Predicted Medical Fee Rise Queried By B.M.A.

Press, Volume CVI, Issue 31195, 20 October 1966, Page 7

Predicted Medical Fee Rise Queried By B.M.A.

A prediction by the New Zealand Medical Association that general medical practitioners will raise their fees early next year, if the 7s 6d general medical service benefit is not increased soon, is questioned by Dr. A. C. Sandston, spokesman for the British Medical Association in Christchurch.

“I do not understand on what basis the N.Z.M.A. arrives at this conclusion,” he said yesterday. Dr Sandston emphasised that practitioners are free to charge patients any fee they consider fair and reasonable for the service given. Some, in case of pensioners, do not charge patients at all. “In his assessment of a fee, the doctor is concerned only with the total fee charged, and not the percentage of the fee which is recoverable from the Social Security Fund,” he added. “This is 7s 6d and has not altered since 1941.” There could well be grounds for increasing the Social Security benefit, and the general policy of the B.M.A. was that it should be increased. This, however, was a separate issue from the question of what fees individual doctors charged their patients. It was also incorrect, said Dr Sandston, to regard the B.M.A. as a fee-fixing body. It might recommend from time to time a fair average fee for a consultation, but this was in no way binding on its members. No General Move Dr Sandston said he knew of no general move in Canterbury and Westland to increase the average, general fee at present being charged. Most general practitioners increased their fees to £1 a consultation and £1 5s a visit last year. They maintained that no skilled tradesman was likely to charge as little for a home visit to fix any appliance. The basis of this thinking, according to Dr Sandston, is that medical practitioners will not give up their right to charge an appropriate fee for their service. The N.Z.M.A. puts it this way: “A fixed fee, irrespective of the service given, would lead to a rapid decline in general practice. “In Britain, to earn a living, a practitioner has to see 80 or more patients a day: he spends no more than about four minutees on each; he is unable to offer them the benefits of latest medical advances, and has to send them for any

trivial service to overcrowded hospital clinics where they have to wait in long queues for endless hours on uncomfortable benches.”

The right of New Zealand doctors to charge their own fees has been strongly defended since 1935, when the Government attempted to get the medical profession to agree to a capitation scheme. Wrong Impression

With the introduction of the benefit scheme in 1941, many doctors accepted the 7s 6d benefit in full settlement of their services.

This practice, said Dr Sandston, together with political promises of free doctors, led to the impression in the public mind that a free medical service existed.

This, he contended, had led to difficulties in acceptance by the public of additional medical charges when later imposed. Now, no less than previously, medical practitioners agreed that any attempt by a Government to increase the benefit, on condition doctors promised to peg their fees, would be strongly resisted. On the other hand, doctors favoured an increased benefit, with no strings attached. It is argued by the N.Z.M.A. that if the State did grant a rise, fees would not come down. A moderate increase in the benefit is all that could be hoped for in any case, it states. The N.Z.M.A. adds that if the benefit is not increased very soon, “another round of increases in medical fees may be confidently predicted in the early part of next year, because many doctors have not yet increased their fees to a level at which they can hope to maintain a decent statndard of medical practice for their patients, and of living for themselves.” “Never Abused” The N.Z.M.A.’s Journal, which is published by Dr. E. Geiringer, of Wellington, says “since both political parties know the doctors will not give up their right to charge an appropriate fee for their service, this gives the politicians a marvellous way out of their obligation to adjust the value of the benefit.” In 23 years, the doctors had

never abused their right to charge an appropriate fee. Their charges had increased only very gradually, and under necessity. “Until a few years ago, most patients paid no more than 2s 6d or 5s in private fees. Even today, very low private fees are charged in many areas.”

Many general practitioners, according to Dr. Sandston, resent the periodic focus of attention on the level of their fees and incomes. They pointed out, he said, that lawyers, businessmen, architects, accountants and other professional men were not under the same scrutiny ,and might raise their fees without public knowledge or outcry. Five-yearly Review This did not mean all medical men were satisfied with the situation. The B.M.A. itself was committed to a fiveyearly review of fees. Last year, Dr. J. R. Hay, writing in the New Zealand Medical Journal, gave a meticulous outline of all aspects of medical salaries, and his findings form the basis of much B.M.A. thinking on the subject. Dr. Hay concluded that the monetary value of the doctor’s income is falling progressively. “The traditional reticence of our profession to discuss monetary matters is not consistent with the wages and salaries practices of the 20th century,” he stated.

He recommended an annual review of incomes and expenses throughout New Zealand, and B.M.A. recommendations on fees, “as the need arises.” He also considered all members should adopt recommendations made.