The press MONDAY, APRIL 3, 1950. Medical Benefits

Press, Volume LXXXVI, Issue 26078, 3 April 1950, Page 6

The press MONDAY, APRIL 3, 1950. Medical Benefits

When Parliament last year passed legislation designed to correct defects in the social security medical benefits scheme by the appointment of disciplinary committees and by some changes in the method of payment, it had the support of the New Zealand branch of the British Medical Association. The date on which the new provisions should operate was left open, apparently for further consultation on the personnel of the committees, most of whom will be appointed by the B.M.A. That the Minister of Health (Mr Watts) was able to announce on Friday that these amendments would come into force immediately suggests that the medical profession is prepared to accept, in the words of the Medical Services Committee of 1948, “ a large degree of respon-

“ sibility for the ethical behaviour “ of its members and for the general quality of all medical services The reforms now introduced may prove less important in themselves than as the first fruits of willing cooperation between Government and profession. The need for reform has been clearly seen both by the Government and the doctors, not only in the unnecessarily high cost to the taxpayer of medical and pharmaceutical benefits but also in the return obtained for that expenditure. The rewards of a State medical scheme were a temptation to young doctors to enter practice soon after they were qualified, instead of first seeking greater experience, increased skill and higher qualifications. The measures now in force were based on the recommendations of the Medical Services Commitfee, which consisted of four medical practitioners, three representatives of the Health Department, and an independent chairman (Mr T. P. Cleary). The committee"found that the Medical Council was the proper authority to deal with grave offences, but that there was a need for some disciplinary authority to deal with such matters as abuses of the social security system. The act passed last year gave the central disciplinary committee power to recommend substantial fines for social security abuses. Mr Watts proposes to go further and give it power to recommend the exclusion of offenders from the right of recovery from the fund. To this extent he intends to strengthen the act, apparently with the concurrence of the B.M.A. On the method by which doctors shall be paid he has apparently moved a little away from the committee’s recommendations of a single system. The committee’s proposal was that a doctor should claim “ on “ behalf of the patient the amount “ payable from the Social Security “Fund and apply that in full or in “ part settlement of his charge This is, in effect, a fee-for-service system amended to meet the wishes of the B.M.A. An exception was provided permitting, on special authority, or in the case of lodge doctors, the refund system, under which the doctor collects his fee in full from the patient, who obtains a refund from the Health Department. It was contended that concentration on the committee’s method would help to eliminate abuses and would reduce administrative detail. A statement (printed to-day) by the chairman of the council of the New Zealand branch of the R.M.A. (Dr. J. O. Mercer) suggests that authority for the refund system may be given rather more freely than was contemplated. Possibly it has been found that the administrative advantages envisaged were not sufficiently great to outweigh the advantages of giving doctors some choice. Either system permits the doctor to collect some additional charge from his patient, and the act restores to him the right to sue for that amount. The abrogation of this right in 1941 was resented by many doctors, who believed it to be an attempt to force them into the fee-for-service system to which they objected. The restoration of this right will not injure the interests of patients (who will have the protection of the disciplinary committees), and will do much to earn the good will of doctors. The committee recommended that a doctor should be able to recover from the fund 10s for a visit to a patient at his home, and that no payment should be made for merely repeating a prescription. The object was to discourage those who were inclined to deal with undue numbers of patients in their surgeries. The act provides an alternative, which seems at least as sound, entitling doctors to recover from the fund a fee “ not exceeding 7s “6d ”, and making it possible to regulate fees for minor and routine services.

The Government has hesitated at adopting another recommendation of the committee: that a small charge be made for prescriptions. The committee suggested that this would discourage people from going to doctors merely to get prescriptions for items they had been accustomed to buy from chemists for themselves. If the committee’s view were correct, and it seems reasonable, such a charge woulcP reduce the cost of both medical and pharmaceutical benefits. It need not bear hardly on the patient. Mr Watts has undertaken to refer the B.M.A.’s support for this recommendation to his Government, which may yet find a small charge of more value in checking the soaring cost of State-provided prescriptions than “ improved methods of “administration” and the help of disciplinary committees.