CANNOT BE CHEAP

Dominion, Volume 31, Issue 243, 11 July 1938, Page 12

CANNOT BE CHEAP

Modern Maternity Care

FEES CONSIDERED MODERATE

“Modern maternity care of tfre stan-

dard rightly regarded as necessary m

New Zealand cannot be cheap,” states

the report, of the committee of inquiry into maternity services. “M bother it be hospital service or full-time domiciliary nursing attention, the expenses are necessarily considerable. Tlie onlj cheap service is a no-doctor district midwife system, with ihe nurse attending daily 'and not living in tbe home; this, the committee is convinced, is not generally acceptable in Now Zealand. “It is satisfied that the fees charged in the public maternity hospitals are by no means high for the service ghen. this is clearly proved by the fact that they rarely cover the cost a patient in these hospitals. Tlie provision of even the minimum facilities and equipment necessary for carrying out tbe recognised aseptic and antiseptic teebinque; tlie addition of ante-natal service requiring extra facilities and extra staff; the payment of nurses in training who previously received no remuneration; the increase iu staffing necessitated by shorter hours; a much-developed teaching syllabus aud a standard of care which calls for closer supervision of the patients—-all these factors have added greatly to the hospital costs.

Private Fees Not High.

“Similarly, the private maternity hospital fees are not high when the costs of maintenance and the work involved are taken into consideration. Maternity nursing is exceedingly arduous and responsible, and' the administration of a maternity hospital is associated with particular difficulties owing to the uncertainty of the dates on which patients will be admitted to hospital; no maternity hospital is able to book patients up to its full-bed capacity. “Few maternity hospitals, regarded as investments, would be found to be giving an adequate return for tbe capital involved. In the majority of eases they are merely providing a home and a moderate living for the nurses who own them. or. in the case of doctorowners, a satisfactory environment in which their midwifery work can be conducted.

“The committee is also satisfied that, taking into consideration the range of service involved, the responsibility and exacting nature of the work, aud the great additional demands of modern ante-natal and post-natal care, the medical fees iu midwifery practice are moderate and iu some eases quite inadequate. Thus, while the total costs when paid by the individual may seem considerable, the charges for the various items of the service are by no means excessive.

"The fact must also be faced that, certain of tlie improvements recommended in this report—the further development of doctor-attendance, the extension of the ante-natal aud postnatal services, and tbe more general administration of pain-relief—would add somewhat to these costs. The economic problem, therefore, appears to be not how the services can be cheapened, but- how the individual in need can be assisted to meet these necessary costs. It is quite clear that the expenses of the service are beyond the means of a large section of the community, aud a definite burden to others.

Care of Indigent.

“Already the care of tbe indigent in maternity has for some years been the statutory responsibility of all hospital boards, and satisfactory provision has been made in most hospital board districts. The position of those who, while not indigent, find difficulty iu meeting the expenses of confinement has also been very considerably helped by the provision of public maternity hospitals—either St. Helens Hospitals or maternity annexes to general hospitals—in which very adequate facilities are available at a moderate fee which is further subject to adjustment according to the circumstances of the patient.

“In a number of instances a ,very valuable assistance has been given to. still another section of the public by making the public maternity hospital facilities available for those who desire the services of their own doctors. It will thus be seen that at tlie present time a very great deal of public assistance is being given both by providing modern hospital facilities and by giving service to the recipient either free of cost or at reduced fees.

“In the majority of eases this public assistance is based ou the midwife system, with a doctor available in cases of difficulty. It will be understood that., under existing conditions, tbe development of tbe maternity services in certain directions which have been considered desirable would necessarily call for further public assistance. “An alternative method of meeting the relatively high costs of this complete maternity service is by a system of health insurance. Iu many countries this principle is being largely developed, and tbe committee was impressed with the ' possibilities of maternity benefit, covering both hospital service and medical attention, in New Zealand.

“The committee does not. however, regard a cash benefit, helpful though it; undoubtedly is. as the most satisfactory form qf insurance assistance, and recommends that in the investigation of a national health insurance scheme for New Zea la ud full consideration be given to a maternity benefit which will cover both hospital and medical expenses by direct payment to those giving the service.”