MEDICAL SERVICE

Press, Volume LXXVIII, Issue 23715, 13 August 1942, Page 4

MEDICAL SERVICE

REFUND OF PATIENTS’ FEES

POSITION OF SPECIALISTS That confusion has recently arisen between the public and the medical profession over the operation of the Social Security Act in relation to refunds for medical services is alleged by the president of the Canterbury Division of the British Medical Association (Dr, E. R. Reay). Dr. Reay, in a statement to “The Press,” says that although the Social Security Act excludes specialists from the operation of the act, within recent weeks people have been encouraged by the Social Security Department to seek refunds for specialist services'by receiving signed receipts from the doctors concerned stating the dates of attendance and that all these refunds have been allowed by the department. “If the service rendered is a genuine specialist service and a high fee is charged, the refunds, are made in breach of the act," says Dr. Reay. If the service comes under the act, then a doctor can have no .right to charge anything but the fee of a general practitioner.

“Section 13 of the Finance Act (No. 4) states inter alia ‘there is hereby excluded from the expression “medical benefits” all medical services that are within any of the following classes; namely: (c) Medical services that involve the application of medical skill and experience of a degree or kind that general medical practitioners as a class cannot reasonably be expected to possess.’ “To clarify the position, the local division of the British Medical Association sent to the Medical Officer of Health a list of medical men whose work was confined to certain specified special branches of medicine. In reply the‘following remarkable communication was received:

Deaf Sir,—Regarding General Medical Services. In reference your letter of the 171h ultimo in regard to certain medical practitioners who desire to be classified as specialists, I have to advise that ■ except as regards obstetricians and radiologists the department has at the moment no machinery for the classification of specialists. Your communication was apparently intended as a notification to the department that no medical service afforded by the practitioners named can properly be regarded as the subject of repayment from the Social Security Fund under the General Medical Services Regulations. The position under the existing legislation is that if any question arises as to whether any service provided by a medical practitioner is Included in the expression "General Medical Services,” it shall be decided by the Minister of Health after consultation with the appropriate committee appointed under Section 83 of the Social Security Act, 1938. In order to clarify the position the department now suggests that if any medical practitioner considers the services afforded by him to be outside the scope of the benefits (general medical services) provided under the Social Security Amendment Act, 1941, he should mark the relative receipt "Specialist service.” It would then remain for the patient, if he so desired, to raise the question as to whether the service was in fact a specialist service and for the Minister to take steps to reach a decision in accordance with Section 83 of the Social Security Act, 1938. The present policy of the department is that refunds will be made in response to claims by patients which are supported by receipts given by any of the medical practitioners mentioned in your letter of the 17th ultimo if such receipts are not endorsed "Specialist service.”—Yours faithfully. T. FLETCHER TELFORD. Medical Officer of Health,

“It seems from this," says Dr. Reay, “that the department denies the existence of specialists unless it has the machinery to classify them. There can be only one judge of the service rendered and that is the doctor who gives it. It is almost an impossibility for the Minister to do so. Mr Heisenberg, secretary of the Department of Health, is on record as saying that ‘the act allows refunds only in respect of general medical services and the doctor’s own signature was the only guarantee the departm/ent could recognise that the service for which the refund was claimed was a general medical service. This was the reason for the doctor’s own signature,! for. no one else could know the character of the service.’ “Why the present difficult position is being forced on the public and the profession, both severely strained by their efforts in the present conflict, only the Minister of Health can tell. Doctors are readily agreeable to people obtaining a refund for specialist services on a straightforward basis. What they do object to is being a party to a transaction which is probably a breach of the act. At some ftiture date charges may be laid against them of aiding and abetting the present very doubtful procedure. "A single regulation validating refunds for specialist services would immediately solve the problem. It is difficult to see why this cannot be done in the. interest of the whole community.”

ALTERATION TO ACT

“PRESENT POSITION NOT SATISFACTORY ”

MINISTER’S INTENTION ‘‘The position is that, under the Social Security Amendment Act, specialist services are excluded from the act and, therefore, it is not legally possible for the department to pay out in respect of such services,” said the Minister of Health (the Hon. A. H. Nordmeyer) when the statement by Dr. Reay was referred to him for comment last night. “It must be recognised, however, that specialist services are not necessarily performed by specialists and that they may occasionally be performed by general practitioners; while, on the other hand, specialists may perform work not necessarily of a specialist nature.” Recognition was. made by the Minister that the present position was unsatisfactory and he said it was intended to have the law clarified as soon as opportunity permitted. “Could that be done by regulation as Dr. Reay suggests?” Mr Nordmeyer was asked.

“It cannot be done by regulation,” he replied. ‘‘An amendment to the act is required, and that cannot be done until Parliament is in session.”