HEALTH SCHEME.

Auckland Star, Volume LXIX, Issue 206, 1 September 1938, Page 13

HEALTH SCHEME.

FARMERS , CRITICISM.

CHOICE OF DOCTORS

''FREEDOM VERT NECESSARY."

The opinion that from a financial point of view a sound health insurance scheme is not open to the same objection as the Government's pension proposals and that it would not impose fresh burdens on the community, but would be merely a rearrangement of the methods of paying for medical services, ie expressed in an official statement issued by the New Zealand Farmers' Union on the question of the health benefits proposed under the Social Security Act.

"A well-designed scheme should relieve the thrifty of some of the burden of providing medical and allied services for the thriftless who would then automatically make some provision for themselves," adds the statement.

"A fundamental difference between the Farmers' Union's idea and what appears to be the idea of the social security proposals in regard to medical benefits is that the Government desires the doctor to be the servant of the State while we desire him to be the servant of the patient. Complete freedom of choice between doctor and patient is. in our view, a very necessary condition, and this is not secured by allowing beneficiaries to change, at prescribed times, the doctor on whose list they are. It is not clear from the bill that, having chosen a doctor, there is a right to change to another doctor. It is certain that if such a right exists it can be exercised only at certain times, which will apparently be prescribed by the Minister. This" does not satisfy the Farmers' Union's idea of freedom of choice.

"The principle for which we stand in this respect is apparently conceded in regard to chemists, a beneficiary being free to go to any chemist who is willing to work under the scheme. It has also been conceded in regard to medical , attention to maternity cases, and there seems to be no reason why it should not be conceded in its entirety in regard to medical services. Country Patients. "The bill makes no specific arrangements with regard to the treatment of country' patients, and we submit that there should be definite provisions in the bill to deal with the treatment of country patients and definite provision for doctors' travelling expenses should be set out in the bill. "We consider it important that the administration and control of the health services should be entirely divorced from the administration and" control of the pension scheme, and that it should have its own finance vested entirely in the controlling authority. That authority should be removed from the political sphere and should consist of a board representative of the medical profession and other professions immediately concerned and representative of hospital j boards and of the patients.

The Farmers' Union has always laid stress on the insurance aspect of health insurance and an enormous amount of detailed administration with its attendant costs and regulations could be avoided by giving beneficiaries the right to obtain medical aid from any duly qualified medical man who was registered under the scheme. The insurance scheme would pay for services of medical practitioners at an agreed on scale of fees. This would also allow a patient who desired to do so to employ a medical practitioner whose services were more costly than the agreed on rate, he, of course, bearing the extra expense. Hospital Finance. "There are many aspects of the health proposals with which we are in agreement, but we are profoundly disappointed that no provision has been made to deal adequately with the question of hospital finance," adds the statement. "It seems to be generally assumed that the bill provides a payment of 6/ a day per occupied bed in hospitals, and it is argued that this is considerably greater than the amount which hospital boards are actually able to collect from patients at present and to this extent is an assistance to hospital finance. Actually there is no provision in the bill for the payment of any stated sum. There is. however, provision for some payment, the amount of which appears" to be entirely at the, discretion of the Minister. A public hospital is, however, prohibited from charging a patient any fees whatever. In our opinion the payment of it is on the basis mentioned and will not help hospital finance, as the extra accommodation required and the extra services will necessitate increased capital and maintenance expenditure which will more than counter-balance any assistance from the social security fund. We are supported in this opinion.by the executive of the hospital boards which, according to the Rev. W. C. Wood, their vice-president, 'was of the opinion that this amount (6/ per bed per day) would be more than cancelled out. Provision and maintenance of additional beds would undoubtedly follow the introduction of free hospital treatment and it would also be necessary to extend out-patient departments and" to provide consultant and specialist services. Boards would also be required to pay the present honorary staffs, as it was perfectly obvious that honorary services could not be reconciled with free hospital treatment for all.'

"Ironical Position." "The position surely becomes ironical when wealthy persons availing themselves of the specialist services, such as radio and X-ray, may not be charged for services which struggling farmers must pay heavy rates to give them. "Summed up, it appears as if the medical scheme will mean that the farmer will (1) still have to pay his hospital rates, (2) have to pay his 1/ in the £ like everyone else, (3) have to bear a large proportion of the extra taxation required, and (4) have his hospital rating greatly increased because of the extra capital'expenditure which is bound to be required."