DEVELOPMENT OF A STATE-WIDE PROGRAM FOR THE CARE OF CHILDREN WITH LONG-TERM ILLNESS.

Abstract

THE medical rehabilitation program for persons under 21 years of age (or crippled children's program) had its inception in New York State with the provision for rural patients of orthopedic consultation services in the severe 1916 poliomyelitis outbreak. While the intervening years have seen a steady development and expansion of the program, changes during the past two years (which are continuing) have radically altered the program's scope and methods of administration. The purpose of this paper is to describe the steps involved in implementation of the broadened program, and to derive some lessons from this experience which may be of general value and interest. Our medical rehabilitation program is a state-aid-to-county program. The State Department of Health establishes the standards and scope of services, and promotes the development of facilities for the provision of services throughout the state. The City of New York and the counties elsewhere in the state initiate the definitive diagnostic treatment and rehabilitation services, and the state reimburses the locality for 50 per cent of the costs in state aid. Determination of medical eligibility is the responsibility of the local full-time health officer, but financial eligibility presently is determined, outside New York City, by the family court judge. Even before its recent expansion, the medical rehabilitation program was broad in scope, including, for example, musculo-skeletal defects, speech and hearing disabilities, congenital malformations, such as those of the heart, gastrointestinal and genitourinary tracts, convulsive disorders, and other neurological defects. The total amount authorized for medical rehabilitation under the program rose from about $4 million in 1950 to $12 million in 1963. At the same time, the amount for dental rehabilitation jumped from less than $200,000 to more than $1,300,000 in the same 13-year-period.