NATIONAL HEALTH INSURANCE

Press, Volume LXXIV, Issue 22345, 8 March 1938, Page 14

NATIONAL HEALTH INSURANCE

DOMINION PROPOSALS CRITICISED REPORT BY BRITISH EXPERT OPPOSITION TO INCLUSION OF WHOLE POPULATION Craoxs ova own correspondent.) LONDON, February 16. The report to the Council of the British Medical Association of the vicepresident, Sir Henry Brackenbury, on his visit to New Zealand in connexion with the proposad national health insurance scheme, is published as a supplement to the latest issue of the British Medical Journal. Sir Henry reports having found a need for more extended inquiries on the Government's part and a more detailed knowledge of the actual operation of such a scheme on the part of the medical profession. On what he describes as the crux of the matter, he sides with the profession in opposing the inclusion of the whole population in the scheme, and recommends that if a disnute arises on this question, the New Zealand branch of the association be given full support, both advisory and financial. Before leaving London, Sir Henry states, he interviewed the New Zealand Minister for Finance (the Hon. W. Nash), who was then in England. "He received me courteously and I kindly, but was unable to give me any real information about the matter in hand," he adds. "I was informed that the principle underlying the scheme was that 'every inhabitant of New Zealand should receive adequate medical attention,' a principle with which, I assured the Minister, the medical profession was in hearty agreement." He found on reaching New Zealand, he states, a feeling among the medical profession that the scheme was not really neded, together with opposition to anything of a wider nature than the outline plan drawn up by the branch. A strong belief existed that the charI acter of medical practice in New Zealand was in most respects on a higher level than elsewhere, and that the conditions of practice were on the whole, except in relation to certain hospital questions, reasonably satisfactory. ft was thought that any changes would be likely to lower this high level of practice. Among the general body of practitioners there was still considerable ignorance of the working of the national health insurance system in Great Britain and a misconception of !ts results alike to the public and to the profession.

A Vague "Idea"

"No further disclosure of the Government's intentions had been made," Sir Henry continues. "Though at the opening of Parliament it was announced that a bill dealing with the matter would be introduced early in the new year to come into force in April next, and although Mr Savage, the Prime Minister, made repeated reference to 'the plan which we have in mind,' I was, after such inquiries as 1 could make, forced to the conclusion that there was no such 'plan,' but only what might more properly be described as a more or less vague 'idea.' " ~. . . He found that the Minister for Health, the Hon. P. Fraser, had a fuller knowledge of the subject and of the position taken up by the medical profession than others he had interviewed. Sir Henry criticises the constitution of the advisory committee set up to consider details of a national health insurance service. "Most unfortunately, as I think, the persons appointed were few in number, were selected entirely from members of one political party, and did not seem to be conspicuously possessed of the qualifications and experience best fitted for the job which they had to do," he states. "The chairman of this committee was Dr D G. McMillan, the only medical member of Parliament, who, however able and sincere as a politician, could scarcely be considered to be in any serlse a representative medical practiThe Government wisely refused to accept any responsibility for the committee's report, he adds. Through the courtesy of Dr. McMillan he was able to see the: report.before publication. He considered it an able document, in many respects satisfactory and certainly necessitating the serious consideration of the profession, but containing some proposals of a far-reaching and very doubtful character.

Apathy of the Public Other features of the situation which •struck him were public apathy and acquiescence, which seemed likely to continue unless opinion became disturbed by considerations of the great cost involved: and the confused condition of health and hospital administration on which any scheme must be superimposed. The impression he had of the Health Department was one ot underpaid efficiency "It appeared desirable that the Government honestly anxious as it was to implement promises which had been made at the election, should be induced, if possible, not to act Precipitately but to make more extended inquiries into certain aspects of a complicated subject of which it had no very wide knowledge or experience to offer much more abundant opportunity for discussion or negotiation with the medical profession and other interests, and to have regard rather to present-day practical necessities than to more or less vague or ab-tract sociological ideals," the report Mates. "The medical profession required greater knowledge and assurance than many members had ot the actual nature, methods, and effects of national health insurance in practical working." Prospect of Dispute Sir Henry gives details of the large number of meetings, discussions and conferences he attended. The outcome of these "somewhat strenuous activities" was not yet certain. "Whatever may be the exact scheme introduced by the Government, there will be a number of important contentious points requiring adjustment, ps well as many minor details; but the crux of the matter, the point which is more likely than any other to give rise to an irreconcilable clash of opinion between the politicians and the profession, relates to the clientele to be included in the scheme," Sir Henry adds. . "The Government's party advisory committee is known to favour the inclusion, not merely of insured persons, together with the small farmer and | shopkeeper (all of whom would be accepted by the profession), but of the whole population of the country. "Such a universal scheme would, I think properly, be unacceptable to the profession: and if a dispute on this point should arise I can only advise that the New Zealand branch should be given such full support, both advisory and financial, as the association can afford. I believe, however, that both the Ministers and the profession, when I left, had become more amen-

able and the gap between them less wide, so that there is a real hope of such a clash being avoided " Before he sailed, Sir Homy concedes, he left with the special committee of the branch a memorandum setting out the profession's position. Tins, with slight revision, had been sent to the Minister.