MEDICAL FEES

Evening Post, Volume CXXXVIII, Issue 84, 6 October 1944, Page 4

MEDICAL FEES

SOCIAL SECURITY

HIGH SALARIES ALLEGED

Considerable discussion on allegations that some doctors* were drawing particularly large incomes under the medical benefits section of the social security scheme arose when the Social Security Estimates were dealt with in the House of Representatives yesterday. Mr. W. A. Bodkin (National, CentraT Otago) said he had been assured by medical men of the highest standing that they could not attend more than four patients an hour and do justice to them. He had been given to understand that there were medical men drawing from the fund over £10,000 a year. Mr. Bodkin added that he, had been assured, and it was generally believed, that one refugee, doctor was drawing about £5000 a quarter from the Social Security Fund. The Minister had not given a tittle of information on the point. He wanted the Minister to say whether it was a fact that there were 'doctors drawing over £10,000 a year from the fund. That was a question that the Minister should answer frankly and freely. No one begrudged pay--ment where service was given, but the Minister knew that at the rate of 7s 6d an attendance, spread over 365 days in the year,' it was impossible for a medical man to give a service that would justify the amount he had quoted. He knew of magnificent service given by medical men, but the House should be told if some practitioners were drawing £10,000. If the information were refused it would appear that there was something to hide. Mr. F. Langstone (Government, Waimarino) said he believed that everybody's income >from all sources should be made public, just as the list of public servants and their salaries was published. If some doctors were receiving the sums mentioned they could not possibly be giving the proper service. The work of doctors should be distributed as evenly as possible, because it was not fair that some doctors should be overworked and others not have sufficient to do. He considered that most doctors were giving very good and skilful service, but there was unnecessary duplication in patients having to pay a doctor 10s 6d and get a refund of 7s 6d from the Social Security Fund. It was the Government's job to lay down a definite scheme, 'and he'believed that \he doctors would be willing to work up to it. The Minister of Health (Mr Nordmeyer) said the first scheme introduced was the ' capitation scheme which was not acceptable to the medical profession. The scheme of general medical services was then brought in, the first proposal being that, doctors should be paid 5s at the surgery and 6s 6d for. visits to the home. 'There was a fair amount of criticism of the Government's action, and as the result of representations and conferences it was decided to increase the amount to 7s 6d. CONSULTATION FEE. The impression left in "his mind said the Minister, was that if the fee were increased the general body of doctors would accept the 7s 6d in full settlement of their accounts. There might have been some room for misunderstanding. Subsequently, the official attitude of the B.M.A. was that its members should, continue to charge their normal fee and place the responsibility of claiming a refund of 7s 6d on the patient. That was in November, 1941. There had been an increasing number of doctors who had been prepared to claim direct on the Social Security Fund and accept the 7s 6d' in full settlement, and now the Opposition suggested that they should revert to the scheme of patients claiming a refund. That would mean that all those people receiving free medical service would have to pay and be put to the inconvenience of claiming a refund His experience was that charging a patient 3s did not necessarily mean that doctors would see fewer patientsm some cases the finding of 3s for each consultation over a long illness was a burden. The service a doctor gave depended in the ultimate on the ability of the doctor concerned, and if some doctors were not giving the service they should that was not due to any method but to the nature of the doctors. He wo.uld suggest that doctors were very largely like other members of the community—no bettef- and no worse. Some took advantage to make as much money out of the individual and the State as they could; but if some made more money than they deserved they were not alone in that respect. Taxation was very heavy on the higher incomes, and if a doctor had a taxable income in excess of £3700 a year he paid 18s in the pound - for every pound earned after that, so that for every £1000 in excess of £3700 he was left with a balance of £ 100. Therefore, for every consultation he received in reality not 7s 6d, but 9d. Was it likely that doctors would go chasing cases at 9d a time? STANDARD OF SERVICE. He would say quite definitely that in his opinion doctors who were getting i a high income from the Social Security Fund could not possibly be- giving their patients the service they should. The position was influenced because of the largo number of doctors serving in the Armed Forces and -.those left in New Zealand ' having to be spread throughout the community. Some doctors were being overworkedand one he knew who received one of the largest incomes was on the verge of a nervous breakdown. He was a doctor who would never turn a patient downf although many other doctors did so. He recognised that there were some doctors—probably a considerable number—who would prefer a scheme where they would be their own masters charging their own fee and letting patients get what they could from the State, but there were some younger men who were quite prepared to support the salary scheme if they could go into a group medical practice, carrying with it annual holidays, postgraduate study, and a superannuation scheme. The Government was now in process of working out a salary scheme which such doctors could be invited to join. Mr. F. W. Doidge (National, Tauranga) said ttiat the Minister had not denied that some doctors were receiving up to £10,000 a year. On the basis of 7s 6d a consultation a doctor would have to see 80 patients a day, but when, the scheme was first being formulated the evidence was that 20 patients were sufficient. Even then, a doctor would be receiving £50 a week. Mr. Bodkin said that apparently the Minister was of the opinion that because the Minister of Taxes was the biggest shareholder in a doctor's prac- ;

EMPIRE PRODUCE

POST-WAR CONTROL

DANGER OF COMPULSION

"There is no doubt whatever that Governmental control of Empire primary produce would necessitate some element of compulsion, and thus we would be1 bringing into the commercial life of the Empire an atmosphere which we would always avoid politically as being entirely contrary to the whole basis which forms the strength of this great Commonwealth of self-gov-erning peoples," states ' a leading London dairy produce importer in discussing the question as to whether it would be desirable for all Empire primary produce to be vested in Government ' purchase and disposal boards. In an article submitted by the Reciprocal Trade Federation of the United Kingdom, he points out that the British Empire was an example to the world, and its success had been achieved because of its loosely-knit character. "Each of the Dominions makes its own decision,"- he continues. ' and it is because of the absence of any form of compulsion : that these separate entities have always agreed m regard to any major item of policy. If, therefore, the absence of any compulsion has been found to be the right policy in international matters, surely the same must apply to the production of each country. It is well known to what lengths the various countries in the Empire have gone during the war to supply precisely what forms of primary produce were required from time to time by the British Ministry of Food, despite the fact that this has involved, the countries concerned in great expense and considerable inconvenience. "Even this, however, has not been achieved by compulsion, but only by a readiness on the part of each country in the Empire to do whatever was considered to be of greatest value in furthering the war effort. THE RIGHT TO DECIDE. "If, however, in times of peace the primary produce of Empire countries was to be the subject- of contract between the respective Governments, this must surely mean that each of the primary producing countries would be told what they were to produce, and tnus take away from them in respect of one important item of their economy their existing right to decide for themselves. This seems to be vitally opposed to the present basis of Empire, policy, and as such would be bound to bring all sorts of difficulties and differences in its train. It would be a major tragedy if, in order to pursue the theoretical advantages of international planning in the production of i.oodstuffs, we introduced any form of control which in any respect cut across the existing basis of Empire unity •+ '<a?-« of the world often finds it difficult to understand how the British Empire does in fact operate as one unit, and sometimes this may be a wonder even to us who form part of it. It is just this freedom of action however, which makes it a matter almost of honour for each of the selfgoverning Dominions to consider the interests of the Mother Country and other parts of the Commonwealth, whereas it is only human nature for any self-governing country to consider its own interests if there is bein« applied to it any form of compulsion "