The Dominion THURSDAY, APRIL 19, 1928. A NATIONAL PROBLEM

Dominion, Volume 21, Issue 171, 19 April 1928, Page 10

The Dominion THURSDAY, APRIL 19, 1928. A NATIONAL PROBLEM

The announcement of an increase of £4500 in. the Wellington district hospital rate comes as a reminder that a national problem is awaiting the resources of our statesmanship. . Changing conditions and circumstances have created a public opinion which is being crystallised into a demand for a review of the whole system of hospital administration. Recent discussions on various aspects of hospital reform show that there is need for a clearer definition of the status and function of these public institutions, an analysis, of hospitals finance, and an examination of the principles governing the levy upon the public purse for their upkeep. Before the various matters raised become subjects for possible legislation it may be well to consider whether the prevalent conception of the status, and function of hospital work should not be amended. Is the hospital a public service, as the Railways, Education, the Post Office, or a public charity? As things are at present it is a little of each, and it is probably because of this circumstance that its finance has become somewhat of a problem. According to an informative appendix to the Annual Report of the Public Health Department there is no problem in respect of actual money. Half the cost of the hospitals, it is stated, is paid by the State, through the public funds, and half by. the public through their rates. ' Under this system, it is declared, "the necessary money for the upkeep of the hospitals is fully assured, and is not dependent upon sentimental appeals.” The real problem, and a very difficult one, however, is to devise a system of taxation for hospitals upkeep more equitable than the present one. If this problem is to be solved, it would appear that our whole attitude towards the hospital service should be reviewed. The Health Department, in the Report Appendix referred to, admits that the question of the incidence of levies is a difficult one. "Rural districts are finding approximately 60 per cent, of the levies, and during the recent agricultural depression naturally complained more than usually regarding -the burden, more of which, they urge, should be borne by urban districts. The taxable commodity having been fixed (viz., the rateable value of the land), any suggestions for altering the incidence of the taxation therein within any individual district requires considerable consideration.”

Manifestly a system which derives part of its income from State grants apportioned on a subsidy basis must be. subject to public opinion as to what should be paid. If the idea became prevalent that the hospitals were costing too much, a public opinion possibly prejudicial to their efficiency might be qreated. There is a growing opinion, for example, that we have too many hospitals; that instead of dissipating our financial resources amongst a number of small hospitals we should concentrate on large central institutions.' Writing in the New Zealand Medical Journal, Dr. J. S. Elliott points out that during the last ten years for which figures are available, in addition to the rebuilding or extension of existing hospitals, no fewer than forty new hospitals have been established. "Forty-six districts with 46 boards make for too cumbersome a framework and militate against both efficiency and economy,” he declares. "A patient in a small district, who is without means, cannot enter a large hospital in an adjacent district unless and until the board of the former district guarantees payment, etc. The cost per head per day of each patient in a public hospital is not less than 155., but the average charge made is not more than 9s. a day. Payments by patients amount to not more than 20 per cent, of the cost of maintenance of hospitals.” If we could agree that hospital work is a State service, and place its administration on a national basis, it might be possible to transfer much of the present administrative money to the professional and equipment side of the ledger. The public, however, has been long habituated to the idea that hospital and charitable ' aid services are community responsibilities, to be discharged by local authority. This sentiment, is inherited from the ancient origins and traditions of the hospital. The healing of the sick and the relief of the poor were missions of mercy, carried out by religious orders. To-day our hospitals are open to all. rich and poor alike, who pay according to their means, or are supposed to. It is not likely, therefore. that the/public would agree to relinquish its control of the hospitals unless very fully convinced that the change would be advantageous both to its pocket and to the efficiency of these institutions. The position, at present, however, is not satisfactory, either to the 'public or the 'hospital staffs, and should be comprehensively reviewed.