HOSPITAL FINANCE

Evening Post, Volume CXXXIX, Issue 49, 27 February 1945, Page 7

HOSPITAL FINANCE

TRENDS DESCRIBED

FIGURES RISE STEEPLY

Sharp increases in figures relevant to most branches of hospital work in New Zealand were one of the features of evidence given before the Parliamentary Committee on Local Government yesterday by the secretary to the Department of Health (Mr. A. Yon Keisenberg). In reply to a question, he said that while levies and rates on local authorities had increased, they had not increased in proportion to costs, which were met by the Government from other sources.

Patients' fees, including receipts from the Social Security Fund in respect of hospital and other benefits, and fees paid by the Government for the treatment of service patients, received by boards in 1943-44, £2,309,600, was an increase of £1,760,574 over the amount received in 1938-39, £549,026. The great bulk of these receipts now came from central Government funds, said Mr. Yon Keisenberg. At the inception of hospital benefits on July 1, 1939, 6s a patient a day was fixed as the rate of payment from the Social Security Fund, that being much above the average fees collection of all boards at that time (3s 2d a day a patient), and, in fact, higher than any individual board had collected. From April 1, 1943, the rate was increased to 9s a day. In respect of maternity benefits, pharmaceutical benefits, out-patients' benefits, and X-ray diagnostic benefits, boards had also received payment on a scale well above the average amounts obtained in the ordinary way from patients themselves.

For the treatment of service patients ■' in hospital the Government now paid i the full maintenance cost. For" the ; treatment of out-patients, boards received 60 per cent, of their expenditure on salaries and wages of person-1 nel affording the treatment and of ma-, terials used in course of treatment. Where additional accommodation had had to be erected for service patient^ the capital charges were, for the tim«> being, borne out of the War Expenses Account. PATIENTS TREATED. Hospital maintenance payments in 1943-44, £3,584,934.-represented an increase of £1,860,096 over those in 1938-39, £1,724,838. In that period the daily average of occupied beds in all boards' hospitals and out-patient attendances increased as follows:— Average daily Attendances number of by in-pntlonts. out-patients. 1935-3!) f,590 5G3.4G* 1939-40 0978 500,6(16 1940-41 5503 6n0.44f) 1941-42 9099 526.37CJ 1942-43 9911 1,031.14(1 Some of the increase shown was not a real increase, but was due to chainges in the classification of institutions^ The figures for 1940-41 included thos« for three hospitals which in previous years were classified as "charitable institutions" and the occupied beds of those three hospitals for 1940-41 totalled 669. i The number of service patients, under treatment, including those in temporary hospitals, also accounted for a considerable part of the increases' since 1938-39. Increased prices and other items of cost accounted for about one-tfyird of the increase in hospital maintenance payments since 1938-39. In 1938J-39 the average annual cost an occupied bed in all boards' hospitals was £)246 16s, and in 1942-43 it was £304, an Sncrease of £57 4s. • Levies on local authorities ever the same period and for 1944-45 had been as follows: —

The levies for 1939-40 were based on estimates which did not include anticipated receipts from the Social Security Fund.. As hospital benefits •and maternity benefits were introduced during that year substantial surpluses resulted and those partly accounted for the considerable reduction in levies in 1941-42. FUNCTIONS OF BOARDS. It had been suggested that coordination of effort in the health and hospital field would more easily be attained if hospital ooards were entrusted with (a) responsibilities in relation to the prevention, limitation, and suppression of infectious disease, including tuberculosis, and Co) tns local administration of some of trie services that are the subject of benefits under part 111 of the Social Security Act, and that administrative areas of hospital boards should, .where necessary, be enlarged for that purpos3. For the ! effective development and carrying out of those additional funccions it appeared there should be about 16 districts. I. It was realised -that/.efficiency in the management of hospitals and allied services required a great deal of flexibility in dealing with the problems of particular localities. For that reason it Jiad been suggested that if hospital districts were generally to ba enlarged by the merging of existing districts, statutory provision should be made for the appointment of local committees for the management of individual hospitals and other activities under the board's control. The problem frequently encountered in connection with the proposed amalgamation of local government areas arose from the disparity in rating as between neighbouring districts. In the case of Thames, Waihi, Coromandel hospital districts merger in 1937, the local authorities of the Thames portion of the new district had to suffer an increase in their-contribu-tions as the result cf the merger. To soften the blow the Government made a special grant in reduction of thoso contributions, a sum of £.750 in the first year, £000 in tho secor.d year, and so on, the grant ceasing in the 1 sixth year. Some^uch method might be necessary to™ achieve amalgamations in other areas. One method of removing inequalities in hospital rating in various districts would oe to alier the incidence of the subsidy scheme. If that were done and the average of pound for pound were preserved, some districts with a low hospital rate would suffer to make up a higher subsidy for those with a high rate. He considered that the amalgamation oi" certain hospital districts would make for easier/ co-ordination of services and for a little economy in administration. It had been suggested that the number of districts could be 16 instead,' of 42 as at present. Those districts would be what the Department cor/sidered good health districts and amalgamation to that extent would ertfable boards to take over wider functvbns; but only local investigation yliould determine the area of a district.

:938-30 .939-40 040-41 941-42 042-43 943-44 .944-45 For For maintenance capital payments, payments. & £ 823,188 120,883 953,999 139,087 7fi2,108 204,122 863,014 202,405 ,■ 1,002.014 225.031 1.033,545 217,75"; 1,011,404 a 304,106 • Total. £ 944,071 l,093,9S(i 0fifl,230 l,0r..-),50!) 1,317,045 1,251,302 1,294,918