Medical Care during the Depression1: A Preliminary Report upon a Survey of Wage‐Earning Families in Seven Large Cities2

Abstract

The problem of giving services free has faced the doctor and the hospital during the depression to an extent unknown in any other field. A factory manager was able to economize during hard times by eliminating unproductive departments, by introducing labor-saving devices, or, as a last resort, by closing his plant until the return of prosperity. No such expedients were available to the doctor or the hospital director. Business had to continue as usual in spite of the decrease of paying patients and the tremendous increase of free care. While the writers of this paper offer no solution for these economic problems, they do have pertinent data to present on the amount of physician's, hospital, and nursing care, both pay and free, received by a group of nearly 7,000 families in seven large cities surveyed early in 1933 by the United States Public Health Service in cooperation with the Milbank Memorial Fund. The reader is referred to previous papers3 for details, method, and scope of the survey. Briefly, it consisted of a house-to-house canvass of some 12,000 white families in the poorer districts of eight large cities, one group of coal-mining communities, and a group of cotton-mill villages. The records obtained by the canvasses included (a) the economic history of the family in sufficient detail for computing family income for each year from 1929 through 1932, and (b) a record of all illness during the three months immediately preceding the date of the enumerator's visit, in the spring of 1933, with the extent of disability and of medical care for each case. The sample population discussed in the present paper comprised 28,959 individuals in 6,686 families for which the data were sufficiently complete for computing the actual income for each of the four years from 1929 to 1932. The population was largely of the wage-earning class, a considerable proportion of which had experienced loss of income due to unemployment and wage reductions. In 1929, 10 per cent of the persons surveyed were in families with an annual per capita income of $149 or less; by 1932, 43 per cent were in this class. On the other side of the picture, 42 per cent of the persons were in families with an annual per capita income of $425 or more in 1929, but by 1932 this figure had decreased to 14 per cent.