PUBLIC HEALTH.

Auckland Star, Volume LXVII, Issue 273, 17 November 1936, Page 8

PUBLIC HEALTH.

INSURANCE PLAN. I INQUIRIES IN HAND. CIRCULAR TO THE B.M.A. QUESTIONNAIRE SUBMITTED. Investigations are being made by the Government, preliminary to the organisation of a heal til insurance scheme, with a view to placing a measure on the Statute Book next session m conjunction with a national superannuation scheme. Medical practitioners are naturally taking the greatest interest in the proposal, and in the absence of any definite lead from the Government as to what form the scheme will take 'they are wondering whether, as far as medical service is concerned, it is proposed to establish the panel system as in operation in England, or whether it will be an organised State medical service, "with complete or partial elimination of private practice. There is a division of opinion among the doctors concerning what should be best for the community as a whole and for the profession as well. The first step to acquire useful information has been taken by the Gov ernment which has appointed a sub-com-mittee in association with the Minister of Health, the Hon. P. Fraler, to report "particularly on a scheme for providing medical and allied services." To facilitate the preliminary work of the subcommittee a questionnaire lias been prepared which has t)ecn submitted to the B.M.A. and organisations concerned with the health of the community. In forwarding the questionnaire the secretary of the sub-committee, Mr. C. E. Wynne, of Wellington, has made a request that all replies should reach Wellington before November 30. B.M.A.'s Action. The B.M.A. decided that the questionnaire should be circulated to all its members with a request that divisions Of the association should formulate tlieir answers as expeditiously as possible. The chairman of the association's national health insurance committee was appointed organiser to travel the country, confer with divisions, and afterwards to call a special meeting in November to prepare a reply to the Government's committee. The B.M.A. also arranged that headquarters of the association should be requested to send a suitable representative, preferably Sir Henry Brackenbury, to assist the New Zealand branch of the B.M.A. in its preparation to meet impending legislation. The questionnaire was briefly considered by the committee of the 8.M.A., which suggested answers to the various questions prepared. These were given in order to stimulate members to consider each question for themselves, and they do not necessarily represent cobclusive decisions. The questions are as follow, with the tentative replies in parentheses:— The Questionnaire. 1. Nature of Scheme. (a) Should this scheme be contributory or noncontributory? (Contributory.) ' T; , ' (b) Should any class or classes of persons be exempted from contributions ? (All should be exempt ' who are not beneficiaries.) (c) If so, should minimum and maximum income limits be applied in determining such exemptions? (Yes, 'both minimum and maximum.) Beneficiaries. (a) Should the benefits extend to dependents of the insured? If so, who are to be regarded as coming within this category? (Yes; legal dependents to age sixteen.) (b) Should any class of person be entitled to benefits without having contributed therefor, e.g., old age pensioned and unemployed? (Yes, all below a minimum income to be decided.) (c) Should an insured person have his rights to benefits modifiedsjn respect of any period during which' he is in receipt of payments under the Workers' Compensation Act? (Medical services ' rendered under the Workers' Compensation Act should n'ot be covered by medical benefit under National Health Insurance.) 3. Benefits. Should any of the following benefits be excluded? (i.) General medical practitioner services; (ii.) special and consultant services; (iii.) laboratory aids; (iv.) medicines and appliances; (v.) dental treatment; (vi.) ophthalmic treatment arid optical appliances; (vii.) orthopaedic appliances; (viii.) nursing and massage services (non-institu-tional); (4x.) maternity services (if not provided under other headings); (x.) hospital and sanatorium treatment; (xi.) transport of patients; (xii.) sickness benefit and disablement benefit, (i. to xi.: All these benefits should be ' provided for beneficiaries so far as cost permits, xii.: Sickness and disablement benefits should be separate fiom medical benefit.) i f Third Party Interests. 4. Contracts and Third Parties." Assuming that the relative benefits are included in the scheme: (a) What should be the basis of pay-ment-for medical services, that is: (i.) General practitioner? (Per capita, •with option alternative methods, as in Britain.) (ii.) Specialist? (For services rendered.) . $ (iii.) Consultant? (For services Tendered.) ". (b) What should be the general basis I «f arrangement for the supply of: .. (i.) Medicines? (Through approved , pharmacies.) (ii.) Appliances? (Through approved \ '■; (c) What should be the basis of payi Jnent for dental treatment ? (Refer to t Dentists' Association.) (d)' What should be the basis of payment for: . _ (i.) Ophthalmic treatment? (For services rendered.) (ii.) Optical appliances? (Through approved firms.) (e) What should be the basis of pay- . ttient for non-institutional nursiii"" and :massage services? (Refer to associations of nurses and masseurs.) (f) What should be the basis of pay- . Jnent for non-institutional maternity -services? (By special fee.) (g) What is to be the basis of payment from the fund in respect of treatment in: (i.) Public hospitals and sanatoria? (Per day.) I (ii.) Private hospitals? (Per day.) (h) What is to be the basis of payment for ambulance and other transport services? (Refer to ambulance and transport authorities.)

Sickness and Disablement, 5. Administration.

(a) Should the administration of cash benefits, such as sickness benefit and disablement benefit, be separated from the administration of benefits such as medical and hospital benefits. (Yes: essential.) (b) What should be the form ot central administration of the schcm °' 4 ;] Should there be a specially constituted central body with executive powers, and, if so what should be its general constitution? (Control of medical services to bo by a commission of medical men in association with the Health Department.) (ii.) Alternatively, should the National Health Insurance administration be made the function of an existingdepartment, or departments, enlai o ed for the purpose? _ , (c) Should local administration be undertaken by specially constituted local insurance authorities? If so, what should be- "tlicir constitution and functions? (Local administration by specially constituted authority of nominees of'interests concerned. Local areas not to be numerous, might correspond roughlv to health districts.) (d) To what extent should Friendly Societies, and other bodiics who are already administering voluntary insurance schemes be entrusted with responsibility under the general scheme ? (lo have no responsibility in regard to medical benefit.) ' , (e) What provision should be made for consultation between the administrative bodies and local) and committees representative of doctors, pharmacists, dentists and others similarly affected as contractors for supply of services? (Liaison by nominee of central administration or local authority.) . . (f) What should be the principal method or methods of payment and collection of income? (Refer to finance experts.) ("•)• Should income from all sources be allocated to separate funds for certain benefits or groups of benefits, and each such fund or the National Health Insurance Fund a-s a whole be kept actuarially sound? (iund for medical benefit to be kept separate and actuarially sound.)