The distribution of the subvention to private charitable institutions is not made, at the present time, according to any rule or predetermined scheme, except in the case of the appropriations to the various semi-state institutions. The amount any hospital, home, or organization shall receive rests primarily with the finance committees. *111 Some of the forces that determine how such an institution shall receive have been mentioned. As near as can be ascertained the following are the principal factors effective in fixing the grants obtained by various homes and hospitals: 1) the amount of the grant in previous years; 2) the requests of the managers of the various organizations; 3) the apparent need for these institutions in the communities where they are located; 4) political influence both of the members of the General Assembly and of other influential citizens in the communities; 5) the desire of party leaders to win or retain the support of the people within the localities; and 6) the recommendations of the Board of Public Charities. How important relatively each of these factors is in any given case cannot be determined. There is, however, no evidence to show that appropriations are made according to any definite rules.

That such procedure in appropriating public funds is uneconomical and undesirable in many other ways goes without saying. No doubt a great many people recognize this fact but as yet no workable substitute has been found. One reason that it has not been found is that many political leaders are well satisfied with things as they are.

For several years the Board of Public Charities has prepared a report which shows for each institution the number of free hospital days, the percentage of free treatment, the total cost of free treatment, and the amount received from the state for maintenance. These data are derived from the books and reports of the various hospitals which did not (in 1914) keep uniform accounts. *112 According to the report about one-half of the cost of the total free days is borne by the state. *113 But in some institutions the state pays practically the entire cost of free treatment, in others it pays less than 15 per cent, while a few hospitals, which have a large number of free beds, receive no state aid whatever.

111 See supra, pp. 217 ff.

112 Statistics Compiled by The Board of Public Charities, 1914.

113 Idem, pp. 39-40.

This discrepancy may, of course, be due in some cases to the ability of institutions receiving little aid to take care of themselves. Wherever this is the case the legislature is justified in refraining from giving them large sums. The present procedure in making the grants permits much flexibility, and enables the state to give liberally where the need is greatest and to withhold its aid where it is less. Hence a hard-and-fast rule in making appropriations would, from many points of view, be less desirable in theory than the plan which leaves the legislature free to make exceptions.

On the other hand, no one has ventured to assert that the comparisons and recommendations in the report of the Board of Public Charities are quite accurate. The board does not have a sufficiently numerous staff to inspect with the greatest care the numerous institutions that receive state aid. In 1915 there were eleven members of the board, including the general agent and secretary. The other ten members are not expected to devote a large amount of their time to the work. The general agent and four assistants and the special agent performed the major part of the inspection work.

As has been pointed out114 the committees do not follow the recommendation of the board. Because of this tendency proposals have been made for a system of appropriations based upon the number of free hospital days furnished in each institution. To accompany this plan there is usually a proposal for uniform accounting and closer inspection of the hospitals. Undoubtedly the innovations would tend to prevent extravagance where it now exists and would eliminate many of the evil effects of the present procedure.

Another method for determining the amount of the subvention to each institution is also frequently suggested. Since a considerable degree of flexibility is desirable, a maximum payment per patient-day might be determined upon. But in case the hospital did not require that much, in case private philanthropy and generosity largely provided for free accommodations, the payment could be reduced. Now, of course, the committees would be unable to obtain accurate data upon which to base a judgment in this matter unless the Board of Public Charities should be armed with the power to prescribe and to enforce a uniform system of accounting. In 1913 the board was given power to require uniform accounts of all institutions receiving state aid. *115 The same act also gave the board the authority to employ such experts and clerks as might be necessary. *116 But the penalty attached to the refusal of any institution to follow the requirements of the board in the matter of accounts is not all that could be desired, for the law merely states that in such a case the board shall not recommend any aid. But the legislature could still make the appropriation. Perhaps a self-denying ordinance will follow later.

114 See supra, p. 217.

115 Act 1 May, 1913, P.L. p. 153.

116 Idem, p. 151.

The application of this scheme to homes for the aged, for the blind, and for other destitute classes and to orphanages would, of course, be much less difficult than to hospitals. In the former cases the population is more permanent and the service rendered is simpler, and, therefore, the determination of costs is much easier than in the case of hospitals.