NATIONAL HEALTH INSURANCE

Press, Volume LXXIII, Issue 22018, 16 February 1937, Page 5

NATIONAL HEALTH INSURANCE

“UNWISE TO COPY BRITISH SYSTEM TOO CLOSELY” H.—SPECIAL CONDITIONS MET IN N.Z. The wisdom or otherwise- °* New Zealand copying the of national, health insmance too closely is touched on m this article, the second of a series of articlcs deal ing with systems of national heahh ■ insurance, an innovation, b oiru, - sidered now by the Government. The articles are quotations from an aa dress given by Dr. J. P. S. ' of Nelson, before the COl i^. ence of the Australian and New zea land Association for the Advancement of Science, in Auckland. .

[By DR. J. P. S. JAMIESON] National health insurance is not a clear-cut scientific problem, but a complicated human question presenting aspects of policy, economics, finance, sociology, and psychology, as well as those of health science. It would be impossible and inappropriate to attempt to discuss the subject from all those points of view. I prepo-c the fore only to make some comparisons of our conditions with those in one or two countries which have had the longest experience of the s y st ®™. operation, and to enquire if tendencies have shown themselves of which we should take note.

The British System The British "panel system” began its life in 1911. Prior to that time there were vast numbers of people living in congested areas, earning barely sufficient for fond, clothing, ana shelter, if employed. Temporary loss ol earning power meant temporary destitution. Medical men could not earn enough among them to be able to live and give them service. The poor-law doctor,, with his £59-a-year salary, could not cone with them. The outpatient department of voluntary hospitals could deal onlv with casualties. The .poor-law infirmaries were practically homes for chronics and incurables. lii all industrial centres those conditions existed. These were to some extent ameliorated by the “Fourpenny" Club doctor, who rushed through what attendance he could, but many could not afford even, that. - These were the conditions the panel system opened with. In Germany it had been the same.

Such masses of people are still in Britain and Germany, and but for the national health insurance it is probable that they would still be under similar handicaos in sickness. Under the scheme, subsistence was provided for the insured worker during sickness. and medical attendance. The latter was limited in scone, and from the numbers included and haste involved, inferior to .the medical services to which the workers New Zealand are accustomed. Still, it was something better than the insured population had experienced before.

Consequently, the Royal Commission on National Health Insurance, which was set up in 1924 under the chairmanship of Lord Lawrence of Kingsgate, after reviewing the working of the system in Britain from its beginning in 1911, was able to report in 1928:

We can say, however, at once, that we are satisfied, that the scheme of national health insurance has fully justified itself, and has, on the whole, been successful in operation. The workers of this country have obtained under it substantial advantages, in particular by securing the title to free medical attention and medicine -whenever and as 's«?Sp as these are required, “and by the proportionate diminution, to the extent of the cash benefits granted, of their anxiety as to loss of wages during illness. Comparability of Conditions

The question which arises here is: Would we be justified in accepting this authoritative and impartial statement on the British system as absolute for the value of national health insurance anywhere? The answer must be, “No”; Conditions qualify conclusions and modify methods. A system'which suits Britain is unlikely to be suitable in New Zealand. The conditions are dissimilar. No one who has not lived in the ’British industrial areas and also in New Zealand can appreciate the difference. No one who has not done medical work in those areas and also in New Zealand can understand how greatly the work of- the British panel practitioner differs from that of the New Zealand doctor.

Our problem has been, and still is, not so much how to bring health service to crowded, lowly-paid masses, as to cater competently for the scattered country dwellers on whom development primarily depends, and to minimise their disadvantages; not so much to assist those in employment, as those unemployed and past employment; and not so much insufficient treatment, as insufficient knowledge of the causes of certain physical disabilities to which New Zealanders are specially prone. For the medical man the problem is not how most expeditiously to diagnose the ailments congregated in a crowded waiting-room and relegate each to the appropriate treatment, but how himself to deal most efficiently with the varied requirements of a scattered population. On account of these divergences we should be unwise to copy the British system too closely. (To be continued.)

NEW ZEALANDER S IMPRESSIONS

HEALTH INSURANCE ABROAD GERMANY’S SCHEME PRAISED Miss Mary McLean, who recently returned to Christchurch after a trip abroad, saw a great deal of the working of various phases of national health insurance in Germany, Sweden, Denmark, Switzerland and England. Miss McLean’s trip was both extensive and intensive: —extensive so far as the field of her travels lay; intensive in that, as a member of the New Zealand Trained Masseurs’ Association, she visited various celebrated clinics and studied'the development of health matters. In Germany, Miss McLean said, national insurance is part of the national health scheme. And Germany is cultivating health. Her’’women are superb in their vitality; her men are lusty and vigorous. There, is little sign of tuberculosis or goitre. “Compared with the people of Germany the people of New Zealand seem below par. Yet New, Zealand has everything to its advantage in the way of food - and -- climate,” Miss McLean added. However, the health of the people of New. Zealand appeared to be distinctly higher than that of the people of Britain. From the cradle the young German becomes part of his country’s health scheme. His general health, /his teeth,his eyes, his hearing are all; of concern to bis Government. The idea-;is not-so much the cure of disease (though this is aimed at); or the payment of benefits in the. case of sickness; (though • this; too, -is part of 4he scheme), but the preyentibh of disease.-New clinics for research have been established everywhere. In massage,and remedial gymnastics the work

done in these departments is particularly fine. All practitioners in every department must pass government examinations, and on the result of these examinations they are registered to practise. “One thing is outstanding,” said Miss McLean. "There is a complete absence of unauthorised practitioners, and absolutely no sale of quack remedies and drugs.” The National Health Scheme in Germany ensures free medical treatment and services, including treatment at famous clinics, and provides for nurses, masseurs, and other curative agents, Miss McLean said. Wages are paid to the worker when he is sick. When he is in employment he pays a regular sum towards this Health Insurance, and this is deducted from his wages. When he is unemployed the money is paid for him; .The whole population of the country is included, from highest to lowest. This national health scheme hot only covers medical treatment and insurance but allows for holidays for workmen, and provides treatment for patients at such places as Nauheim and Weisbaden, both of which resorts, until two years ago, were accessible only to the wealthy. Everything is now on the one level, with no special consideration for American millionaires, though these still frequent the places. * Austria, though at the present time a poor country, has a health insurance scheme by which opportunity is given for medical treatment in institutions or by famous specialists at a very low fee. The Scandinavian countries, according to Miss McLean, have all their schemes of National Health Insurance. This is developed to the fullest extent in Sweden, where the health ' of the people is of a very high standard. The national health insurance, for workers under a certain income, is covered, partly by the Government, and partly by the workers themselves. The health, of the race is protected by the national health scheme, and the people of Sweden pay great attention 1 6 their health. The women are the finest in the world —tall, straight, and well made. The prevention rather lhan the cure of disease is. the rule, . A curious sidelight on this 5 health' protection is seen in the fact that the

\■' ' • law decrees that a man, when drinking alcohol, must eat as well, Miss McLean said. The drink question of the nation is therefore controlled, unobtrusively, by its natural gastric juices. The centre of Denmark’s health scheme is a National Board.of Health composed of medical men, each one of whom is responsible for a certain district Switzerland, though it has yet no recognised health insurance scheme. Has made great advances in research, particularly in goitre and tuberculosis. : “In England I heard a doqtor, opening a congress, state that the country was doing more to promote, physical fitness than any other country in the world.” Miss McLean said. “If that s so, the standard of nhysical fitness a vear or two ago must have'been low. Britain has not yet reached the Continental standard. The British health insurance scheme covers workers under a certain salary, and paymer are made partly by the worker and partly by the employer. The policies do • not coyer everyone, and q}° ' not carry full benefits. “Britain's insurance scheme provides certain treatments at panel hospitals, arid London County Coun 1 clinics. Thousands are treated each week. The scheme does not yet provide full dental or massage treatment as in Germany and Scandinavia, nor > is there provision, as in those other , countries, for preventive work. It | is purely remedial. Any preventive . work is done by private subscriptions I and volunteer workers. It is, without doubt, the beginning of a big scheme, .which though progressing ; slowly, may perhaps be more lasting than. those in other lands. It must be remembered, too. that, more than in any ’ other country, enormous sums are given by private people in England, for benevolent causes. In Germany ’ all philanthropic effort is under gov- ’ eminent control.” ■ Not exactly under any health scheme, • but worthy of mention, said Miss Mc- . Lean, was the enterprise of the Glast gow Corporation, For mile upon mile, i- during the four summer months, the ~ banks of the Clyde were covered with ■■ camps, where, the dwellers in the 5. slums of the city enjoyed l the limited 1 amount of > sunshine the country provided. ft