NATIONAL HEALTH INSURANCE

Dominion, Volume 30, Issue 121, 16 February 1937, Page 11

NATIONAL HEALTH INSURANCE

“Unwise to Copy British System Too Closely”

IL—SPECIAL CONDITIONS MET /IN N.Z.

The wisdom or otherwise of New Zealand copying the British system of national health insurance too closely, is touched on in this article, the second of a scries of

articles dealing with systems of national health insurance, an innovation being considered now by the Government. The articles arc quotations from an address given by Dr. J. P. S. Jamieson, Nelson, before the recent conference of the Australian and New Zealand Association for the Advancement of Science, in Auckland.

National health insurance is not a clear-cut scientific problem, but a complicated human question presenting aspects of policy, economics, finance, sociology, and psychology, as well as those of health science. It would be impossible and inappropriate to attempt to discuss the subject from all those points of view. I propose, therefore, only to make some comparisons of our conditions with those in one or two countries which have had the longest experience of the system in operation, and to inquire if any special tendencies have shown themselves of which we should take note. The British System. The British “panel system’’ began its life in 1911. Prior to that time there were vast numbers of people living in congested areas, earning barely sufficient for food, clothing, and shelter, if employed. Temporary loss of earning power meant temporary destitution. Medical men could not earn enough among them to be able to live and give them service. The poor-law doctor, with his £5O-a-year salary, could not cope with them. The out-patient department of voluntary hospitals could deal only with casualties. The poor-law infirmaries were practically homes for chronics and incurables. In all industrial centres those conditions existed. These were to some extent ameliorated by. the “Fourpenny” Club doctor, who rushed through what attendance he could, but many could not afford even that. Those were the conditions the panel system opened with. In Germany it had been the same. Such masses of people are still in Britain and Germany, and but for the national health insurance, it is probable that they would still be under similar handicaps in sickness. Under the scheme, subsistence was provided for the insured worker during sickness, and medical attendance. The latter was limited in scope, and from the numbers included and haste involved, inferior to the medical services to which the workers of New Zealand are accustomed. Still, it was something better than the insured population had experienced before. Consequently, the Royal Commission on National Health Insurance, which was set up in 1924 under the chairmanship of Bond Lawrence of Kingsgate, after reviewing the working' of the system in Britain from its beginning in 1911, was able: to report in 1928: — We can say, however, at once that we are satisfied that the scheme of national health insurance has fully justified itself, and has, on the whole, been successful in operation. The workers of this country have obtained under it substantial advantages, in particular by securing the title to free medical attention and medicine whenever and as soon as these are required, and by the proportionate diminution, to the extent of the cash benefit granted, of their anxiety as to loss of wages during illness.

Comparability of Conditions.

The question which arises here is: Would we he justified in accepting this authoritative and impartial statement on the British system as absolute for the value of national health insurance anywhere? The answer must'be, "No”; conditions qualify conclusions and modify methods. A system which suits Britain is unlikely to be suitable in New Zealand. The conditions are dissimilar. No one who has not lived in the British industrial areas and also in New Zealand can appreciate the difference. No one who has not done medical work in those areas and also in New Zealand can understand how greatly the work of the British panel practitioner differs from that of the New Zealand doctor. Our problem has been, and still is, not so much how to bring health service to crowded, lowly-paid masses, as to cater competently for the scattered country dwellers on whom development primarily depends, and to minimise their disadvantages; not so much to assist those in employment, as those unemployed and past employment; and not so much insufficient treatment, as insufficient knowledge of the causes of certain physical disabilities to which New Zealanders are specially prone. For the medical man the problem is not how most expeditiously to diagnose the ailments congregated in a crowded waiting-room and relegate each to the appropriate treatment, but how himself to deal most efficiently with the varied requirements of a scattered population. On account of these divergences we should be unwise to copy the British system too closely. (To be continued.)