MEDICAL CARE.

Press, Volume LXVIII, Issue 20624, 13 August 1932, Page 16

MEDICAL CARE.

BENEFITS OF GROUP PRACTICE. ANNUAL. PER CAPUT PAYMENTS. SYSTEM DECLARED APPLICABLE TO NEW ZEALAND.

An organised system of medical cure uuder which every man, woman, and child in the State ■would contribute towards a common "health fund" and receive in return expert medical service embracing not merely the cure but the prevention of illness, is that envisaged by Dr. Allon Peebles, a distinguished medical economist of the United States, who is now approaching the end of a five years' research into this problem. Dr. Peebles, who has arrived in Christchurch on a holiday visit, declared iu an interview last night that not 10 per ceut. of the people of the United States were receiving the full benefit of scientific knowledge in medicine, partly because individual doctors could not apply it and partly because the people ' themselves could not pay for it.

Tho system which ho urges, and which ho claims may be as readily adopted in New Zealand as in the United States and Canada, would at once increase the efficiency of medical practice to a marked degree and reduce its cost to the individual. "Group medical service must come—tho situation demands it," declared Dr. Peebles.

A Thorough Investigation. Dr. Peebles, who is a Ph.D. of Columbia University, is a member /of the committee on the Costs of Medical Care, composed of 50 doctors, dentists, nurses, public health officials, and representative laymen, which has been engaged on a five years' research programme on the following ' three subjects:— (1) The extent of illness and defectiveness in the United States and the existing facilities for taking care hi sickness. (2) The costs of" medical care to individual families and to the nation, and the incomes received by physicians, dentists, nurses, etc. (3) Existing experiments in the provision of, and payment for, medical care. The committee is a national organisation, established privately by a number of people who were agreed that the problems involved lvoro so urgent as to warrant immediate study. State Conferences to be Held.

Dr. Peebles explained that the committee was essentially a fact-finding organisation, and was not obliged to find solutions for •"' e problems involved. At the same time it was committed to making a series of recommendations to the public, and when those wero brought forward in November next State conferences would bo called to discuss, them.. Through the 15,000 people who had been recoiving its publications, the committee had already built up an informed body of public opinion. "There are two main necessities in the situation as it is to-day in the United States," said Dr. Peebles. "The first is that medical sendee should t>e provided on an organi d rather than an individualised basis. Personally, I'believe that independent private practice cannot be so efficient in a medical sense as group practice, and cannot bo so economical as group practice. When the practitioner could carry all his instruments and all hiß techniqup in a saddle-bag there was no need for co-operative practice; but to-day, when more and more instruments are developed, and the science of medicine becomes more and more specialised, it is very wasteful and very expensive for each man to have a full equipment when 15 or 20 physicians could use one plant in common.

Improving Medical Care. "Even the reduction of expense which would be brought about in this way is second* in importance to the improvement in the quality of medical care—an improvement that would result not only from the stimulus given ito each man by co-operation with his fellows and the case of consultation for the public, but through the fact that each practitioner would have a wellequipped laboratory and would be able to use the most modern aids to accurate diagnosis and sound therapy." The second necessity was that payment for medical care should be made on a regular, annual basis. The present distribution of the -costs of medical care was very unequal. Every year a majority of people paid nothing while a small minority were severely hit. Tho committee had had instances where as much as 50 per cent, of families' incomes in a single year had gone to expenses. Systems of Group Practice. Different systems of gremp practice with annual payments had already been put into effect in the United States. Many large business firms- deducted small amounts from, their employees' pay, contributed subsidies themselves, and thus organised very efficient medical units as part of their businesses. Many of the universities had taken similar action. Finally, there .were private group clinics—associations of physicians, mostly on a profit basis, which entered into contracts with individuals to give medical care fQr an annual fee.

"There is no earthly reason why some modification of these schemes could not be worked out in New Zealand," added Dr. Peebles. "There must be businesses that have as many as 1000 employees; if there are not, two or more businesses could combine. As for the general public, for'them,- too, some scheme could be devised, although one ,eould not have a'complete group clinic for less than 40,000 to 50,000 people. Personally, I am much in favour of group practice. I have no doubt whatever that it would lead to better medical practice and the economies effected by it would be passed on~ to patients in the form of reduced fees."

Mere grjbup practice, he emphasised, did not guarantee reduced fees, although it did make reduced fees possible. He himself could liot see any other effective method of control of the economics of the system than control by the St'ate; not that the incomes of the doctors should be fixed by law, but that some kind of effective administration should be set up to control fees. Otherwise there was nothing to prevent the establishment of group clinies for profit.