NATIONAL MEDICAL SERVICE.

Press, Volume LVI, Issue 16847, 29 May 1920, Page 9

NATIONAL MEDICAL SERVICE.

B.M.A. COMMITTEE'S EEPOET. The following interim report of a committee of the New Zealand branch of the British Medical Association is published in the latest number of the "Journal of Public Health, ' by arrangement between the Department .md the Association. The report i-übmittod to the Minister ot i'ubiic Health, who was advised by the Association that if he tliougut iit to do so he should authorise publication: — Tiie question 01 national medical service is prominent at tiie picseiit time for various reasons, chief ot winch is the increased responsibility of the Scaio to undertake the prevention of disease and the promotion of the health of tne people. . 'iiie organisation of medical servicn during the Great War lias given this movement a great impetus. l-ocal conditions, such as the scarcity cf Ir.ec.lcal service in country districts, are also causative factors, and there is the necessitv for provision of adequate hospital .organisation on a large sea.e lor the benefit of paying as well as ! \ on " paying patients, enabling the nieciical profession to continue tho " rci v n work," which will be as serviceable m civil life as it has been during the ar j From the point of view of medical mcu individually, the present system 01 medical practice, and the enormous development of specialisation, have made the work of the general practitioner difficult and burdensome, and the measure of his success is his deprivation of leisure for recreation and study.Control. —This Association is emphatically of tho opinion that the success of any modified scheme of national medical service is mainly dependent upon suitable control, and the medical profession, to ensure the success of any scheme, must have the control of .the service largely in its own hands. For this purpose it would be advisable to constitute a controlling Board, of tvhic.i the majority of members should bo elected by the profession, the Health Department, having representation on this Board. . _ . . Scheme of Modified National c>erv'.ce in New Zealand. —The New Zealand branch of the British Medical Association. which practically expi esses the opinion of the profession in New Zealand, considers that national medical service should be established in the following ways:— _ , I. Tho Public Health Department should bo extended and strengthened, and the function of the various administrative heads more clearly defined. The listrict health areas should be of a size convenient for proper control. The Health Department as at present constituted appears to be almost entirely administrative, and should be brought more into contact with flic clinical side I of medical work. The various Health Acts should bo modified and consolidated. • The medical service under other Departments, such as the Education Department,

;hould be brought tinder tlic control of t :hc Health Department, which should r >ecome the Ministry of Health. q Board of Health—As regards the institution of the Board of Health al•eadv established, we consider that the ippointment of medical members should not be nominative, but that they should < je elected by the profession. v National " Service.—2. A modified > Form of national service should be at ] Dnce established for the "benefit of re- r mote and sparsely-populated areas, and 1; such special districts as mining districts, t Medical officers in this service should be t under the control of this Board, as al- i ready proposed. 1 Pay.—These medical officers should be 1 paid by salary, on terms to be fixed by i t.Ue Board, and on such a scale as to 1 provide for special payment in accord- i ance with the nature of the services s rendered, and for special ability. " • The medical officers should not be bur- ] dened with book-keeping, which could . lie well done through the agency of the : local Hospital Board. Proper provision should be made to prevent friendly : society services or any other form of : contract work from gaining advantage . at the expense of the medical officer or the rest of the community. 7 ._ , Service for the Poor.—3. A modified i form' of national service should be at once established for the benefit of poor patients in the cities and larger towns ; of the Dominion —such patients as re- i quire medical attention, in their own homes. ~ , , ' This form of service could be undertaken by a part-time medical officer. : Hospitals.—We arc of opinion that while the State control of hospitals should he largely increased, yet it wduld be unwise to abolish the local Hospital Boards. Stipendiary staffs of hospitals, as at present constituted, should be appointed and controlled by the Health Board, local Hospital Boards having; power to make recommendations in this. respect to the Health Board. There should be no honorary staffs, but the ; work done at present by the honorary i staff should be adequately paid for on a part-time basis. While adequate provision is at present. made for patients who may be classified as unable to pay for private medical at-; tention and nursing, there is a largo; and important section of tho commu-1 nity who are able to pay for such ser-j vices who find it increasingly difficult to get suitable accommodation, and who j must at present content themselves, in j some cases, with, inadequate arrange-1 ments in their own homes, or with, in ' other instances, imperfect arrangement} dependent on the enterprise of priva'to hospitals. Tho necessity for adequate operjfting-rooms and appliances, X-ray, . electrical, and other specialist treatment, and new diagnostic methods make I

this difficulty a matter of urgency. The i present system too often is unjust to I the patient as well as to the medical adviser, who cannot provide the full service which he conscientiously desires to , supply. j To meet this end we recommend what may be called the Canadian or Toronto i scheme, which, briefly summarised, i 3 this: —(a> A building or buildings in the general hospital grounds, or in some other location not too far remote from the general hospital, should bo provided for private patients of the class alluded to. (b) The charge for accommodation, 1 maintenance, and nursing will depend j upon the room provided, as regards, I position, aspect, and so on. (c) The! patient will select his own doctor, '(d) The fees paid for nursing attendanco will be on the private-hospital scale. ' (o) The fee 3 to be paid to the doctor will be a matter between him and his patient, (f) The profits arising out of the maintenance of these patients will be used in the finance of the general hospital. | The committee urgently advocate this j reform in view of _ the large amount of hospital abuse which exists at present-, | more particularly in country districts, and which shows no signs of abatement. This cannot be satisfactorily accomplished unless provision is made for hospital accommodation of patients who are well able to pay, and who will make their own arrangements for adequate payment for medical and surgical service with the medical attendant of their own choice. This is by no means a new and untried scheme, being at present in practice in Canada, America, various hospitals in the United Kingdom and the Continent, and in maternity annexes in this country. I Minister cf Health.—lt is desirable, : whenever possible, that the Minister of Health should be a medical man, in the same way that the head of the legal profession and of the administration of justice is one who has been technically trained.