A HALT CALLED

Evening Post, Volume CVI, Issue 55, 13 September 1928, Page 13

A HALT CALLED

HOSPITAL COSTS LOCAL BODIES COMPLAIN MINISTER IN DEFENCE Following a meeting of representatives of local bodies held in Wellington last night, a representative deputation waited on the Minister of Health (the Hon. J. A. Young) to-day to urge alterations in tho system of hospital control. The deputation placed the following resolution before the Minister: That this meeting of representatives of local bodies draws the attention of the Government to the great increase of expenditure in hospital administration, and urges, with a, view to more efficient administration, that hospital boards should be given power to strike and collect a rate, failing which the contributing local bodies should have representation on hospital boards. Also that an additional subsidy on hospital and charitable aid contributions should bo paid out of tho Consolidated Fund. In his reply, the Minister pointed out that it would cost £50,000 a year to give hospital boards tho right to levy rates. He also warmly defended the boards against charges of extravagance in the matter of expenditure. The Mayor of Palmerston North (Mr. A. J. Graham) said the ever increasing burden of hospital and eliaritablo relief upon the ratepayers of tho Dominion was a matter that had occasioned local bodies a great deal of grave concern. "For some time past," said Mr. Graham, "the system of hospital management and local body representation on hospital boards has received serious consideration by tho Palmerston North Borough Council, which ultimately came to the conclusion that there was urgent need for joint action on the part of all contributing bodies in the matter of approaching the Government with a request that the whole system of control be revised with the object of definitely defining the future policy in regard to public hospital revenue and expenditure. "In regard to tho constitution of hospital boards, my council was also of opinion that the Hospital and Charitable Aid Institution Act should be amended to enable city, county, and borough councils to have direct representation thereon. Eealising that it was only by co-ordinated effort that direct results could be achieved, and pressure brought to bear upon the Government, wo circularised tho various contributing bodies throughout the Dominion, soliciting an expression of opinion on tho policy at present governing tho administration of hospitals in New Zealand. The replies received show that 85 were in favour of a revision of tho present system and of direct representation, while two wore in favour of revision of the system only. Thus we are armed with a strong declaration of opinion from tho majority of the local bodies that /.o increasing burden of hospital taxation deserved the serious and close attention of the Government. CALLING A HALT. We are present hero this morning to give expression to a strong assertion and a sure conviction that a halt should now be called in hospital expenditure, and that the Government should seriously consider whether in the interests of ratepayers a change should not be made in tho policy of hospital administration. "I do not go so far as to say that there has been gross extravagance by the boards, but I do urge that there is a pressing need for tho reduction of capital expenditure and for a greater economy of administration in all departments. Reference to the DirectorGeneral's reports clearly show that he is fully alive to the necessity for a 'crisp halt" in what he terms "tho extraordinary increase in hospital expenditure," and I submit that it is the duty of the Government and the Department to ascertain without delay whether under the present system it is possible to minimise tho cost and, if not, to devise some scheme whereby the burden of taxation can be lightened, or at least not increased. "We recognise, of course, that under the present Act a contributory local authority has a statutory right of appeal to the Minister when it considers tho proposed expenditure excessive, and that it is laid down that the Hospital Board shall furnish to each contributory local authority in April of each year details of actual receipts and expenditure in the preceding year, and of estimated receipts and expenditure for the current year. But I submit that the failure of local bodies to exercise that right of appeal is no proof that they were not greatly concerned with the rapidly increasing cost, for on the contrary some of them by resolution protested to certain boards against the continued increase and enjoined them to see that every effort was made to avoid all unnecessary expenditure. INCREASE IN FUNCTIONS. "There can be no doubt that the increased cost is due in some measure to the great extension of a board's functions in matters pertaining to public health, the prevention of disease, and to maternity work, whilo the increasing popularity of the Hospital is such as to attract those who are well able to pay for private treatment, whereas in the past the Department recognised the policy that the hospitals were maintained only for those unable to pay for private medical and nursing treatment, the basic principle being that the beds were primarily for tho needy. "In this connection we contend that those able to pay should do so, and pay such fees as are equivalent to the full cost of treatment. With regard to representation, we are of opinion that the direct control of hospital expenditure should bo in the hands of the contributing bodies. As tho consent of ratepayers is not necessary, there is a danger that boards may spend too freely the money which they do not raise themselves. "In conclusion, let me express the hope that, if after due consideration the Government considers it unwise to make any alteration in the present system, the Department will exercise the very greatest vigilaneo in order to keep the expenditure within reasonable limits and that the various boards will by efficient and economic administration obviate the necessity for increased levies in tho future." "SYSTEM WILL CRASH." Mr. A. E. Mansford, a member of tho Palmerston North Borough Council, said they were all proud of the hospital system in Now Zealand, but unless some drastic changes in administration were made ho was afraid tho whole system would crash under the burden of its own weight, for costs were piling up at an alarming rate. At one time the hospitals were regarded as institutions for those who were unable to pay the charges at private institutions, but that was not the position at tho present time. In 1910 only twenty-four in every thousand used tho public hospitals, but in 1920 53 in every thousand were making use of them, showing very definitely tho growing popularity of the public institutions. One of tho main causes of tho present difficulty w,-ih tho failure to collect fees from those who were really able to pay. If tho public hos-

pitals were to be open to all there would have to be a change in the system of finance. Mr. M. A. Eliott, also a member of the Palmerston North Borough Council, said it was felt there should be more equitable representation on hospital boards. Those who paid the levies should havo soino say in tho control of tho hospitals, and local bodies should bo represented on tho boards. Local bodies had representation on lire- boards, river boards, and so on, and there was no reason why the principle should not be extended to hospital boards. There had been an enormous increase in tho levies in recent years. Those who made use of tho hospitals and were ablo to pay should bo called upon to pay the full maintenance charges. EFFICIENCY AND ECONOMY. The Mayor of Wellington (Mr. _ G. A. Troup) said tho meeting last night was unanimous in tho opinion that the hospitals should bo as efficient as it was possible to make them, bu> that efficiency should be accompanied by economy. That it was felt could be brought about if the proposals contained in the resolution wore given effect to. It would bo preferable it hospital boards were obliged to collect their own rates, as that would tend to make boards more careful in regard to expenditure. Failing that the local bodies should be given representation on the boards, for where there was no representation there should bo no taxation. That was a democratic principle, more democratic, in fact than the present system. Tho local bodies had no desiro to impose heavy charges on patients who were in straightened circumstauces, but they did think that patients who were in good positions should be called upon to pay for their treatment. The caso for local body representation on hospital boards was supported by Mr. S. Coulter, Mayor of To Aroha, who said that many small districts in New Zealand had no voice in the control of hospital affairs at all. THE MINISTEE'S KEPLY. In replying to the deputation, the Minister of Health said there appeared to be some confusion in the country districts as to what was actually wanted. Some little time ago a deputation from the Counties' Conference had waited on tho Prime Minister and himself and had suggested that levies should be based not on capital value alone but on population and capital value in equal proportions. If the local bodies concerned were ablo to reach an agreement on some such basis ho would be prepared to ask the Government to bring down legislation to that effect. A member of the deputation: "Would you call a conference for that purpose?" The Minister said that he would be glad to assist the various bodies to come together. Tho statements of the deputation in regard to representation on hospital boards sounded very effective, but they would not stand much analysis if they were closoly looked into. The Mayor of Wellington had said there should be no taxation without representation, but as a matter of fact the pepole who found tho money were the ratepayers and property owners within the local districts, and they elected the local bodies in the uamo way as they elected the hospital boards. In regard to the general administration of hospital boards tho Department of Health kept a close watch on things and insisted that there should bo efficiency with economy, but the Department did not intend to sacrifice efficiency to econmy, as that would be disastrous. Ho was satisfied the community would not stand for it. Prior to ISO 9 local bodies had limited representation on hospital boards, but it did not work out satisfactorily, and change was made. It would bo impossible to grant representation to every local body, for in some districts there were as many as 30 to 40 local bodies. If they were all going to havo representation it would mean setting up a number of miniature parliaments, and that would make for increased expense of administration. Even if some form of representation were granted there would have to be a system of grouping. REASONS FOE INCREASES. The local bodies were merely the machinery for collecting tho rates, as they could do it more efficiently and more economically than hospital boards could. It had been said that the hospital boards were extravagant in their expenditure, but that was a matter of opinion. Ho was satisfied that the expenditure of hospital boards in New Zealand was not extravagant. There were many reason why the expenditure had increased in recent years. One of those was the improved equipment provided in the hospitals, and tho consequent increased desire on the part of tho people to make use of tho institutions. It had also to be remembered that the war had resulted in. greater charges on hospitals, as they had been called upon to look after many patients whose illness was the result of war service. No one could say that the boards or the Government could avoid that responsibility. The Minister pointed out that in recent years there had been a decrease in the capital expenditure of hospital boards of £119,217 —a decrease which was not readily apparent. The increases in the total levies and subsidies for the last three years were as f0110w:—1926-27, £39,959; 1927-28, £133,774; 1928-29 (estimated), £77,233. The rate of the levy per £ was as follows:—l 926-27, .245 din the £; 1927-28, .266 din tho £; 1928-29, .28d in the £. Those figures showed a slight increase over the whole of the Dominion. Figures at his disposal showed that the cost of maintenance per head in regard to hospitals would be between 15s and 16s. That included interest on capital charges and other overhead costs. People who could not afford to pay for their hospital treatment were not expected to do so, but the boards goneraly did insist on getting their dues in from people who were in a position to pay. Members of Parliament were continually criticising the increased expenditure of hospital boards, but that did not prevent them from coming to him and asking that certain accounts should bo written off. The question of increasing fees had been discussed from time to time, and the Hospital Boards' Association had the matter under consideration at tho present time, but tho tendency had been to resist anything in the nature of an increase. If the proposal to give hospital boards the right to levy rates was adopted it would mean an increase of £50,000 per annum in the cost of collecting rates. That would havo to come out of the pockets of the people of this country. Ho was satisfied that the time was not yet ripo for such a change as that. If later on there was n general demand for a change in the system the matter would havo to be considered. ' Tho Minister concluded by saying that he had taken a careful note of the representations made, and would discuss the matter with Cabinet.