This hearing constitutes the first congressional review made of the program since these increased benefits went into effect. We want to examine what problems have resulted from this major extension of the program and what steps have been taken to overcome these problems.

There have been complaints about undue delay in processing claims, about confusion and red tape for service families, and about the adequacy of information provided to service families on benefits available. We shall look closely at the cost experience of the program. We want to know how present costs compare with estimates made in 1966. In other words, the subcommittee intends to look not just at the level of benefits but at the functioning of the program. And we shall prepared to make such recommendations to the full committee or to the Department of Defense as appropriate for legislative or other actions which we determine should be taken to solve existing problems.

A number of studies have been made of the civilian health and medical program over the past year, including a study by the School of Public Health and Administrative Medicine at Columbia University under a contract with the Department of Defense. I have asked that the findings of this study be explained to the subcommittee.

DENTAL CARE

A subcommittee in the 90th Congress, of which I was chairman and on which our colleagues Mr. King and Mr. Dickinson served, recommended a program of dental care for dependents of uniformed service personnel. At that time the Department of Defense reserved its position on such a program and indicated that it was conducting a survey to determine the extent to which dental care was required.

While I am generally aware of the findings of that survey, I will ask that the Defense Department be prepared in these hearings to make a comparison of the findings of their survey with the findings and recommendations of the subcommittee. Our recommended dental care program was not considered in the 90th Congress due to a combination of budgetary pressures and footdragging by the Department of Defense. I have again introduced our recommended dental care program in the present Congress as H.R. 10794.

The Department of Defense has recently submitted an unfavorable report on this legislation. I shall expect representatives of the Office of the Assistant Secretary of Defense for Manpower to be prepared to explain this position.

I think the question of providing dental care is particularly appropriate at this time in view of the expressed intention of the present administration to move as rapidly as possible to an all-volunteer force.

PHYSICIANS' COMPLAINTS

A relatively small portion of the medical care budget involves care for active duty service personnel from civilian sources while on leave or traveling to a new duty station. A number of complaints have reached the committee regarding the difficulties which civilian physicians encounter in attempting to have these bills paid. We shall look briefly at procedures for financing this kind of care.

We will now hear from our first witness, Brig. Gen. George Hayes, the staff director in the Office of the Assistant Secretary of Defense for Health Affairs.

General Hayes.

Mr. HUNT. Mr. Chairman.

Mr. BYRNE. Yes, Mr. Hunt.

Mr. HUNT. Will you excuse me for a few moments? I am due next door at another subcommittee hearing, by 18 minutes ago, and I will go over.

Mr. BYRNE. Be back 25 after.

Mr. HUNT. All right. Thank you.

Mr. BYRNE. General Hayes.

General HAYES. Good morning. I hope your cold improves promptly.

Mr. BYRNE. Thank you, General. So do I. Go ahead.

BIOGRAPHICAL SKETCH OF BRIG. GEN. GEORGE J. HAYES

Date and place of birth: July 10, 1918-Washington, D.C.

Pre-medical education: Catholic University of America, Washington, D.C., B.S.-June 1940. Medical Education: Johns Hopkins University Medical School, Baltimore, Maryland, MD-November 25, 1943.

Internship: Johns Hopkins Hospital, Baltimore, Maryland, January 1, 1944 to September 30, 1944.

Residency: Lahey Clinic, Boston, Massachusetts, October 1, 1944 to February 12, 1946; Duke University Hospital, Durham, North Carolina, July 1949 to June 1950; Georgetown University (Gallinger Hospital Service), July-December 1951. Board certification: American Board of Neurological Surgery-June 1952.

Given the 1965 Annual Alumni Achievement Award in the Field of Medicine by The Catholic University of America at the Homecoming Banquet held Saturday, 13 November 1965 at the Sheraton-Park Hotel in Washington, D.C. Military or Government Service:

Entered the U.S. Army on 13 February 1946, rank of 1 Lt. Promoted to BG effective 1 February 1966.

There has been continuous active military duty since entering in 1946. Chief, Neurosurgery Service, Walter Reed Army Hospital May 1947 to June 1949 (Captain).

Chief, Neurosurgery Service, Walter Reed Army Hospital June 1950 to August 1951 (Major).

Commanding Officer, 160th Neurosurgical Detachment, Korea; February 1952 to October 1952 (Lieutenant Colonel).

Commanding Officer, 46th Surgical Hospital, Korea; October 1952 to September 1953 (Lieutenant Colonel).

Chief, Neurosurgery Service, Brooke General Hospital, Texas; September 1953 to July 1953 (Lieutenant Colonel).

Chief, Neurosurgery Service, Walter Reed General Hospital, July 1955 to 1 February 1966 (Lieutenant Colonel and Colonel).

Consultant, Neurosurgery to The Surgeon General of the Army, January 1956 to February 1966 (Colonel).

Director, Professional Service, Office of The Surgeon General, 1 February 1966 to August 1968 (Brigadier General).

Commanding General, U.S. Army Medical Command, Japan; 20 August 1968 to 30 June 1969 (Brigadier General).

Staff Director, Office of the Deputy Assistant Secretary of Defense (HA) 1 August 1969 to present (Brigadier General).

Hospital Appointments: (see under "Military or Government Service") Consultant in Neurosurgery at Mt. Alto Hospital (See 213, Title 58 USC); Appointed 20 October 1959 to June 1968.

Teaching Appointments:

Assistant Professor of Clinical Surgery, Neurological Surgery, Baylor Univ. Sch. of Med., Feb. 54-Jul. 55.

Associate in Neurological Surgery, George Washington Univ. Sch. of Med., 1 Apr. 56-6 Sep. 61.

Assistant Clinical Professor in Neurological Surgery, George Washington Univ. Sch. of Med., 1 Apr. 61-31 Mar. 65.

Associate Clinical Professor in Neurological Surgery, George Washington Univ. Sch. of Med., 1 Apr. 65–Apr. 68.

Clinical Professor in Neurological Surgery, George Washington Univ. Sch. of Med., Apr. 68.

Adjunct Clinical Instructor in Neurology, Georgetown University, Sep. 51Jan. 52.

Professor in Surgery (Honorary), Soo Do Medical College, Seoul, Korea, 6 Jan. 57.

Professor emeritus in Neurosurgery, St. Mary's Medical Center, Seoul, Korea, Feb. 67.

Membership in Other Medical Societies:

American Medical Association (Military Membership), 1948.

Society of Neurological Surgeons, 1964.

American College of Surgeons, 1959.

American Academy of Neurological Surgeons, 1962.

Harvey Cushing Society, 1955.

International College of Surgeons (Honorary Member), 1966.

Korean Neurosurgical Society (Honorary Member), 1967.

The Scientific Advisory Board of Consultants, Armed Forces Institute of Pathology, 1968.

Association of Military Surgeons of the United States.

Home Address: 303 Skyhill Road, Alexandria, Virginia 22314.

Office Address: Director of Staff, Office of the Deputy Assistant Secretary of Defense (Health Affairs).

Wife: Catherine Conger Hayes-BA degree 1939-Alburtus Magnus; MA degree 1940-Catholic University.

Children: Timothy, 22; Patrick, 20; Joseph, 19; Kathleen, 17; Monica, 16; Christopher, 14; Steven, 12; Martin, 11; Brendan, 9.

Hobbies and Other Interests: Military Medical History, Archaeology, Photography, Small Arms, Drama during high school and college.

General Hayes is the author of many articles found in various medical publications.

STATEMENT OF BRIG. GEN. GEORGE J. HAYES, MEDICAL CORPS, U.S. ARMY

General HAYES. Mr. Chairman and members of the subcommittee, I am Brig. Gen. George J. Hayes, Medical Corps, U.S. Army. I am here this morning representing Dr. Louis M. Rousselot, the Deputy Assistant Secretary of Defense for Health Affairs, in whose office I am the staff director. Dr. Rousselot, as you know, is unavoidably out of the country and regrets that he could not appear before you this morning.

I am authorized to speak for Dr. Rousselot and the Department of Defense regarding the matters you are considering today. I am accompanied by Mr. Vernon McKenzie, health administrator on Dr. Rousselot's staff.

I have a brief prepared statement which I would like to present to the subcommittee.

The Department of Defense operates a wide variety of health care programs. Our outlays for medical and health-related activities for this fiscal year are expected to total $2.007 billion.

We have a comprehensive program of health care for active duty members of the Armed Forces and their dependents and for retired members and their dependents and the survivors of deceased members. U.S. civilian employees overseas and their dependents are also provided care in our facilities.

Civilian employees in the United States who suffer occupational injury or illness are also provided care in limited circumstances. We provide care for the categories I have just described through our military medical services, which operate approximately 240 fixed hospitals and 465 fixed dispensaries worldwide.

There are approximately 10 million people who are eligible for care in our facilities, but not all of these individuals obtain care in our facilities in any 1 year. However, those who did obtain such care last. fiscal year (fiscal year 1969) generated the following workload: Admissions, 1.2 million; beds occupied on an average day, 43,610; outpatient visits, 53.3 million; and live births, 146,145.

With the exception of admissions, in which there was no significant change, the figures I have just given you reflect increases from the previous fiscal year, and this has been a constant trend in recent

years.

Active duty members and retired members are also provided care under certain circumstances in hospitals of the Veterans' Administration and the Public Health Service. The latter agency, in addition, provides some care for our dependents.

The care in our facilities of the various classes of beneficiaries, other than active duty members, is on a space-available basis. Providing such care, however, within that framework is consistent with the military mission. Moreover, in many parts of the country the medical resources of the private sector would not be sufficient to accommodate all of these patients.

Also of importance in this regard is our realization that the so-called professional growth concept requires that our career health professionals be afforded an opportunity to treat patients of all ages and both sexes.

Active duty members obtain health care from civilian sources in an emergency or when the distance between their place of duty and the nearest Federal facility is such that it would be more economical for the Government to obtain the care locally. There is no cost to the member for care of this type. The administrative procedures covering this type of care differ from service to service and service representatives will describe to you later this morning how their services handle this problem.

Most of the Department of Defense's expenditures for care in the private sector are generated by the civilian health and medical program of the uniformed services, which is generally referred to in the military by its acronym, CHAMPUS. The details regarding that program, however, will be described to you later by General Hackett, who is the head of the Army office in Denver that administers the CHAMPUS program for all seven of the uniformed services.

One of the most important aspects of health within the military community is prevention and control. The objectives of this aspect are to prevent the occurrence or progression of diseases and injuries. through the application of the principles of public health.

We also have an occupational health program the objective of which is to protect military and civilian personnel from health hazards in their working environment, to place personnel in jobs they can perform efficiently and safely and to enourage personal health maintenance. The activities of this program include physical examinations, diagnosis and treatment, evaluation and control of the working environment, and health and safety counseling.

I would also like to mention briefly our medical and health-related research and development programs. These are oriented toward the means to prevent and treat those diseases and hazards which pose a particular threat to our combat forces. Methods of surgical management of injuries resulting from combat are constantly being evolved and improved.

An important aspect of any health care program is dental care and it is my understanding that dental care for dependents is a matter of particular interest to this subcommittee.

At present, routine dental care in uniformed services facilities for dependents is authorized by law on a space-available basis under the following conditions: For those dependents who are in areas outside the United States; and for those who are in one of the approximately 100 areas inside the United States which have been designated as "remote areas" because adequate civilian facilities are unavailable.

Emergency dental care and dental care that is a necessary adjunct to medical and surgical treatment is authorized by law from uniformed services facilities on a space-available basis worldwide.

Care in civilian facilities at Government expense is limited by law to (1) care required as a necessary adjunct to medical or surgical treatment; and (2) care required by a seriously handicapped dependent of an active duty member which is necessary to correct or improve the handicapping condition.

Despite these restrictive conditions the extent of dental care now provided our dependents is appreciable. In fiscal year 1969, 7.4 million dental procedures were performed for dependents in our facilities representing over 16 percent of the total number of procedures performed.

You may recall, Mr. Chairman, that when we testified in 1967 before your Subcommittee on Military Dental Care we indicated that we planned to make a dependent dental care survey because we did not then know the extent to which the services we were providing met our policy that a military dependent should not be disadvantaged compared to his civilian counterpart in having equal access to qualified dental services at reasonable costs.

The major findings resulting from our survey were as follows:

1. The transient status of military families generates difficulties, both in the selection of civilian dentists and in the execution of a treatment program.

2. Dependents of military personnel in the lower enlisted ranks had serious difficulties in obtaining dental care.

3. The cost of dental care is the greatest single obstacle to the fulfillment of dependent dental care needs. For example, 25 percent of the military respondents stated that in their view their dependents did not get the dental care they had needed the previous year. Of these respondents, 82 percent cited cost as the main reason why adequate care was not obtained.