BRITISH DOCTOR CRITICAL

Press, Volume LXXI, Issue 21580, 17 September 1935, Page 11

BRITISH DOCTOR CRITICAL

High Fees Attacked "DREADFUL" HOSPITAL ADMINISTRATION IN N.Z. (UWITEU PiIESS ASSOCTATTOK—COPYRIGHT.) (Received September 16, 7.5 p.m.) MELBOURNE, September 16. Much comment has been aroused by statements made by Dr. Guy Dain, of Birmingham, at the final session of the Medical Congress, when he criticised the standard half guinea fee charged by Australian doctors.

Dr. Dain said the basic charge for consultations at his surgery was' half-a-crown. Australian charges drove patients to consult chemists, i Chinese herbalists and public clinics. He blamed the high cost, pi Australian private medical services for much of the congestion at the public i hospitals. The lowest price of a' bottle of medicine in Australia was 3s 6d, whereas in the country areas! of England the doctors did their own dispensing. Dr. Dain also condemned the New! Zealand haspital system where the hospital boards changed every two years, with the danger of frequent changes of policy and administration. Never had he seen anything more dreadful in hospital administration than that. In defending the fees charged, Victorian doctors claimed that much of their work was done free, and that much of it was done cheaply for lodge patients. The half-guinea enabled them to pick up on the swings what they lost on the roundabouts. There could be no reduction while so much was done free.

PRESENT SYSTEM DEFENDED

CHRISTCHURCH DOCTORS' J COMMENT i REMARKS DESCRIBED •AS j "UNFOUNDED" The criticisms by Dr. Guy Dain of the New Zealand hospital system are regarded by representative Christchurch medical men as exaggerated and even without foundation. They consider that the Birmingham doctor, when making his remarks at the British Medical Association conference in Melbourne, overlooked the close association of the Department of Health with hospital boards in the control of New Zealand hospitals. This association, they contend, automatically exerts quite a definite continuity of policy in hospital administration here. "In fact, I think our system is the best in the world. I cannot conceive a better arrangement than the one we have, where the hospital boards and the departmental authorities act as partners in the control of the institutions," said Mr H.' J. Otley, the chairman of the North Canterbury Hospital Board, when commenting on Dr Dain's criticism. Mr Otley mentioned the Christchurch hospital as an example which would refute Dr Dain's suggested lack of continuity of policy following changes of control. For many years there had been very little alteration in the personnel of the North Canterbury Hospital Board, he said. It was true that there had been more marked alteration in personnel in Auckland. The boards were subsidised by the Health Department and so long as that system was followed —a system which really put the board and the department in the position of partners—continuity must follow as a consequence and policy was not likely to be altered.

"No Change in Policy" The same point of view was taken by Dr. P. Stanley Foster, a member of the North Canterbury Hospital Board. He also mentioned the few changes in the board's personnel for many years. There had been no change of policy at all, he said. It simply did not happen. All the expenditure of the board had to be passed by the department and any radical change likely to be intended in policy came under the notice of the department through this supervision of expenditure. The board could not spend anything at all until it was authorised officially. So there was continuity in financial administration and consequently continuity in general policy. Another well-known city doctor concurred in the view that Dr. Dain had spoken without full knowledge of the New Zealand system. "In fact I think that he has merely exaggerated his criticism to make a point," he said. Throughout the Dominion there was no evidence of the frequent changes in policy, even if there was the danger of it happening. Dr. J. Restell Thomas said that the conditions in New Zealand were quite different from those in England. Charges in the colonies had always been much higher than those in England, but against that was the fact that the cost of living was much higher in the younger countries. For medical charges Christchurch was the cheapest town in the Dominion, and had always been so. Discussing hospital administration. Dr. Thomas said that conditions in New Zealand again differed considerably from those in England. The system that was being followed here was fairly satisfactory, he thought. "A Sweeping Statement"

Another city doctor described the remarks as laughable. Hospital administration was a large subject, and obviously Dr. Dain had made a sweeping statement. The system in New Zealand could not be called perfect, but it was not imperfect. Indeed, it ran very well, and no one could condemn it in-one phrase. The charges for consultations were only designed to give doctors a normal living, and considering the service they gave doctors were not comparatively wealthy people. If they were to be compelled to give consultations for 2s 6d, it would mean that they would have to give scanty attention to their patients. If the fees were reduced, doctors would have to be supported by the state.

Otherwise there would, be only one quarter of the number of doctors in practice, or else three out of four would become specialists, and thus the other one would treat people only for minor ailments. The whole statement was loosely put together, he thought, and was not a good criticism. The general reply of city doctors when asked to comment on Dr. Dain's criticism of medical and consulting charges was that he had spoken without realising the existing conditions in Australia and New Zealand. Conditions were so different in England that it was hardly jfair to make a comparison, one said. There was no doubt that in the poorer districts the fees'were considerbaly lower than those charged in New Zealand, but the doctor, had not taken into, consideration the point that the greater density of population allowed a far greater turnover and a reduction of fees was possible. Standard of Wealth A doctor working in a closely populated compact community could charge lower fees than one in a more scattered community. The average standard of wealth was higher in Australia and the Dominion, and people could afford to pay more and get treatment based on what they paid. It had also to be remembered that the doctors m New Zealand were certainly doing a tremendous amount of work for which they received, nothing at all at the present time. One chemist seemed to summarise the views of others in his comment on Dr. Dain's criticism of Australian charges for medicine. It had to be remembered, he said, that conditions were very different from those in England and that the New Zealand and Australian chemist had to account in his charges for the higher landing costs of medicines. Frequently English people, buying medicine in Christchurch, were known to have complained about the high charges—or at least charges which seemed high to them. But when details of high landing costs, exchange, etc., were explained they saw the matter in a different light.