HOSPITAL MAINTENANCE

Evening Star, Issue 17636, 15 April 1921, Page 3

HOSPITAL MAINTENANCE

£75,000 REQUIRED. CHAIRMAN STATES POSITION. At last night’s meeting of the Hospital Board a special committee reported as follows : As per statement of estimates of receipts and expenditure, the sum of £75,000 is the amount required to be provided by levy and Government subsidy thereon during the year 1921-22 for ordinary maintenance. The division between tne local bodies and the Government will bo as follows;—Local authorities, £40,268 9s; Government subsidy of 17s 3d in the pound, £34,731 11s. The committee recommended that authority bo granted to give each contributing local'authority notice of the estimate of expenditure and income and the proposed apportionment, in order that formal making of the levy might be proceeded with at the next meeting of the board. Mr A. F. Quelch (chairman of the Finance Committee), in moving the adoption of the report, said that after a perusal of the receipts and expenditure na thought it must bo conceded that a genuine attempt was being made—in accordance with the expressed wish of several local contributing bodies—to keep the proposed levy for the current year as low as circumstances and conditions would allow. Councils and most local bodies could, with fair accuracy, compute their estimates for the year, but with hospital boards it was more difficult. The board had estimated for what might he termed a norma! hospital year, while taking into consideration prevailing prices of commodities and rates of wages; and, by the exercise of rigid economy, was hopeful of keeping expenditure down to tho specified sum. However, it should he remembered that hospital calculations were very easily upset, and_ should tho board be faced with an epidemic during tho next twelve months—the cost of which was not provided for, nor was it usual to do so—the board would probably have to draw on its bank overdraft for’the time being Tho hoard proposed to bo extremely moderate so far as capital expenditure was concerned for some time to come. Probably tbis_ was the first occasion on which no capital estimate had been presented to members. Certain buildings and works would be proceeded with out of bequest money in hand and some to come in during the' year, which should tie sufficient for the purpose. The cost of erection _ and equipment of country hospitals, provision for which had not been made, would require to be met by loans on mortgage. —The Levy.— The amount to be levied on local con tributing bodies came to £40,268 9s, and tho Government subsidy on same was £34,731 11s, making a total of £75.000. The levy was practically the same as last year, having been reduced by equivalent amount formerly paid to the counties of Bruce when part of tho Otago hospital district. Of the £75,000 reciuired for the maintenance,of all the boardSs institutions and charitable aid, the sum of about £50,000 was allowed for the Dunedin Hospital. It was here that the greatest economy was necessary to help the board’s finances. When the remaining portion of the new boiler plant arrived and was installed it was anticipated that there would be a substantial reduction in the coal bill. —-Increased Work and Cost.—

The work of some of the special departments had greatly increased, and likewise the cost of same to the board. In 1917-18 the net cost of running the X-rav-depart-ment had been £2lO, and for 1920-21 £9OO. If the medical men in charge of the special department were to meet the board periodically in regard to the business side of their work ho was of opinion that the expenditure could be reduced without impairing the efficiency of their departments. AH recommendations from the board’s officials tending to reduce expense would be welcomed. The radium department, which fn th'e near future would likely become the Radium Institute of New Zealand, and the facial and jaw department at Dunedin Hospital were not only for local requirements, but were for patients from ah over the Dominion. —Qovemme.li. Grants.-• The Government should make special grants for the maintenance and imnrovement of these departments. The Hospital Commission, which had been set up to go into matters of this description, should be supplied with information by the board to enable it to recommend the Government to pay an adequate sum towards these departments. Of the more complex matters affecting the finances, he would direst attention to the following:—(1) With the Dunedin Hospital was closely associated the Medical School. Undoubtedly this was to the advantage of patients, as the board had the services of several highly qualified medical men who were attached to the school. —The Expenses.— To what extent the expenses at the Hospital were actually increased owing to the facilities accorded medical students by the board he was not in a position to say, nor to his knowledge had this matter ever been gone into sufficiently to ascertain same. According to the ‘Hospital Gazette,’ December, 1920. Sir William Davison asked the Minister of Health if he would state what was the average weekly cost per patient in the London hospitals in respect to maintenance and in respect of medicine and medical attendance. Dr Addison replied: “No figures are available for the present year, but, according to the statistical report of the King Edward’s fund, the average cost per occupied bed in 1919 worked out at £l5B 13s 6d, or approximately £3 5s per week, for the hospitals having medical schools {with exception of St. Bartholomew’s), and at £l4O ICa 3d, or approximately £2 14s per week, for the larger general hospitals without medical schools.” The Medical School was a national institution serving the whole of the Dominion, so in fairness to the local ratepayers and the board the Government should render some financial assistance. He suggested representations should be made accordingly. (2) Owing to recent legislation, which cut off from the board the Counties of Bruce and Clutha. a loss in revenue—approximately £20,000 per annum—had been sus. tained. —Separation.— The departure from the presumed former policy of tho Health Department of base hospital with subsidiary hospitals spread over a fairly large rating area must be denlored by every citizen who had taken aiTinterest in and noted the progress of hospital work during tho last ten or twelve years. The loss of income occasioned by separation of the South Otago districts was somewhat serious, as the hospital staff or plant could not be reduced in proportion. A simple illustration would make this clear. A farmer with 200 acres of land acquired another 100 acres, and as he had a staff and plant the working of tho additional 100 acres cost relatively little more. If the 100 acres had been purchased by another farmer who had to erect buildings and purchase implements the cost of working would be considerably more, apart from the capital involved. It was obvious that the cost of farming the 300 acres in one lot would be very much less than if worked by the two fanners independently. On the other hand, take fifty acres away from the farmer with 200 acres, and his loss was heavy, as he still had to maintain practically the same staff and plant to work his remaining 150 acres. This was very much the position in which the Otago Hospital Board now found itself. Coming to he contended that the greatest economies in hospital administration could best be effected by having large areas to operate over and not email areas. As the hospital districts were now fixed this could still be brought about to a great extent by the various hospital boards working in unison, and so avoiding unnecessary duplicating of costly buildings, equipment, and special skilled staffs., —Taxation.— The basis of hospital taxation was that the wealthy paid for the poor—possibly theoretical' to some' degree—so there apba no iust reason wta the rate-

payer of one hospital district should pay more than the ratepayer in another district. Tlie Otago Board had some special departments at base hospital and a sanatorium at Palmerston, which could easily cope with all the requirements of all the hospital boards south of tho Waitaki. If such special departments and special institutions were utilised and paid for proportionately by all the boards in that area, it would be good business for all concerned. The paying for treatment to the board, providing buildings, plant, and staff, at so much per patient was scarcely satisfactory, unless at rates very much in excess of those charged at The Wellington Board (similar population to Otago Board) by sending their T.B. cases to Government sanatoria did so at a total cost of not half the amount it took to maintain Pleasant Valley Sanatorium. The linking up of the different hospitals on the lines indicated for tho special treatment of their patients, would, he felt sure, be to the mutual benefit of all. He commended this matter to the favorable consideration of board members, and with a view to attaining practical results it should bo brought before the Hospital Commission. In touching on these phases of hospital finance, he recognised he had left himself open to criticism, but if tho outcome was that the standard of our hospital treatment was not only maintained but kept abreast of the times at a reasonable minimum of cost to the ratepayers ho would be pleased. Mr Larnach seconded the motion.

Dr Nowlands, in supporting the motion, said that the chairman of the Finance Committee had made it abundantly clear that the board had earnestly endeavored to meet the wishes of local bodies without actually imperilling the efforts of the board to do its duty to the ■ community. It was a matter for congratulation that the statement of Mr Quelch was strongly supported by a report in that night’s paper by the Chief Inspector of Hospitals (Dr Wylie) in his statement before tho Commission in Wellington. Tho report was adopted.