Fulton, Welch, Kirkman, Pincoffs, Weiss. Physicians, state employees,
hospital administrators—they worked closely together in the common
interest of better medical care for all Marylanders.

From the turn of the century, when the State recognized its responsi-
bility for the hospital care of low-income patients, the development of
the program to its present status can be summed up quickly. In 1912,
the Board of State Aid and Charities attempted to compute a per diem
cost per patient and to relate the annual state appropriation to the cost
of care less hospital revenue. In 1940, the State began to pay hospitals
for the number of days of care rendered to the indigent at a fixed rate.
In 1943, the State Department of Welfare undertook to determine eligi-
bility of patients. In 1949, the financing and administration of the
program was transferred to the Health Department, while welfare con-
tinued to determine eligibility. In 1958, for the first time a formula was
adopted which tied state payments to hospital costs, with all hospitals,
large and small with consequent variation in costs, being paid the same
amount per patient day.

And then, during the first year of my term, the State took the mo-
mentous step forward which I mentioned—payments to hospitals in
direct relationship to the actual cost of rendering the service. The new
formula reimburses hospitals for 80 per cent of their actual costs, and
computes this for each hospital's individual costs. This new concept has
been of tremendous benefit to our community hospitals. In Baltimore,
we have institutions with a broad scope of service and enjoying inter-
national reputations. Voluntary community hospitals have been estab-
lished to serve other areas of the State.

The State, on its part, operates a system of hospitals for the care of
long-term illnesses, including chronic disease, mental illness and tuber-
culosis. It also maintains, as a part of the University of Maryland, the
University Hospital, which renders a community service and at the
same time serves as a teaching hospital for the University of Maryland
School of Medicine.

The so-called "progressive care" of patients—classifying them as to
hospital requirements rather than as to diagnosis—has been practiced
in Maryland for a number of years. The voluntary non-profit com-
munity hospitals offer short-term care for the acutely ill. If, after the
acute stage has passed, the patient is in need of rehabilitative services,
he is transferred to one of the State's chronic disease hospitals. And
finally, if the patient is in a condition that requires continuing nursing
care, he may be transferred to a nursing home.

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