SOCIAL SECURITY ACT

Evening Post, Volume CXXVII, Issue 32, 8 February 1939, Page 6

SOCIAL SECURITY ACT

MEDICAL AND HOSPITAL SERVICES

STATEMENT BY MINISTER OF HEALTH

(Special to the "Evening Post.") NEW PLYMOUTH, This Day. An outline of the arrangements proposed in connection with those hospital board services coming within the scope, of the hospital and maternity benefits under the Social Security Act, was given by the Minister of Health (the Hon. P. Fraser) when opening the conference of Hospital Boards today. The Minister also touched on the question of hospital finance in relation to the Act.

"It has been emphasised by representatives 'oi the medical profession and is fully recognised by the Government that the arrangements for the provision of medical, pharmaceutical, hospital,' maternity, and other benefits should be developed not only as parts of a comprehensive plan of curative services but also in co-ord-ination with the preventive phases of public health administration," said the Minister.

"The administration of Part 111 of the Act is placed under the Minister of Health and the Director-General of Health has been appointed one of the Commissioners under the Act and with this unified control the objective of a thoroughly co-ordinated scheme of preventive and curative health services should be attainable. "Having regard to the negotiations that would have to be conducted and to' the administrative arrangements, it was foreseen at the time the legislation was framed that until the arrangements for any particular benefits were complete or nearly complete, it would not be practicable to'name the date of commencement. This was the reason for the provision of Section 79 of the Act, giving the Minister the necessary power to determine the date on which any of the several classes of benefits are to be made available, 'being the earliest possible date on which arrangements for their effective administration can be brought into operation.' . "For the present, in accordance with the Act, efforts .are being chiefly directed to the, making "f arrangements for the four main benefits, medical, pharmaceutical, hospital, arid maternity. As a necessary preliminary, consultations are being carried on with representatives of the medical profession and steps are being taken to arrange other consultations. "I wish to take this opportunity of inviting the further co-operation of the Hospital Boards' Association in this matter," said Mr. Fraser. "There are many questions in connection with the medical and related benefits under the Social Security Act on which I am anxious to have the viewpoints of boards, and I shall be gratified if the executive of your association or any special committee is appointed by the conference as a ready means of consultation with myself and with Departmental officers. I desire active consultations to commence as soon as possible.

"I wish to press on with the arrangements and to be, in a position very soon to y indicate the date on which these benefits are to commence. That is a point of special moment to all those closely connected with the existing system including friendl.- so-

cieties and other bodies who have voluntary hospital benefit schemes operating. The Government naturally is anxious to have the benefits in full operation as soon as possible. j HOSPITAL. BOARD SERVICES. "The important benefits with which hospital boards ar.? concerned .are hospital benefits and ftiaternity benefits arid I propose to indicate the main arrangements contemplated. Unless, of course, they are determined by the Act, it is not to be taken that such details now indicated by me are finally settled upon. Many of them are given merely to facilitate discussions. "The types of institution which the Minister may specifically recognise and approve as hospitals; for the purpose of the Act may include the Karitane Hospitals maintained by the Plunket Society and the Home of Compassion hospitals. ' The definition of 'hospital patient' is intended to be wide enough to apply to persons admitted to a hospital for treatment, isolation, examination, observation, or medical restraint. In the case of a public hospital it will be seen from the definition of 'hospital treatment' in the Act that it includes 'such treatment as may be prescribed in respect of outpatients.' "'Out-patient consultations and treatment of a character that will come within the range of the general practitioner services (under medical benefits) will, when these services are arranged, cease to be proyided at public hospitals. Certain other outpatient services provided at public . hospitals will, however, be continued or developed. v Out-patient services in this category are: (a) Casualty and emergency attention; (b) X-ray examination and treatment, radium treatment, and i other special examinations and treat- ' ments; (c) laboratory services; (d) consultations with specialists at tuberculosis, cancer, ophthalmic, diabetic, etc., clinics. "Some of these out-patient services may "be the subject of payment from the fund from the inception of hospital benefit whilst others may be included only when the relative specialist and consultant benefit is provided. These are details for early decision following consultations. ADMISSIONS AND DISCHARGES. "In most cases a patient will secure admission to hospital on the recommendation of his medical attendant, but the discretionary power to refuse admission must remain vested in the institution's medical officers, (subject as regards public hospitals to the existing overriding authority of the Direc-tor-General of Health, in particular cases).

"The reason for this is that the condition of the patient is not in. all cases

the sole factor in determining whether institutional care is necessary or whether domiciliary care is, sufficient. The patient's home conditions and location have in frequent cases to be taken into account. The availability of suitable accommodation is another important factor, and is one that is subject to. considerable variation from time to time.and in different localities. "Further, until public hospitals can meet all reasonable demands on them there will still occur from time to time the necessity for deciding priority of admission." After outlining the clauses relating to payments from the fund for hospital treatment, the Minister said that one section provided /that a person who was liable to pay \conir pensation' or damages in respect of hospital treatment afforded to another was not freed from such liability. Another section provided for payment in respect of hospital treatment in private hospitals or in approved institutions' and ensured that the rate of payments j from the fund, should be on the same scale as payments in respects of hospital treatment ..given .in a hospital board institution. Special provision was made to enable the payment of grants in the case of hospitals which were, precluded by their constitution from'accepting payments for treatment. "After suitable -consultations general rules will be made to define where necessary the types of treatment coming within, the scope of hospital-bene-i fits for in-patients, .particularly as. affecting private- hospitals," said the Minister. • "Kates of payment for. hospital treatment and the general procedure regarding claims will be the subject of regulations. ! "It is riot, of course, -intended that the. Social Security Fund will pay the full cost of care, or, indeed, at a scale approximating ordinary charges, but at a scale that will in the case of hospital boards represent on average j an increase over the amounts ordinarily collected in fees. "A consequence of the inauguration of hospital benefit may be a considerable alteration in the present honorary system of medical staffing. The introduction of the hospital benefits may cause an increased demand for hospital treatment. > "Even under' .present conditions there is a shortage of accommodation, and boards, may, therefore, be under the necessity of providing some dbmi-j ciliary medical attention pending the inauguration of. the ; practitioner service-under ihe Act and also to extend district ■.nursing. services. . I am. desirous that these factors shall j be given due "'■. Weight, when" the rate] of payment to hospital boards is.de-1 cided upon. .' . : ... •■ ! HOSPITAL BUILDING. "The hospital accommodation question is one that gives great concern. I have an. up-to-date return supplied me by the Acting Director-General of Health. This return goes into considerable detail and there is no need to quote it at length. "It is notable that in the past ten years while the population has increased by 10.2 per dent, and hospital beds have increased by 13.5 per cent, the number of in-patiei*ts has increased by 34.7 per cent. "An estimate has been made of requirements over and above additions in course' of construction or for which tenders have been let, and it appears that the number- of- beds- needed is at, least 1000. ■ This heed will be mainly filled by additions at- the ■' main hospitals. ■• --■ ■■■ ■'■•' ■ ' ■■■■ '■- ■'-' : MATERNITY : BENEFITS. ■ "So far as hospital boards are . concerned maternity; benefits are next; in importance to hospital benefits, and it is very desirable that boards should

be given an indication of the arrangements proposed. "The general form of the benefits comprises payments from the fund to hospitals, midwives, maternity nurses, and doctors affording care in maternity. As far as public hospitals, midwives, maternity nurses, and medical practitioners (except specialists) are concerned, the payment is intended to be in full payment for services rendered, but in the case of private hospitals the amount ie to be in full or partial satisfaction of the hospital's claim. It has been represented that recognised obstetric specialists should be permitted to charge the patient an additional approved fee, but this is a point to be decided. The payments will be paid direct to those rendering the service. In respect of hospital care a specific fee will be fixed in respect of the child-birth and a daily rate for each day thereafter up to 14 days.

"A hospital receiving a patient after delivery will be entitled to the daily rate specified for maternity cases for any unexpired portion of the 14 days. Any necessary treatment after the period of 14 days following confinement ■will be the subject of hospital benefit and payment accordingly made from the fund at the rates and under the conditions specified under 'hospital benefit provisions.' "Care at confinement in an unlicensed maternity home will not be regarded as hospital care. Steps will be taken to set out terms and conditions of a contract of service and the rates of payment and doctors, nurses, and hospital authorities will be invited to signify their willingness to provide service; accordingly. "The rate of payment for maternity care afforded by hospital boards is a matter for future determination, but it has already been indicated that it will be on a basis approaching current charges in hospital institutions. HOSPITAL BOARD FINANCE. "Before leaving this subject it is desirable to refer generally to the efiec\ of the Social Security Act on hospital board finances. I have already indicated that it is intended the scale of payments from the fund to hospital boards in respect of hospital benefits wiil be determined by careful regard to the position of boards. "The introduction of free treatment in public hospitals may result in increased demands on these institutions, but the introduction of medical benefits assuring adequate remuneration to medical practitioners for domiciliary medical attention should, of course, be a definite factor in reducing the number of cases sent to hospital. "The inauguration of medical benefits will also permit of considerable reduction in the outpatient services of public hospitals, whilst such outpatient services as are of special.character and are necessarily continued at the hospital may be the subject of payments from the fund. .. "With the payment from the fund for hospital treatment, and in respect ,of maternity care provided under maternity benefit, as well as the relief igiven to hospital board-finance from the payment of monetary benefits under Part II of the Social Security Act, to which should again be added

the saying in administration costs in respect to charitable aid administration ,and patients' fees collections, the operation of the Act should be of considerable financial assistance to boards. EMPLOYMENT CONDITIONS. "Remits in the agenda relating to awards and salaries of nursing staff j are a reminder of the response by boards to the Government's desire for reduction in the working hours and for increases in pay and general improvement ,in the. working conditions of

nurses and others in hospital board employ.

"The difficulties in regard to accommodation are fully recognised, but' it is gratifying to observe that boards generally have appreciated the need for improvements and are continuing actively to promote them. "In connection with awards I was recently informed that some board members were under the impression that there had been legislation by the present Government specifically bringing hospital boards under awards. That, of course, is not correct. I made recent inquiries on'this point and have a memorandum from the Minister of Labour on the matter. "I find that at least since. 1927 hospital boards were cited as parties to awards. It appears that for many years there has been nothing to prevent an employee of a hospital board from obtaining the benefits d>f an award through the appropriate organisation. "With the introduction of compulsory unionism, however, unions have j become far more active in endeavour-! ing to assist workers to secure the benefits, of. awards and hospital board employees have realised the advantages and are availing themselves of them to an increasing extent. IMPORT LICENSING. j "In the realisation that the needs of the sick and suffering of the community must not be jeopardised by the recently-imposed import restrictions, the Government has decided that when importing is necessary the widest consideration of preferential treatment! should be given to applications received from hospital boards by the Customs Department for equipment, medicinal preparations, dressings, and supplies considered essential to properly carry out the treatment it patients and provide the necessary amenities. There will be no restrictions of essential supplies as far as medicine and other items necessary for the promotion of health are concerned. "At the same time, it cannot be too strongly stressed that wherever it is j possible to purchase New Zealand-1 made goods or supplies for which to carry on its work the hospital board should do so. For example, such lines as sterilisers, certain rubber goods, glass bottles, certain aseptic furniture, bedsteads, malt, and many other products of New Zealand factories peculiar to hospital use can be satisfactorily: made in the Dominion. GIFT OF "IRON LUNGS." "The Government has received through the High Commissioner in London an offer from Lord Nuffield to Supply free at the works, Cowley, Oxiord, a supply of iron lungs for the hospitals of the Dominion. Soon after the conference hospital boards will be invited to make application to the Department. The hospital board will have to pay transport charges from the works. This addition to Lord Nuffield's long line of benefactions for the relief of suffering will I am sure be.regarded with deep gratitude by us all." ' :..;■: ■-■~...; \ -.;'