NEW COMPENSATION LAW -I Chaos predicted over illness and injury

Press, Volume CXIV, Issue 33434, 16 January 1974, Page 17

NEW COMPENSATION LAW -I Chaos predicted over illness and injury

(By ROSEMARY WILSON)

Doctors throughout New Zealand predict chaos when the Accident Compensation Act, now law, comes into effect on April 1. From that date, every patient who enters the surgery will have to be sorted into one of two categories: the sick, who will continue to pay for all treatment, and the injured, who will be entitled to a refund of all medical and hospital expenses, and to compensation for lost earnings.

In many cases there will be little difficulty in reaching a decision, but there will be plenty of border-line cases, or cases involving both accident and injury. For example, there will be the patient who has collapsed through illness, and injured himself in falling. Doctors contend that the dividing line between accident and illness is often so fine that there will be colossal medico-legal problems in establishing the point at which compensation applies. The Accident Compensation Commission, which will be responsible for administering the act, agrees.

Its medical director sug- < gests that doctors pass on i difficult problems to the < commission for decision, and t in other cases, consult the i commission’s handbook to r doctors, which will contain guidelines for reference. This ■, will help, the commission i says, to “placate the irate r patient who is convinced < that his symptoms are due ; to accident rather than ill- < ness.” That there will be “irate; ( patients” in plenty, there is[j no doubt. The average" reader of the list of benefits , which the commission is ad- ; vertising will expect free , treatment after an accident, ; and to most people, an “ac- , cident” is something which is not intended to happen. , But under the terms of the act, the definition is not | so simple. Drunken drivers The child who needs years ; of treatment because of the I “accident” of being born with a heart defect. pays;i< the drunken driver who hits! a power pole (or a pedest- j! rian) receives free treatment. The schoolteacher who de- I velops a neurosis because of i an overcrowded classroom may well get compensation; < the businessman who suffers a coronary because of overwork, may not. It is doctors who will 11 have to explain the ano-, malies and injustices arising out of the act to patients,; and it is doctors who will ; form the buffer between' patient and commission. There is likely to be a marked deterioration in doc-tor-patient relationships if i patients look on their doctors as “agents” for the commission, intent on depriving them of their rights. This is one of the reasons' why many doctors will insist that all patients pay for! treatment, and then claim a refund directly from the commission. They are attempting to keep the haggling out of the surgery, and return it to the place where it rightfully belongs. They want to remove any impression that they charge some patients and not others, and most important of all, hope to maintain a contract with the patient himself, rather than with any third party. Effect on services The biggest single question arising from the Accident Compensation Act, is what effect it will have on the availability of medical and hospital services to the public in general. Government spokesmen are quoted as saying that there will be no more accidents after April 1, than there are at present, and few could argue with this reasoning. Yet Mr K. L. Sandford,; chairman of the Accident! Compensation Commission,' deems it necessary to ask' the public “not to descend 5 in waves on hard-worked doctors for free treatment of, trivialities” since this might; “drive out more doctors than the country could afford to lose.” Are services free at the point of consumption more open to abuse than those for which we have to pay? The question would be academic if there were endless facilities to deal with additional work, and endless funds to meet the costs incurred. We have an existing doctor shortage, serious enough to be called a major problem. The Health Department reports that the number of patients to each general practitioner has increased by | 28 per cent in the past eight years. Private treatment We have such waiting ! lists for free hospital treatment, that over ten per cent■

of the population has already elected to carry personal insurance so that it can afford private hospital treatment, which is more rapidly available. Casualty departments in; all major public hospitals, are under strain, and] Middlemore, Auckland’s “ac-; cident treatment centre” is already so burdened with accident cases that patients; with arthritic conditions, for! example, must wait painful years for surgery. It is possible that, given; public co-operation, as Mr Sandford hopes, existing services could cope, but will the community accept a situation in which accident patients will receive considerable financial advantage compared with non-accident patients? The man who is hit by a virus will feel he has as; much right to compensation as the man who is hit by a bus. Will the public demand an extension into the field of compensation for illness? The Minister of Health.; Mr Tizard, agrees that it will. He says that public concern could well “speed up” consideration of com-1 pensation for illness. He could well imagine that a situation where compensation was available for accident only, might not

continue for very long. For years, the medical profession has suggested that the socialisation of medicine is imminent. Politicians have replied that this is “jumping at shadows” and that no socialisation is intended, but Mr Tizard is tossing a very different straw into the wind. High cost What happens when medical and hospital services become available free to all patients? The cost must be 'high where accident only is 5 concerned. It will become [astronomical when both accident and illness are involved. The cost must be met by the community, in one way or another. Whether such high social purpose is necessary in our society, and in this century, is a political question and there will be differing views at each end of the scale. But one question which must be answered is whether we have, or can quickly acquire, the facilities to cope with the demand. Free services become useless if they are simply not available. The Government denies that freedom from payment on the part of the patient will over-extend medical services. Doctors disagree. They point out that the Government pays all expenses for maternity treatment, for instance, which suggests they !believe that any fee, how- ' ever small, might prevent ;some pregnant women from availing themselves of medical help. It is logical to extend the same principle to the field of general medicine. More people will be encouraged to seek medical attention. Open to abuse This is laudable, but it is wide open to abuse. Small cuts, bums, bruises and strains can already occasion time off work with all expenses paid, under the new act. How many work-shy individuals will seek the “free treatment of trivialities” which Mr Sandford mentions? If people are unable to afford medical treatment, then this is certainly cause for community anxiety. But will free treatment really help? i Doctors are warning that if people are unable to obtain medical treatment because of an overload on available ser-

vices, the situation will be just as desperate — and less easily remedied.

The act is “unprecedented anywhere in the world.” states the Government with pride. Unfortunately, it appears that world innovators cannot expect reciprocal arrangements with any other country. From the moment the new legilsation takes effect, on April 1, every visitor and migrant to this country is entitled to the same benefits under the act, as any New Zealander. It seems a little hard on those who contrib-< I ute (under compulsion) to such benevolence that they I should be denied it themselves in the countries from which our migrants and |tourists are drawn. I Worse, the contributor in 'New Zealand is not entitled to any benefits from his own country if he suffers an I injury during a period, how'ever brief, on holiday abroad. Regardless of the amount he has contributed to the scheme, he cannot claim any compensation on his return. A New Zealander who goes to Australia for a week's holiday, is hit by a Sydney taxi, and returns a paraplegic, is not covered ■under the act. His expenses |in Australia will have to be met out of his own purse, or personal insurance which he takes out to cover himself, and there is no provision for him to be awarded compensation of any kind on his return to New Zealand. At best, he could apply for an ex gratia benefit at the hands of the commission, but he would have no legal entitlement to compensation.

in the case of lesser injuries, it is not too ludicrous to imagine that airports are going to become the scene of a large number of accidents.

Those who step from the plane in one piece (albeit a little stiffly, or with gritted teeth and a pained expression) and have a most unfortunate stumble at the foot of the gangway, may be carried away with smites ion their faces.