HEALTH SERVICES

Evening Post, Volume CXXV, Issue 84, 9 April 1938, Page 10

HEALTH SERVICES

SCHEME DISCUSSED

DIRECTOR'S EVIDENCE

INITIAL BENEFITS

Detailed evidence on the activities of the Health Department was given to .■ the Select Committee on National Health and State Superannuation yes- " terday afternoon by the Director-Gene-ral of Health (Dr. M. H. Watt). Dr. , Watt presented three statements to the , Committee, the first being an outline : of health administration in New Zealand from the foundation of the Department in 1900 until the present time; the second an outline of the hospital and charitable aid system; and . the third comments on the Government's proposals for national health , service and State superannuation. The first two statements were mainly composed of historical data and a resume of the present health system. Commenting on the initial major benefits of the proposed health services, Dr. Watt first dealt with the proposal to provide "a universal general practitioner service free to all members of the community." . "The general arrangements for -giving effect to the proposal would pre- ' sumably be such as to give every qualified and registered practitioner the right to participate and at the same time to provide freedom of choice as between patient and doctor," he said. "The arrangements will involve a general contract between the State and medical practitioners. To that end it is probable that regulations would be made prescribing the terms of the service to be given by the doctors. They would define inter alia the persons for whose treatment the practitioner is responsive, the range of professional and other services, including supply of drugs and appliances which the practitioner is to g;ve, surgery hours and accommodation, requirements regarding visits, records to1 be kept, reports and certificates to be furnished, obligations in regard to supervising medical officers and in regard to disputes; limitations as to acceptance of fees from patients, procedure in disputes affecting practitioners, etc. TERMS OF SERVICE. "It is anticipated that the capitation system of remuneration would be adopted. Doctors would be invited to take, service on the terms and conditions offered; lists of those accepting would be made available to the public, . who would be invited to take steps to have their names placed on the list of the doctor of their choice. Upon acceptance by the doctor, notification would be sent to the district office of the governmental authority to form among other things the basis for payments to doctors. Detailed procedure will of course require to be laid down to provide for the allocation to a doctor's list where for instance a person . fails to secure voluntary acceptance by a doctor of his choice. Limitations will have to be placed on the number a doctor may accept on his list. These and other relevant matters are already dealt with'fairly fully in the report of the National Health Insurance Investl- ' gation Committee. " '"A return' compiled by the Department at the request of this Commit- - tee showed that in 1937 there were approximately 724 practitioners who might be available for general practitioner service in some degree. Of these 508 were regarded as available V for full-time general practice, 29 for • part-time service only owing to illhealth, age, etc., 112 were engaged ■in both general practice and specialist vwork, and 75 were general practitioners in part-time hospital board or State employ. In addition to the 724 there were 118 specialists and 136 practitioners of different classes in full-time hospital board employ. The , figures indicate that the average number of persons per general practitioner is about 2000. "The general arrangements just outlined will not be suitable in sparsely •populated districts nor in districts where there are considerable numbers of Maoris, and in these districts special arrangements will have to be made as indicated on pages 50 and 55 of the Investigation Committee's report. SPECIAL PROVISIONS? "Special provision may be required in respect of persons. who are en- - titled to receive medical treatment and attendance under arrangements made 'by friendly societies, medical associations or other bodies or, institutions and already in force. In order to avoid undue disturbance of such arrangements and perhaps loss to the groups of persons concerned it may be necessary to enable the body or institution concerned to receive out of the fund, contributions representing the amounts which would otherwise be expended in providing medical practitioner's' services under the general arrangements. The receipt of such contributions would of course be conditional on the body or institution providing a service at least equivalent to that provided under the general arrangements." The next' point dealt with by Dr. Watt was "free hospital or sanatorium treatment for all." "It is assumed that this benefit is to be of the nature and scope described in the Investigation Committee's report," he said. "If so, it would comprise full relief from personal liability in respect of hospital care received in or at public hospitals and sanatoria in addition to partial relief from personal liability for care received in private hospitals. "Hospital care for the purpose of the benefit might be defined as such care requiring nursing and medical or surgical attendance, treatment, or oversight of a character that cannot efficiently and economically or in the public interests be provided elsewhere than in a hospital. It. would presumably include maintenance in hospital. Those eligible'for the bene- , fit would include persons admitted to hospital or similar institutions for , treatment, isolation, examination, ob- , servation or medical restraint. GENERAL ARRANGEMENT. "The general arrangements for providing this benefit might be as follows: —Hospital boards, in consideraiton of payments at prescribed rates to be made from the Social Security ■ Fund uvrespect of care which is the subject of hospital and sanatoria benefit, would be required to accept such payments in full satisfaction of the , cost of the care provided. ... "With, respect to hospital care received in private hospitals, payments at prescribed rates would be made towards the cost either to the person liable therefor or to the proprietor of the private hospital. "Regulations would be made defining more particularly the scope and nature of hospital care and providing for the determination of disputes which may arise as to whether any particular hospital or sanatorium care is or is not the subject of the benefit. "It is assumed that free medicines would include appliances," Dr. Watt said. "The Department is again in agreement with the suggestions made by the Investigation Committee with regard to the general procedure and arrangements for the benefit." MATERNITY TREATMENT, Free maternity treatment including the cost of maintenance in-ftitoaternity;-

home, was the next proposal dealt with by Dr. Watt. "The scope of this benefit as envisaged by. the Investigation Committee is set out on page 15 of its report," he said. "Except that the period of treatment in hospital or attendance by a midwife or maternity nurse for which free service is proposed is limited to 14 days, the Investigation Committee's proposals appear to meet the present proposal in a reasonable way. The arrangements for this benefit are not gone into fully in the Investigation Committee's report, but it is implied that the arrangements will involve the preparation of terms of service for medical practitioners, midwives, and maternity nurses, and general contracts for payment of fees direct from the fund to those rendering the service. However, further consideration may suggest the desirability of adopting a system of grants in order to save administrative expense far out of proportion to the value of the benefit. SUPPLEMENTARY BENEFITS. "Anaesthetic. —Reference to this benefit is made at page 17 of the Investigation Committee's report. It is presumed that the intention was to recommend special payments from the fund in respect of any general anaesthetic given where the services of a general practitioner or specialist anaesthetist are employed for that purpose, provided that where an anaesthetic is given in a hospital no fee would be paid. As to the arrangements for payment, reference is made at page 51 of the Investigation Committee's report, where the suggestion is made" that the total payments for anaesthetics should.be controlled by establishing an anaesthetic fund. "Laboratory and Radiology.—This benefit would presumably consist of payment from the fund in respect of a prescribed range of bacteriological and pathological work, X-ray examinations and treatments, and radium treatment and other examinations and treatments as may be generally available in laboratories, clinics, or other departments of public hospitals. At present the great bulk of these services are supplied by hospital boards, and it is for this reason no doubt that in the Investigation Committee's report the suggestion is made that laboratory and radiology services to outpatients (as well as, of course, in-patients), should form part of hospital and sanatorium benefit. Payment to hospital boards for the services would in part no doubt be on the basis of lump grants covering a specified range of examination r.nd in part on a fee for service basis. It should be borne in mind that there are specialists in radiology and pathology who engage in private practice and whose cases may require further consideration. WORK OF SPECIALISTS. "Specialist and Consultant.—The range of practitioners who are regarded as specialists includes the two general classes of specialist surgeons and specialist physicians and those devoting themselves to more particular branches of professional work such as eye, ear, nose, and throat, gynaecology, orthopaedics, plastic surgery, urology, radiology, physio-therapy, pathology, neurology, dermatology, venereal diseases, tuberculosis, etc. According to a return compiled by the Department last year there are some 118 practitioners engaged in full-time specialist work, and there are 112 engaged in specialist work of some kind in conjunction with general practice. This is exclusive of full-time salaried specialists employed by hospital boards, etc. "The general arrangement for specialist and consultant benefit would require the careful prescribing of conditions under which a specialist service would be recognised. Certain specialists would be subject to specified conditions, and be officially recognised as such, but if, as would be expected, a fee for service method of payment is adopted, it would of course be necessary to impose some restrictions as to the services paid for out of the fund. In the case of general practitioners undertaking work of a specialist nature for which separate payment is to be made the need for fairly close control is still more evident. It is recognised, of course, that specialist* services are in certain ailments of greater necessity and generally involve heavier expense than general practitioner services. . "For a considerable proportion of the population at present specialist and consultant services are provided at public hospitals. Most of these services are honorary. "Massage and Physio-therapy.—The general arrangements for this benefit would, it is anticipated, involve authorisation of individual treatment by a district medical officer and payment at prescribed rates on a fee for service basis. The total number of registeredmasseurs who took out practising certificates for the past year was 222. Of that number approximately 84 are in the employ of hospital boards and Government institutions. Service to and from Hospital.—Ambulance services of the Dominion are at present in the main provided by hospital boards operating for some twenty-two centres, the St. John Ambulance Association operating from some seventeen centres, and free ambulance associations from two or three centres, the Wellington Free Ambulance being a major one of this class. The St. John Ambulance services are in most instances subsidised by -the local hospital boards, one of these services (Wanganui) being a free service. The trend is towards the inauguration of free or almost free ambulance services as it is becoming increasingly recognised that high fees for ambulance transportation militate somewhat against the co-ordination of hospital services. DENTAL SERVICES. "It is, of course, within the powers of hospital boards to provide dental services," Dr. Watt continued. "Expensive dental departments are, however, provided at only five centres in four instances by the hospital boards directly and in one case (Dunedin) by arrangement between, the hospital board and the Dental School. In some other centres general contracts have been arranged between hospital boards and local dentists to provide dental services for indigent persons. Generally speaking the provision of dental services by hospital boards is at present very much restricted. "Optical Benefit—The scope of this benefit is outlined in the Investigation Committee's report. The arrangements for the benefit would, it is thought, require authorisation of individual examinations by eye specialists or opticians and of the individual supply of optical appliances." The doctor's evidence was followed by questions regarding medical practice and the possibilities of securing service under a "panel" system.