The role of epidemiology in the committee on the costs of medical care.
Among the most important 20th century documents of American public health is the 1932 report of the Committee on the Costs of Medical Care (CCMC). In May 1927, leaders of medicine, public health, and the social sciences, met at the annual meeting of the AMA, to consider that, despite advances in medical sciences, a vast amount of preventable disease and unnecessary death existed. A committee of 50 men and women, the CCMC, was formed to investigate. Of the six public health members, three were epidemiologists. A spectrum of governmental and private organizations supported the CCMC and eight foundations provided funding. A staff of 51 conducted 26 studies, many epidemiological, to support its five categorical recommendations. Briefly these were: 1) Medical services, preventive and therapeutic, should be provided by interdisciplinary groups; 2) Basic public health services should be available to all without cost; 3) The costs of medical care should be placed on a group basis (insurance, taxation, or a combination thereof); 4) Study, evaluation, and coordination of medical and public health services should be important functions for local and state governments; and 5) Professional education for a wide variety of medical and public health personnel should be greatly expanded with emphasis on prevention and social considerations.Perhaps the most interesting of the CCMC's epidemiological studies was, "The Incidence of Illness and the Receipt and Costs of Medical Care Among Representative Families: Experiences in Twelve Consecutive Months During 1928-1931." This study included 8,639 families comprising 38,668 persons and described the then current status of medical care and public health practice in the U.S.A.The final report of the CCMC contained minority reports ranging from claims that the recommendations were too radical to assertions that they didn't go far enough! Nevertheless, they have been the focus for medical and public health concern and controversy for almost three-quarters of a century. Their roots in epidemiology should not be forgotten!
Winkelstein
W
Division of Population Biology and Epidemiology, School of Public Health, University of California, Berkeley, CA, USA