HEALTH SCHEME

Dominion, Volume 31, Issue 278, 20 August 1938, Page 13

HEALTH SCHEME

Minister’s Letter To Dr. Jamieson MEDICAL BENEFITS Details Of * Administrative Arrangements PART OF PROFESSION

\ Further information on the proposed administration of medical benefits under the Spcial Security Bill is contained in a letter sent by the Minister of Health, Hon. P. Fraser, to the president of the New Zealand branch of the British Medical Association, Dr. J. P. S. Jamieson. The -letter, a copy of which was released for publication yesterday by the Minister, is dated. August 11, and is that which was referred to by Dr. Jamieson in his letter of August 13 informing the Minister that the B.M.A. was unable to offer further co-operation in connection with the national health-section of the social security proposals. .

Mr. Fraser states that he is sending the letter by way of formal confirmation of the statement made by the Minister of Finance, Hon. W. Nash, at a meeting the two Ministers had with Mr. T. D. M. Stout, Dr. P. P. Lynch, and Dr. Jamieson the previous evening.

Similarity to British Scheme,

"Our object is to inform your association not only of the principal features of the Bill affecting the profession, but also of those details of the proposed administrative arrangements that have been the subject of representations by the association,” Mr. Fraser states.

1. Medical Benefits.— This is to comprise general practitioner services. The range of service is intended to be somewhat similar to that of the British scheme, i.e., services of medical practitioners other than those involving the application of special skill and experience of degree or kind that general practitioners as a class cannot reasonably be expected to possess. Medical attendance in maternity is included under maternity benefits. S. Reniune-raiU" - x his is a matter Epcil which the Government is willing to enter into immediate discussion. It is recognised that in the interests of the service the aggregate professional remuneration of practitioners as a ’■ whole should under the scheme be something better than it is under present conditions. The proposal is to determine “a basic capitation fee,” i.e., the average amount per person that is represented l by the aggregate remuneration (including .mileage) of the doctors for (a) general practitioner services and (b) for attendance on maternity cases. Subject to a reasonably equitable

distribution and practicability from an administration viewpoint, it' is proposed to allow-the .profession itself to decide tlie methods of distributing the remuneration. - '

Principles Put Forward. 3. Administration.—ln the course of preparing the present legislation careful regard has been given to the various conditions put forward by the profession, and it is now .possible as regards some of these conditions, to give a definite indication as to the' extent to which the legislation and the arrangement generally are likely to give them practical recognition. The following principles have been put forward in the course of discussions with representatives of the profession :—• ‘‘(1) Thqt medical practitioners should have the right to be consulted by the Government or its nominees before any regulations are promulgated that can in any way.affect them.” The Government proposes to take every possible step to ensure the fullest consultation with the profession before any regulations affecting it are gazetted. The Bill provides for the appointment, of consultative bodies and the formal recognition for consultation purposes of, to quote the Bill, "any committee or other representative body for the time being constituted to promote or safeguard the interests of the members of any profession affected by the operation of this part of the Act” Right to Representation. “(2) That medical practitioners should have the right to be adequately represented on any controlling body arid that they should have the right to approach the responsible Minister directly through their representatives.” The form of control proposed is by three commissioners, one of whom is to be the Director-General of Health. Advisory bodies itre, however, to be set up to assist both the central and district administration. Particular reference is made to the constitution and functions of these advisory bodies later. “ (3) The statutory right of every registered medical practitioner to undertake national health insurance service.” s Tliis right is provided for in the Bill “ (4) Free choice as between doctor and patient subject to the righti of the doctor to refuse to accept a particular patient.” (Any regulations affecting this must be most carefully drawn. The present British regulations seem quite fair to all parties and work well.) Specific provision to give effect to this principle is made in the Bill. The procedure and arrangements generally for the exercise of the right of selection and also for the assignment of patients who have failed to make a selection or who have been refused by the doctor they have selected will be very similar to the provisions under the British scheme. Administration and Discipline. “(5) Administration of medical benefit to be separated from the administration of the cash benefits, and to be through a body having effective representation of the practising profession.” The Bill provides for medical and other treatment benefits to be placed under the Minister of Health and the Health Department. Administration on the technical side will be by the Director-General of Health and district medical officers under his control. The general administration, apart from the technical and professional side, will, as already indicated, be in the hands of three commissioners, one

of whom will be the Director-General of Health.

‘‘(6) Professional discipline to be maintained by tribunals mainly professional in constitution as in the British system.” This principle is recognised in. the Bill.

“(7) The relations between specialists and general practitioners to be adjusted by a central medical authority set up by the profession.”

This is understood to mean the determination of questions whether a particular professional service rendered or to be rendered by a particular practitioner falls within or outside the scope of general practitioner service. Tliis procedure will be determined on the recommendation of the central medical committee or a committee nominated by it.