Medicine: Prepaid Medical Care: Nation's Biggest Private Plan

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Just 17 miles from downtown Los Angeles, the brand-new Kaiser Foundation Hospital at Panorama City looms above the summer-dried landscape like a pair of upended binoculars. But the rush of patients to the twin seven-story towers this week was far more than a response to architectural novelty. It was a testament to the success of the Kaiser Foundation Health Plan Inc.. a repetition of the warm response that greeted the opening of Kaiser's new Medical Office Building at Hayward, near Oakland, fortnight ago. it was one more impressive statistic to add to the success of the eleven other hospitals and 38 clinics that the foundation operates in California. Oregon and Hawaii.

"Medikaiser,'' as insiders now call it. is the nation's largest nongovernmental, womb-to-tomb program for prepaid health and hospital care. Since World War II it has grown to a grand total of 911.001 members, representing about 337,000 subscribers and their families. Contrary to widespread belief, employees of Tycoon Henry J. Kaiser and his gangling industrial empire make up only 5% of Medikaiser's subscribers.

Best in Groups. Anyone in an area served by Medikaiser is eligible to join. And for their money subscribers get more complete protection than is available from most other forms of U.S. medical insurance. In most of the U.S., Blue Cross pays only hospital bills and Blue Shield pays only surgeons' fees and some doctors' bills; H.I.P. (the Health Insurance Plan of Greater New York), runner-up to Kaiser as the nation's biggest prepaid care plan, does not cover hospital bills. Medikaiser covers almost everything.

Among a dozen variants, there is one basic plan. Under this plan, an employed subscriber pays $7.80 a month for himself, or $14.20 for himself and wife, or $18.35 for self, wife and dependents. (If he is part of a group and is over 65, or is an individual member and over 60. he pays an additional $1.20.) For his dues, he and his family are entitled to visit Medikaiser doctors in their offices as often as they like at a charge of $1 a visit. With two minor exceptions, all operations are done without charge. Patients are entitled to: 60 cost-free days of hospitalization for each illness in any year, plus 51 days at half-price; free blood on a replacement basis; a 50% discount on prevailing rates for laboratory work. X rays and physical therapy; free ambulance service; free home calls by nurses; doctors' home calls at $3.50 by day, $5 at night (less than half the prevailing West Coast rates). Pregnancy care, through the birth of the baby, costs $95.

For all this, there are still admitted gaps in what Kaiser can offer. "In care of the aged," laments General Manager Clifford H. Keene, "we are only feeling our way along and haven't found any really good answers yet. We have no real dental care, and only limited psychiatric services." But Kaiser doctors are justly proud of other aspects of their organization. Besides its twelve hospitals, the plan operates a specialized rehabilitation center in Vallejo.