INCREASED HOSPITAL COSTS

Dominion, Volume 21, Issue 261, 4 August 1928, Page 13

INCREASED HOSPITAL COSTS

CRITICISM OF EXPENDITURE

STATEMENT BY MR. W. .WALLACE

The agitation with regard to the burden of hospital expenditure upon the taxpayers and the proposals which are being put lorward in the direction of altering the present system were replied to last evening by the chairman of Ibe Hospital Boards’ Association, Air. W. Wallace (Auckland). “There is,” said -Mr. Wallace, "an inclination in some quarters to ascribe tho increase in expenditure to a laxity on the part of hospital boards, and a belief that a mere alteration in the constitution of the boards (such as, for instance, would result if contributory local authorities appointed their own representatives on the board) -would remedy matters. In the appendix to the Director-General’s annual report for 1926-27 the increase in hospital and charitable aid expenditure during the past ten years is discussed at length. So far aS hospitals are concerned it. is apparent that whilst there has been a real increase in tho cost of maintenance -treatment per occupied bed ascribable almost wholly to staffing, the immediate explanation of the largely increased burden of expenditure lies in . the growing number of patients obtaining treatment. “The increase in the number of patients treated in public hospitals is ■doubtless due to several factors, including the introduction of improved diagnostic and treatment measures, an increasing tendency on the part of patients to submit themselves to surgical treat- ■ meat, an increasing number of accidents of various kinds, and of late the econo- • mic situation forcing many to utilise the public hospitals in preference to private hospitals. The growing tendency on the part of patients to submit themselves to surgical treatment has been a matter of comment by members of the profession, chiefly in regard to alleged excessive operative work at outlying hospitals. Unfortunately statistics showing the number of operations performed in publie hospitals generally are available only for 1925 and 1926, the total figures being for 1925 24,896 operations of the 5(,387 cases dealt withj and for 1926 26,657 out of the 64,037 cases.” Mr. .Wallace said that whilst these figures were no more than evidence that/ surgical work was a very important feature of public hospital activities, it -would appear' from figures given in the Government Statistician’s report on vital statistics for 1926 that surgical cases, including those treated for “external causes,*’ had in recent years increased in numbers out of proportion to other cases. Adenoids and tonsils, appendicitis, miscellaneous injuries and fractures, dislocations, etc., constituted the principal conditions dealt with in hospitals. Each showed practically a steady increase from 1922 t0'1926. Cancer also occupied a high position both as regards the number of cases and the upward movement of cases admitted, due in greater part to the rapid advancement in diagnosis and treatment of the disease. “External causes,” said Mr, Wallace, “accounted for no fewer than 2629 addi- ■ tional cases as between years 1Q22 and 1926, the percentage increase being 47.04. . Of this class, fractures, dislocations, and • miscellaneous injuries- accounted for the bulk of the cases, and although the cases were not classified according to the cause of the injuries, it was probable that vehicular accidents easily showed the greatest increase. It was pointed out that apart from the great increase in cases under the category “external causes,” the number of deaths iu this class showed the rapid advance of 87.42 per cent., the . numerical increase in deaths being J3J. . .This point was .mentioned as rather countering the suggestion that there was a growing tendency to admit trivial eases. The fact that the economic situation of 'late has forced more patients to utilise the public hospitals. will doubtless bo accepted. Unfortunately, in addition to increasing the demand for accommodation, this factor has a tendency to "wean many' persons permanently off the idea • of-obtaining private treatment. It has ■been urged tluit the comparatively low scale of fees charged at our public hospitals has been largely responsible for the increasing number of patients treated. - “In 1921-22, the daily charge for treatment in general hospitals was in very ■ few instances more than 7s. 6<l. per diem for adults; in the majority of instances, 6s. per diem. During the following year the .majority of boards adopted the charge of 9s. per diem. A few more came into line in 1923-24, and in 1924-25 there were only nine general hospitals charging less than 9s. per diem. Whilst only a few boards have since advanced the daily maintenance charge beyond “s., the practice has grown of charging extras for operations, etc., and . the average ■ "earnings” per occupied bed continues, therefore, to increase at an appreciably greater rate than the cost per occupied bed ”

■ The public, he said, were apt to lose sight of the fact that low charges for public hospital services not only contributed to their popularity ;iml increased the burden on the taxpayers, but resulted in high fees for those patients, who, for various commendable rea::u:is, availed themselves of private trealmenl, and also injposed a handicap on private hospitals in the development of modern methods. “If we recognise each public hospital as part of a system, and not as a separate entity,” continued Air. Wallace, “we see the necessity of standardising the charges as much as possible, so that the patient who enters the small hospital 'shall not be at a disadvantage with a patient whose nearest hospital is a large one. A difficulty, therefore, arises as soon as an endeavour is made to- fix fees which, oil the average, approximate cost, in that it is necessary in the ease of some hospitals, to charge less, and in others to charge more (han actual cost. Herein lies the chief obstacle to the adoption of a .scale of fees charges which, if all were paid, would return an amount approximating the cost of the public hospital services. Nevertheless, as has been already stated, there is room for an all-roun(l increase in the fees without hospital hoards being placed in the position of making a profit out of the sick.” The question will be discussed at the next general conference of hospital boards.