0 
90.0 
78.0 
77.0 
77.0 
77.0 



' Includes all technical personnel other than directors-expressed in full-time equivalents. 



3.3-6 



Health Insurance 1968: 

Table 3.3.2 NUMBER OF INDEPENDENT LABORATORIES, BY TYPE OF PROCEDURE APPROVED, 
RECTOR AND TECHNICAL STAFF, REGION, DIVISION, AND STATE— Con. 

[See NOTES preceding General Tables] 



Participating Independent Laboratories 
TRAINING OF LABORATORY Dl- 



Region, division, State, and 
type of procedure 



Total laboratories 



Number 



Percent 



Training of laboratory director 



Pathologist Other physician Non-physician 



Technical staff 



Total 
number ' 



Average per 
laboratory 



Physician 



Non-physician 



KENTUCKY 

All laboratories 

Microbiology - 

Serolog>' 

Clinical chemistry _ 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures __ -- 

LOUISIANA 

All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

ExfoUative cytology. 

All procedures 

MAINE 
All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology. 

All procedures 

MARYLAND 

All laboratories 

Microbiology 

Serology 

Clinical chemistry _ 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 

MASSACHUSETTS 
All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology __ 

Exfoliative cytology. 

All procedures 

MICHIGAN 

All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 

MINNESOTA 
All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology _ 

Tissue pathology 

Exfoliative cytology. 

All procedures 

MISSISSIPPI 

All laboratories 

Microbiology 

Serology 

Clinical chemistry _ 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology. 

All procedures 



28 
13 
31 
30 
10 



53 
39 
86 
84 
56 
12 
17 
10 



66 
67 
73 
74 
30 
26 
27 
22 



100.0 

87.5 
40.6 
96.9 
93.8 
31.3 
25.0 
28.1 
25.0 



100.0 

58.2 
42.9 
94.5 
92.3 
61.5 
13.2 
18.7 
11.0 



100.0 

83.5 
84.8 
92.4 
93.7 
38.0 
32.9 
34.2 
27.8 



9 


75.0 


8 


66.7 


9 


75.0 


11 


91.7 


8 


66.7 


9 


75.0 


10 


83.3 


7 


58.3 


9 


100.0 


7 


77.8 


8 


88.9 


B 


88.9 


8 


88.9 


7 


77.8 


7 


77.8 


8 


88.9 


7 


77.8 



10 

9 

10 

10 

9 



17 


85.0 


9 


15 


75.0 


9 


18 


90.0 


9 


18 


90.0 


9 


16 


80.0 


9 


16 


80.0 


10 


16 


80.0 


9 


15 


75.0 


9 


2 


100.0 


- 


1 


50.0 


- 


2 


100.0 


_ 


2 


100.0 


- 



21 


63.6 


9 


20 


60.6 


11 


26 


78.8 


12 


27 


81.8 


12 


24 


72.7 


12 


13 


39.4 


12 


18 


54.5 


15 


10 


30.3 


9 



12 
11 
16 
17 
13 
12 
13 
10 



22 
24 
25 
25 
25 
23 
25 
21 



17 

3 

18 

18 

1 



6 

5 

15 

14 

7 



11 

12 

13 

13 

3 

2 

1 

1 



35 
23 
55 
53 
36 



33 

31 

35 

36 

2 

1 

1 



98.6 

90.6 
50.6 
98.6 
95.6 
46.6 
36.6 
36.6 
36.6 



138.0 

133.0 
127.0 
135.0 
135.0 
132.0 
128.0 
129.0 
127.0 



4.0 
4.0 



201.2 

120.2 

101.2 

185.2 

187.2 

161.2 

77.5 

90.5 

73.5 



258.2 

176.8 

135.7 

246.2 

239.2 

170.9 

71.5 

84.5 

62.5 



364.1 

321.9 
332.6 
347.6 
347.6 
200.1 
180.1 
187.7 
148.1 



87.0 

76.0 
66.0 
76.0 
87.0 
66.0 
61.0 
61.0 
50.0 



3.1 

3.2 
3.9 
3.2 
3.2 
4.7 
4.6 
4.1 
4.6 



6.9 

7.8 
8.5 
7.5 
7.5 
8.3 
8.0 
8.1 
8.5 



2.0 
2.0 



6.1 

5.7 
5.1 
7.1 
6.9 
6.7 
6.0 
5.0 
7.3 



3.3 
3.5 
2.9 



4.6 

4.9 
5.0 
4.8 
4.7 
6.7 
6.9 
7.0 
6.7 



8.3 
8.4 
7.9 
8.3 
6.8 
6.1 
7.1 



5.6 

5.9 
5.2 
5.2 
5.2 
5.9 
5.9 
6.3 
5.9 



27.0 

27.0 

13.0 

27.0 

27.0 

13.0 

9.0 

9.0 

9.0 



29.0 

28.0 
27.0 
28.0 
28.0 
28.0 
28.0 
27.0 
27.0 



27.5 

16.5 
19.5 
26.5 
26.5 
26.5 
15.3 
19.3 
15.3 



37.0 

18.3 
19.0 
31.0 
32.0 
18.3 
12.3 
17.3 
8.3 



47.2 

38.5 
38.7 
42.7 
42.7 
35.0 
26.0 
25.7 
20.0 



40.0 

35.0 
28.0 
35.0 
40.0 
28.0 
28.0 
28.0 
23.0 



7.0 

3.0 
3.0 
3.0 
3.0 
3.0 
3.0 
7.0 
3.0 



71.6 

63.6 
37.6 
71.5 
68.6 
33.6 
27.6 
27.6 
27.6 



109.0 

105.0 
100.0 
107.0 
107.0 
104.0 
100.0 
102.0 
100.0 



4.0 
4.0 



173.7 

103.7 

81.7 

158.7 

160.7 

134.7 

62.2 

71.2 

58.2 



221.3 

158.5 

116.8 

215.3 

207.3 

152.7 

59.2 

67.2 

54.2 



317.0 

283.4 
294.0 
305.0 
305.0 
165.1 
154.1 
162.1 
128.1 



47.0 

41.0 
38.0 
41.0 
47.0 
38.0 
33.0 
33.0 
27.0 



43.5 



38. 

38. 

38. 

38. 

36 

38. 

43.5 

38.5 



' Includes all technical personnel other than directors-expressed in full-time equivalents. 



3.3-7 



Health Insvi-ance 1968: Participating Independent Laboratories 



Table 3.3.2 NUMBER OF INDEPENDENT LABORATORIES, BY TYPE OF PROCEDURE APPROVED, 
RECTOR AND TECHNICAL STAFF, REGION, DIVISION, AND STATE— Con. 

[See NOTES preceding General Tables] 



TRAINING OF LABORATORY Dt- 



Region, division, State, and 
type of procedure 



Total laboratories 



Number 



Percent 



Training of laboratory director 



Pathologist Other physician Non-physician 



Technical staff 



Total 
number ' 



Average per 
laboratory 



Physician 



Non-physician 



MISSOURI 
All laboratories -- 



Microbiology 

Serology 

Clinical chemistry __. 

Hematology 

Immunohematology _ 

Tissue pathology 

Exfoliative cytology.. 
All procedures 



MONTANA 
All laboratories. _. 



Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology _ 

Tissue pathology 

Exfoliative cytology- 
All procedures 



NEBRASKA 
All laboratories 



Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology _ 

Tissue pathology 

Exfoliative cytology- 
All procedures 



NEVADA 
All laboratories -- 



Microbiology 

Serology 

Clinical chemistry--. 

Hematology 

Immunohematology - 

Tissue pathology 

Exfoliative cytology- 
All procedures 



NEW HAMPSHIRE 
All laboratories 



Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology - 

Tissue pathology 

Exfoliative cytology-. 
All procedures 



NEW JERSEY 
All laboratories 



Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology - 

Tissue pathology 

Exfoliative cytology-. 
All procedures 



NEW MEXICO 
All laboratories 



Microbiology 

Serology 

Clinical chemistry — . 

Hematology 

Immunohematology - 

Tissue pathology 

Exfoliative cytology- 
All procedures 



NEW YORK 
All laboratories -.- 



Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology _ 

Tissue pathology 

Exfoliative cytology- 
All procedures 



53 
47 
58 
57 
46 
34 
37 
34 



5 

6 

11 

12 

7 
4 
4 
4 



129 

97 

105 

122 

116 

57 

25 

27 

22 



19 

9 

21 

20 
9 
9 
9 

7 



257 

179 

190 

222 

234 

104 

65 

68 

34 



100.0 

89.8 
79.7 
98.3 
96.6 
78.0 
57.6 
62.7 
57.6 



7 


87.5 


5 


62.5 


7 


87.5 


7 


87.5 


6 


75.0 


5 


62.5 


5 


62.5 


5 


62.5 



16 


84.2 


14 


14 


73.7 


14 


17 


89.5 


14 


16 


84.2 


14 


14 


73.7 


14 


15 


78.9 


15 


16 


84.2 


15 


14 


73.7 


14 



100.0 

38. 5 
46.2 
84.6 
92.3 
53.8 
30.8 
30.8 
30.8 



100.0 

100.0 

100.0 
100.0 
100.0 



100.0 

75.2 
81.4 
94.6 
89.9 
44.2 
19.4 
20.9 
17.1 



100.0 

82.6 
39.1 
91.3 
87.0 
39.1 
39.1 
39.1 
30.4 



100.0 

69.6 
73.9 
86.4 
91.1 
40.5 
25.3 
26.5 
13.2 



34 
35 
35 
35 
35 
34 
35 
34 



24 
23 
24 
24 
24 
24 
24 
22 



59 
59 
67 
71 
49 
59 
60 
33 



14 
13 
16 
16 
10 
1 
2 



21 
18 
33 
33 
9 



13 

9 
16 
15 

5 



59 
69 
82 
76 
23 



376.5 

363.0 
335.0 
373.5 
372.0 
352.5 
314.5 
323.5 
314.5 



34.6 

33.6 
26.1 
33.1 
33.1 
32.1 
26.1 
26.1 
26.1 



226.5 

206.0 
203.5 
222.0 
206.0 
203.5 
206.5 
208.0 
203.5 



41.0 

13.0 
18.0 
25.0 
33.0 
31.0 
11.0 
11.0 
11.0 



5.0 

5.0 

5.0 
5.0 
5.0 



263.4 

222.3 

225.8 

247.3 

240.9 

151.4 

79.6 

82.6 

71.6 



6 




76.5 


1 




63.5 


7 




76.5 


6 




76.5 


1 




63.5 


- 




64.5 


- 




64.5 


■ 




61.5 


136 


1 


302.1 


99 


1 


047.1 


113 


1 


021.0 


122 


1 


146.1 


130 


1 


155.1 


46 




745.2 


2 




618.8 


2 




611.8 


- 




423.6 



6.4 

6.8 
7.1 
6.4 
6.5 
7.7 
9.3 
8.7 
9.3 



4.3 

4.8 
5.2 
4.7 
4.7 
5.4 
5.2 
5.2 
5.2 



11.9 

12.9 
14.5 
13.1 
12.9 
14.5 
13.8 
13.0 
14.5 



3.2 

2.6 
3.0 
2.3 
2.8 
4.4 
2.8 
2.8 
2.8 



5.0 

5.0 

5.0 
5.0 
5.0 



2.0 

2.3 
2.2 
2.0 
2.1 
2.7 
3.2 
3.1 
3.3 



3.5 

4.0 
7.1 
3.6 
3.8 
7.1 
7.2 
7.2 



5.1 

5.8 
5.4 
5.2 
4.9 
7.2 
9.5 
9.0 
12.5 



64.8 

63.8 
53.8 
64.8 
64.8 
64.8 
52.8 
52.8 
52.8 



2.0 

2.0 
2.0 
2.0 
2.0 
2.0 
2.0 
2.0 
2.0 



48.0 

39.0 
39.0 
47.0 
39.0 
39.0 
40.0 
40.0 
39.0 



11.0 
14.0 
4.0 
4.0 
4.0 



1.0 

1.0 

1.0 
1.0 
I.O 



20.3 

17.3 
18.3 
19.3 
19.3 
13.3 
11.3 
11.3 
11.3 



7.0 

7.0 
3.0 
7.0 
7.0 
3.0 
3.0 
3.0 
3.0 



311.8 

299.3 
281.3 
308.8 
307.3 
287.8 
261.8 
270.8 
261.8 



32.6 

31.6 
24.1 
31.1 
31.1 
30.1 
24.1 
24.1 
24.1 



178.5 

167.0 
164.5 
175.0 
167.0 
164.5 
166.5 
168.0 
164.5 



25.0 

9.0 

12.0 

19.0 

22.0 

17.0 

7.0 

7.0 

7.0 



4.0 

4.0 

4.0 
4.0 
4.0 



243.1 

205.0 

207.5 

228.0 

221.6 

138.1 

68.3 

71.3 

60.3 



72.5 

69.5 
60.5 
69.5 
69.5 
60.5 
61.5 
61.5 
58.5 



76.3 


970.8 


71.0 


950.0 


94.3 


1 051.8 


92.3 


1 062.8 


57.3 


687.9 


55.0 


563.8 


64.0 


547.8 


35.0 


388.6 



' Includes all technical personnel other than directors-expressed in full-time equivalents. 



3.3-8 



Health Insurance 1968: 

Table 3.3.2 NUMBER OF INDEPENDENT LABORATORIES, BY TYPE OF PROCEDURE APPROVED, 
RECTOR AND TECHNICAL STAFF, REGION, DIVISION, AND STATE— Con. 

[See NOTES precedinE General Tables] 



Participating Independent Laboratories 
TRAINING OF LABORATORY Dl- 



Region, di^ion. State, and 
t\T)e of procedure 



Total laboratories 



Number 



Percent 



Training of laboratory director 



Pathologist Other physician Non-physician 



Technical staff 



Total 
number 



Average per 
laboratory 



Physician 



Non-physician 



NORTH CAROLINA 
All laboratories 



Microbiology 

Serologj- 

Clinical chemistry 

Hematologj' 

Immunohematology _ 

Tissue pathology- 

Exfoliative cj'tology.. 
All procedures 



NORTH DAKOTA 
All laboratories 



Microbiologj' 

Serology 

Clinical chemistry — . 

Hematolog>' 

Immunohematology _ 

Tissue pathology 

Exfoliative cytology.. 
All procedures 



OHIO 
All laboratories. 



Microbiology 

Serology 

Clinical chemistry 

Hematologj- 

Immunohematology _ 

Tissue pathology 

Exfoliative cytology.. 
All procedures 



OKLA.HOiLA 
All laboratories 



Microbiology 

Serology 

Clinical chemistry 

Hematology. 

Immunohematology _ 

Tissue pathology 

Exfoliative cytology.. 
All procedures 



OREGON 
All laboratories - 



Microbiology 

Serology 

Clinical chemistry 

Hematology.. 

Immunohematology . 

Tissue pathology 

Exfoliative cytology- 
All procedures 



PENNSYLVANIA 
All laboratories 



Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology . 

Tissue pathology 

Exfoliative cytology. 
All procedures 



RHODE ISLAND 
All laboratories 



Microbiology .^ 

Serology 

Clinical chemistry 

Hematology 

Immunohematology . 

Tissue pathology 

Exfoliative cytology.. 
All procedures 



SOUTH CAROLINA 
All laboratories 



Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 



9 
10 

7 
5 



7 

8 

10 

8 

7 
7 
6 
6 



106 

70 
96 
101 
100 
«4 
31 
35 
27 



33 
23 
35 
37 
26 
18 
20 
17 



22 
22 
27 
27 
17 
10 
11 
8 



127 

75 
52 
115 
115 
36 
29 
38 
26 



15 

10 

15 

17 

9 

1 

1 

1 



100.0 

63.6 
72.7 
81.8 
90.9 
63.6 
^5.5 
54.5 
45.5 



100.0 

70.0 
80.0 
100.0 
80.0 
70.0 
70.0 
60.0 
60.0 



100.0 



66. 
90. 

95. 



.0 
.6 
.3 
94.3 
41.5 
29.2 
33.0 
25.5 



100.0 

84.6 
59.0 
89.7 
94.9 
66.7 
46.2 
51.3 
43.6 



100.0 

71.0 
71.0 
87.1 
87.1 
54.8 
32.3 
35.5 
25.8 



100.0 

59.1 
40.9 
90.6 
90.6 
28.3 
22.8 
29.9 
20.5 



100.0 

88.2 

58.8 

88.2 

100.0 

52.9 

5.9 

5.9 

5.9 



100.0 

83.3 

100.0 

100.0 

100.0 

83.3 

83.3 

83.3 

83.3 



24 
26 
26 
26 
26 
27 
27 
24 



14 
14 
14 
14 
14 
13 
14 
13 



14 
12 
17 
17 
14 
10 
10 



25 
23 
26 
26 
24 
25 
34 
22 



13 
27 
29 
28 
14 
1 



5 
13 
12 
7 
1 
1 
1 



33 
43 
46 
46 



11 

3 

12 

14 



42 

24 

76 

77 

5 

3 

3 

3 



12 
14 

7 



40.3 

32.0 
33.3 
38.3 
39.3 
32.0 
26.0 
27.0 
26.0 



110.0 



72.0 
102.0 

110.0 

102.0 
71.0 
71.0 
69.0 
69.0 



355.9 

294.9 
345.1 
350.9 
348.9 
237.3 
209.5 
220.0 
194.5 



218.5 

200.2 
137.2 
209.5 
213.5 
150.5 
115.2 
124.2 
114.2 



220.5 

117.5 

140.5 

209.5 

165.5 

141.5 

50.5 

98.5 

44.5 



410.0 

342.3 
190.3 
378.0 
374.0 
193.8 
168.8 
191.8 
161.8 



46.2 

45.2 

30.2 

45.2 

46.2 

29.2 

5.0 

5.0 

5.0 



132.0 

132.0 
132.0 
132.0 
132.0 
132.0 
132.0 
132.0 
132.0 



3.7 

4.6 
4.2 
4.3 
3.9 
4.6 
5.2 
4.5 
5.2 



11.0 

10.3 
12.8 
11.0 
12.8 
10.1 
10.1 
11.5 
11.5 



3.4 

4.2 
3.6 
3.5 
3.5 
5.4 
6.8 
6.3 
7.2 



5.6 

6.1 
6.0 
6.0 
5.8 
5.8 
6.4 
6.2 
6.7 



7.1 

5.3 
6.4 
7.8 
6.1 
8.3 
5.1 
9.0 
5.6 



3.2 

4.6 
3.7 
3.3 
3.3 
5.4 
5.8 
5.0 
6.2 



2.7 

3.0 
3.0 
3.0 
2.7 
3.2 
5.0 
5.0 
5.0 



22.0 

26.4 
22.0 
22.0 
22.0 
26.4 
26.4 
26.4 
26.4 



3.0 

2.0 
3.0 
3.0 
3.0 
2.0 
2.0 
2.0 
2.0 



32.0 

10.0 
31.0 
32.0 
31.0 
10.0 
10.0 
9.0 
9.0 



22.0 
16.0 
15.0 
15.0 
15.0 



63.0 

58.0 
43.0 
63.0 
63.0 
50.0 
32.0 
32.0 
32.0 



12.0 
11.0 
11.0 
11.0 



29.0 

24.0 
22.0 
27.0 
27.0 
22.0 
20.0 
22.0 
20.0 



4.0 

4.0 
4.0 
4.0 
4.0 
4.0 



35.0 

35.0 
35.0 
35.0 
35.0 
35.0 
35.0 
35.0 
35.0 



37.3 

30.0 
30.3 
35.3 
36.3 
30.0 
24.0 
25.0 
24.0 



78.0 

62.0 
71.0 
78.0 
71.0 
61.0 
61.0 
60.0 
60.0 



333.9 

275.9 
324.1 
328.9 
326.9 
221.3 
194.5 
205.0 
179.5 



155.5 

142.2 

94.2 

146.5 

150.5 

100.5 

83.2 

92.2 

82.2 



205.5 

105.5 

128.5 

194.5 

152.5 

129.5 

39.5 

87.5 

33.5 



381.0 

318.3 
168.3 
351.0 
347.0 
171.8 
148.8 
169.8 
141.8 



42.2 

41.2 

26.2 

41.2 

42.2 

25.2 

5.0 

5.0 

5.0 



97.0 

97.0 
97.0 
97.0 
97.0 
97.0 
97.0 
97.0 
97.0 



' Includes all technical personnel other than directors-expressed in full-time equivalents. 



3.3-9 



Health Insurance 1968: Participating Independent Laboratories 



Table 3.3.2 NUMBER OF INDEPENDENT LABORATORIES, BY TYPE OF PROCEDURE APPROVED, 
RECTOR AND TECHNICAL STAFF, REGION, DIVISION, AND STATE— Con. 

[See NOTES preceding General Tables] 



TRAINING OF LABORATORY Dl- 



Region, division, State, and 
type of procedure 



Total laboratories 



Number 



Percent 



Training of laboratory director 



Pathologist Other physician Non-physician 



Technical staff 



Total 
number ' 



Average per 
laboratory 



Physician 



Non-physician 



SOUTH DAKOTA 
All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology. 

All procedures 

TENNESSEE 

All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 

TEXAS 

All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology. 

All procedures 

UTAH 
All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology... 

All procedures 

VERMONT 
All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology. 

All procedures 

VIRGINIA 

All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology _. 

Tissue pathology 

Exfoliative cytology 

All procedures 

WASHINGTON 

All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 

WEST VIRGINIA 

All laboratories 

Microbiology 

Serology 

Clinical chemistry _ 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology. 

All procedures 



18 
21 
21 
22 
11 
12 
12 



195 

183 

87 

188 

190 

119 

74 

77 

70 



55 
48 
58 
62 
46 
38 
40 
30 



100.0 

100.0 
100.0 
100.0 
100.0 
100.0 
100.0 
100.0 
100. 



100.0 

66.7 
77.8 
77.8 
81.5 
40.7 
44.4 
44.4 
29.6 



100.0 

93.8 
44.6 
96.4 
97.4 
61.0 
37.9 
39.5 
35.9 



9 


69.2 


4 


30.8 


9 


69.2 


2 


92.3 


8 


61.5 


3 


23.1 


4 


30.8 


3 


23.1 





50.0 




25.0 




100.0 




100.0 




25.0 




25.0 




25.0 




25.0 



100.0 

86.2 
73.8 
89.2 
95.4 
70.8 
58.5 
61.5 
46.2 



7 


87.5 


4 


50.0 


8 


100.0 


8 


100.0 


3 


37.5 


1 


12.5 


1 


12.5 


1 


12.5 



10 

11 
11 



72 
65 
72 
73 
70 
68 



17 


73.9 


14 


16 


69.5 


13 


19 


82.6 


14 


19 


82.6 


15 


18 


78.3 


14 


13 


56.5 


11 


18 


78.3 


15 


11 


47.8 


10 



33 
32 
33 
36 
29 
35 
37 
28 



57 

14 

68 

59 

41 

4 

5 

4 



10 
5 
11 
11 
8 
1 
2 
1 



11 

11 

11 

1 



48 
48 
B 
2 
2 
2 



13 

11 

14 

15 

9 

1 

1 

1 



35.0 

35.0 
35.0 
35.0 
35.0 
35.0 
35.0 
35.0 
35.0 



135.5 

93.5 
100.5 

99.5 
100.5 

89.5 
110.5 
115.5 

83.5 



960.1 

941.8 
521.7 
944.8 
954.1 
764.6 
562.4 
572.5 
554.2 



43.0 

33.5 
20.0 
33.5 
36.5 
30.5 
19.0 
25.5 
19.0 



8.0 

7.0 

1.0 
8.0 
8.0 
1.0 
1.0 
1.0 
1.0 



112.7 

98.5 
91.5 
103.5 
106.5 
101.5 
75.5 
99.2 
72.5 



277.0 

232.0 
219.5 
236.0 
267.0 
221.5 
164.5 
174.5 
143.5 



15.2 

14.2 
8.7 
15.2 
15.2 
7.7 
1.0 
1.0 
1.0 



5.0 

5.2 
4.8 
4.7 
4.6 
8.1 
9.2 
9.6 
10.4 



4.9 

5.1 
7.1 
5.0 
5.0 
6.4 
7.5 
7.4 
7.9 



3.3 

3.7 
5.0 
3.7 
3.0 
3.8 
6.3 
5.4 
6.3 



2.0 

3.5 
1.0 
2.0 
2.0 
1.0 
1.0 
1.0 
1.0 



4.9 

s.e 

5.7 
5.4 
5.5 
5.5 
5.8 
5.5 
6.5 



4.3 

4.1 
4.6 
4.1 
4.3 
4.8 
4.3 
4.4 
4.8 



1.9 

2.0 
2.2 
1.9 
1.9 
2.6 
1.0 
1.0 
1.0 



8.0 

8.0 
8.0 
8.0 
8.0 
8.0 
8.0 
8.0 
8.0 



17.0 

12.0 
12.0 
12.0 
12.0 
12.0 
16.0 
17.0 
12.0 



195.5 

191.6 
120.0 
189.6 
194.6 
150.6 
113.0 
116.6 
111.0 



5.0 
5.0 
5.0 



3.0 
3.0 



3.0 
3.0 



22.0 

18.0 
16.0 
18.0 
20.0 
18.0 
12.5 
19.5 
11.5 



30.0 

28.0 
20.0 
28.0 
28.0 
19.0 
20.0 
20.0 
15.0 



2.3 

2.3 
0.3 
2.3 
2.3 

0.3 



27.0 

27.0 
27.0 
27.0 
27.0 
27.0 
27.0 
27.0 
27.0 



118.5 

81.5 
88.5 
87.5 
88.5 
77.5 
94.5 
98.5 
71.5 



763.5 

750.2 
501.7 
755.2 
759.5 
614.0 
449.4 
455.9 
443.2 



34.0 

28.5 
15.0 
28.5 
31.5 
25.5 
14.0 
16.5 
14.0 



5.0 

4.0 
1.0 
5.0 
5.0 
1.0 
1.0 
1.0 
1.0 



90.7 

80.5 
75.5 
85.5 
86.5 
83.5 
53.0 
79.7 
51.0 



247.0 

204.0 
199.5 
208.0 
239.0 
202.5 
144.5 
154.5 
127.5 



' Includes all technical personnel other than directors-expressed in full-time equivalents. 



3,3-10 



Health Insurance 1968: 

Table 3.3.2 NUMBER OF INDEPENDENT LABORATORIES, BY TYPE OF PROCEDURE APPROVED, 
RECTOR AND TECHNICAL STAFF, REGION, DIVISION, AND STATE— Con. 

[See NOTES preceding General Tables] 



Participating Independent Laboratories 
TRAINING OF LABORATORY Dl- 



Region, division, State, and 
type of procedure 



Total laboratories 



Number 



Percent 



Training of laboratory director 



Pathologist 



Other physician 



Non-physician 



Technical staff 



Total 
number ' 



Average per 
laboratory 



Physician 



Non-physician 



WISCONSIN 
All laboratories _ 

Microbiology 

Serology .._ 

Clinical chemistry- 

Hematology. 

I m munohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 

WYOMING 
All laboratories 

Microbiology 

Serology .__ _ 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology. 

All procedures 

OUTLYING AREAS 

Guam 

All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology. 

All procedures 

Puerto Rico 

All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology _ 

Exfoliative cytology... 

All procedures 

Virgin Islands 

All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 

Other Outlying Areas 

All laboratories 

Microbiology 

Serology 

Clinical chemistry 

Hematology 

Immunohematology 

Tissue pathology 

Exfoliative cytology 

All procedures 



10 
12 
14 
15 
12 
10 
13 
7 



46 
6 
48 
44 
4 
5 
6 



100. 

55.6 
66.7 
77.8 
83.3 
66.7 
55.6 
72.2 
38.9 



100.0 

100.0 
100.0 
100.0 
100.0 
100.0 
100.0 
100.0 
100.0 



100.0 

86.8 
11.3 
90.6 
83.0 
7.5 
9.4 
11.3 



100.0 

100.0 
100.0 
100.0 
100.0 
100.0 
100.0 

100.0 

100.0 



9 

11 
11 
11 
11 

10 
13 

7 



11 

1 

11 

10 



35 

5 
37 
34 



160.0 

108.5 
139.0 
140.0 
141.0 
139.0 
112.0 
133.0 
89.5 



20.0 

20.0 
20.0 
20.0 
20.0 
20.0 
20.0 
20.0 
20.0 



142.9 

135.4 

6.0 

135.4 

127.4 

23.0 

7.5 

14.5 



2.0 

2.0 
2.0 
2.0 
2.0 
2.0 
2.0 
2.0 
2.0 



8.9 

10.9 
11.6 
10.0 
9.4 
11.6 
11.2 
10.2 
12.8 



6.7 

6.7 
6.7 
6.7 
6.7 
6.7 
6.7 
5.7 
6.7 



2.7 



2.9 
1.3 
2.8 
2.9 
5.8 
1.5 
2.4 



2.0 

2.0 
2.0 
2.0 
2.0 
2.0 
2.0 
2.0 
2.0 



40.0 

26.0 
32.0 
31.0 
31.0 
30.0 
23.0 
34.0 
16.0 



8.0 
8.0 
8.0 



1.0 

1.0 
1.0 
1.0 
1.0 
1.0 
1.0 
1.0 
1.0 



120.0 

82.5 

107.0 

109.0 

110.0 

109.0 

89.0 

99.0 

73.5 



12.0 

12.0 
12.0 
12.0 
12.0 
12.0 
12.0 
12.0 
12.0 



114.9 

110.4 

8.0 

110.4 

102.4 

17.0 

4.5 

8.5 



1.0 

1.0 
1.0 
1.0 
1.0 
1.0 
1.0 
1.0 
1.0 



' Includes all technical personnel other than directors-expressed in full-time equivalents. 



3.3-11 



U. S. GOVERNMENT PRINTING OFFICE : 1972 O - 452-433 



Other Data Sources On The 
Health Insurance For The Aged Program 

The Health Insurance Statistics series is designed to present 
current, quick-release data from the Medicare program. Two re- 
port series are issued in this format : 

The Health Insurance (HI) series has included 30 releases since 
1967. Issues released prior to 1970 are out of print, but available 
in many libraries. 

The Current Medicare Survey (CMS) series, based on data 
from the continuing Current Medicare Survey, has included 15 
releases since 1967. These issues are available in most libraries. 

Future releases in the HI and CMS series may be obtained upon 
request to the Publications Staff, Office of Research and Statistics, 
Social Security Administration, Room 3643, HEW North Building, 
330 Independence Avenue, SW., Washington, D.C. 20201. 

The Social Security Bulletin, published monthly, presents 
authoritative articles and analyses of medical care expenditures, 
prices, and utilization, as well as current operating statistics from 
the Medicare program. The Annual Statistical Supplement to the 
Bulletin includes summary data on trust funds, services, claims, 
enrollment, average charges, and participating providers of service 
under Medicare. The Bulletin, including the Supplement, is avail- 
able in most libraries and by subscription at $4 a year from the 
Superintendent of Documents, U.S. Government Printing Office, 
Washington, D.C. 20402. 

The Research and Statistics Note series reports on-going re- 
search, preliminary findings, or provides addenda to material al- 
ready published on the old-age, survivors, disability, and health 
insurance program. Designed to get information quickly into the 
hands of users, the series includes data on medical care prices, 
outlays, and expenditures. The series is available in many 
libraries. Future releases may be obtained upon request to the 
Publications Staff, Office of Research and Statistics, Social Secur- 
ity Administration, Room 3643, HEW North Building, 330 Inde- 
pendence Avenue, SW., Washington, D.C. 20201.