OPEN HOSPITALS

Evening Post, Volume CIX, Issue 132, 8 June 1925, Page 4

OPEN HOSPITALS

With only one dissentient, the Hospital Boards Conference approved the Health Department proposal that, instead of the present honorary staffing arrangements, there should be payment either on a whole or part-time basis. The Hospital Boards are, of course, free to decide for themselves when and to what extent they will carry out this recommendation. Most of them, having made financial provision for the current year, will be unable to provide immediately for payment, but they will no doubt arrange for the change next year. The principle at least has been accepted, and the ' best method of bringing it into operation may now 1 be settled by the. individual boards and the medical practitioners. The decision removes an anomaly which has arisen with the gradual change in the work done by general hospitals. When these institutions were maintained chiefly for the poor it was reasonable that doctors should give their services without charge, but it is now established as a principle that hospitals shall be open to rich and poor alike, and it is quite unfair that those able to pay should be asked to pay for hospital maintenance but not for medical attention. This change, however, deals with only one quesl tion arising from the altered character of the hospitals. While nominally open to all, the institutions are, by conditions, closed,to those who desire privacy and special service.

A patient entering a public hospital cannot be attended by a private practitioner, even though that practitioner has had full charge of the case up to the time of admission and the patient wishes to retain his services. It is probable that many people who are really uuable to pay private hospital fees are forced to do so or to remain in their homes because they wish to be treated by their own doctors. Of course it may be said that the hospital is staffed by men of equal skill, and that the desire for private attention is unreasonable, but it is now recognised that the patient's confidence in the doctor is often of great importance in assuring recovery, and where that confidence exists it is desirable that it should be maintained. Then there is the question of privacy— a separate room and the privilege of receiving visitors at all times as they may not be received in a public ward. ; This is more difficult to decide than the question of private attention. At the root it is an issue of finance. While hospital boards are barely able to provide money for essential extensions, they cannot be expected to build special accommodation. If it can be shown that the cost of such building will not be a charge upon the general funds, but that the paying wards will pay their own way, the issue is somewhat different. But can this assurance be given ? Hitherto we have seen no detailed estimates of what the cost of building, equipping, and maintaining the private wards would be ; nor any estimate of the revenue expected. Such estimates cannot be made hurriedly. Even to estimate the cost per bed of the General Hospital is not a simple calculation, because the Hospital Board activities are so various. There arc special depart-; incuts, and wsirds for chronic invalids which may be more costly' than the general section.. A division of total, coat by the number of beds doua not give a fair statsiaeat

of the cost of the average patient to the institution. It would be interesting to know if the calculation of cost per bed as now made allows for these special charges.