The Evening Star FRIDAY, APRIL 13, 1928. HOSPITAL FINANCE.

Evening Star, Issue 19840, 13 April 1928, Page 6

The Evening Star FRIDAY, APRIL 13, 1928. HOSPITAL FINANCE.

The Otago Hospital Board’s draft estimates for the financial year lately entered were confirmed yesterday. . The totals, about the same as last year’s, will necessitate within a few pounds of £50,000 being levied on the local authorities in the district. There is thus the prospect of a continuance of the rate of 6d in the £, to which figure it was raised last year from 4Jd. City ratepayers have not taken the increase without some grumbling, but the conn try ratepayers have, through their county councils, protested much moie vigorously. Figures which appear in the Health Department’s recently issued appendix to its last annual report seem to justify the country ratepayers in their complaint that they bear by far too heavy an end of the log. The rateable capital value of tho con Utica aim road districts of New Zealand is in the proportion of about 3 to 2 as compared with that of the boroughs (including tho large cities) and the independent town districts. But the population of the counties is something like 2 to 3 as compared with that of tho boroughs and town hoards. As the rating is based on capital values, the upshot is that the 35.5 per cent, of the population resident in the country pay 58 per cent, of tho hospital and charitable aid levies, wdiile tho 61.5 per cent, living in the large and small towns pay only 41 per cent. These are tho averages for the whole dominion, and arc subject to variations in respect of individual hospital districts. Nevertheless, there seems to bo something inequitable in a system of taxation which means that on an average each town dweller contributes 6s Id and each conn'.ry dweller 13s lid towards each pound levied by the hospital boards. In tho face of such figures as these it is surprising that the Health Department strongly champions tho continuance of this system. The appendix mentioned takes cognisance of tho dissatisfaction of the rural population. It records that protests have been made against the system from time to time by county councils, the Fanners’ Union, etc., who have suggested that it should ho altered to a basis of tho mean between the population and tho rateable capital value of the contributing local authorities. The supporting argument that tho country districts pay for the hospitals and the town dwellers use them is dismissed as fallacious, though it is admitted that, if the levies on each contributory local authority were divided by the number of patients from its district, it would he found that in most cases the amount per patient from the country districts would be considerably higher than the amount per patient from the towns. But it is contended that, if the basis of taxation were changed as suggested, only the wealthy counties (those with a high average capital value per aero) would benefit, while the poorer counties would probably be in a worse position as regards taxation than they are now. The suggestion that levies should bo made partly on a basis of population and partly of property valuation is not favored by the Health Department (continues the report); it is opposed by the Hospital Boards’ Association; it is opposed by the Commissioner of Taxes; it was not favored by the Hospitals Commission; the House of Representatives rejected tho proposition; it stands to reason that the Municipal Association, which does not appear to have dealt with the matter, would not recommend it. There is thus a great array of authorities opposed to mitigating a grievance the airing of which the department itself admits not to have been “ entirely unreasonable ” at times, such as recently, when many of the farming class were, in effect, paying rates and taxes out of capital. If there seems no prospect of alteration in the incidence of taxation lor hospital and charitable aid purposes, there does not seem any better prospect of any reduction in the total amount required. The report states that, “ comparing the 1916-17 figures with those for 1926-27, it is found that the total increase in levies, subsidies, and expenditure out of the Health Department's vote for the ten years lias been 156.5 per cent., or an average of 15.6 per cent, per annum.” There was a very largo increase in hospital building operations, dating.from about 1922, and this was soon followed by a sharp upward tendency in maintenance expenditure. The health authorities, however, incline to the opinion that tho peak in hospital and charitable expenditure seems to have been reached, for the following main reasons That there is already a considerable drop in hospital building operations, that the cost of living should not show a lurtlier upward tendency, and that the boards are realising tho necessity to curtail their estimates as much as possible. The chief cause of the past heavy rise in these latter appears to be increases in the staff out of proportion to the increases in the accommodation provided for patients. During the past decade the decrease in the number ol beds to each member of the staff Im-< been 23 per cent. The percentage i • crease in the stipendiary medical stall has been nearly double that of the nurses, while the increase in the domestic staff is nearly double that of the medical stall. The quality of the nursing staff has, however, been improved by an increase in the proportion of trained nurses to probationers. The department is therefore suggesting for the consideration of boards whether hospital staffs have increased in excess of requirements, and whether businesslike methods are always pursued in regard to the purchase and use ol stores. Tho possibility of economies being effected which would appreciably relieve the taxpayer is, however, evidently not highly regarded, for the report states: “It would seem that the time is ripe tor the consideration of some universal contributory scheme to meet the growing cost ol hospital expenditure.’’ Mention is made of existing voluntary schemes, such ns those at Denniston and Knitangata, under which workers can make provision for hospital treatment by contributing to a hospital fund. The suggestion is thrown out that each hospital board should‘organise its own industrial contribution fund, on a voluntary basis for a start, and if it were then found that not all large employers would join with the Government in supplementing the workers’ weekly payments a compulsory scheme should be substituted.