COMMUNITY HOSPITALS

Evening Star, Issue 19842, 16 April 1928, Page 8

COMMUNITY HOSPITALS

HEALTH DEPARTMENT NOT ANTAGONISTIC THE SYSTEM ANALYSED AN ESTIMATE OF COST. An interesting departmental survey of the system of establishing private wards* in public hospitals, known popularly as the community hospital system, is given in the appendix to the annual report of the Health Department just issued. “ From time to time .suggestions are made that hospital boards should provide private wards in their institutions for those Mulling to pay the higher fees necessary to meet the cost of such wards,” states the report. “Tu the past the department has recognised the polity that the hospitals are maintained only for those unable to pay for private medical and nursing treatment, leaving it to a very great extent to the' various boards themselves to apply such policy, according to the particular needs and circumstances of each district. An outlying district with no adequate moans for private medical or nursing service would, _of course, admit anyone to its hospital. The basic principle, however, has been that the beds arc primarily for the, needy. If after the needs of the destitute are met there are vacant beds, then those in bettor circumstances are granted admission. NOT ANTAGONISTIC. ‘‘The establishment of private wards is strongly opposed in some quarters on the ground that it will promote class distinctions. ’The department has never shown any antagonism to the proposal, recognising that, provided alivays private wards could bo established without recourse to the public funds, more efficient treatment should result, even if there were no saving in cost to the patient. The department, in fact, would be willing, wdicn the time is opportune, to see one board at least try the experiment of a block of private wards, “ In view, however, of the increased burden on the public funds of hospital expenditure and the heavy building programmes that have had to be laced; and in view also of the fact that, generally speaking, at present there is no lack of accommodation in the hospitals, and no immediate need to relieve the congestion by further building; and, lastly, in view of the recent economic depression through which the dominion lias passed, hospital boards have wisely for the present shown no inclination to indulge in any experiments in this direction. In many of the country districts the settlers arc quite content to avail themselves of the services of the hospitals as they now exist. The homelike atmosphere of these small institutions and the privacy that can often bo obtained there!ii do not make the establishment of private wards a crying necessity, whilst in the larger centres ample private hospital facilities at present exist.

“As regards tho erection of such private wards, this might be effected try way of Joan. There would be no objection to loans for fairly long terms to meet the cost of erection, the fees for treatment being fixed so as to meet tho interest and sinking fund payments as well as the maintenance cost. With a view to avoiding bad debts, which it would be essential to guard against if these wards were to bo made to pay for themselves, it 'would bo necessary to insist in every case upon payments being made in advance. AN ESTIMATE OF COST. “ It would be imagined that such private wards could be adminstored at a slightly lower cost than that of the fees charged usually in a private hospital; but that would hardly bo found to be the case, in view .of tho fact that the running costs of the public wards of our hospitals are approximately as much as those of a private hospital for the following reasons Public hospitals cannot always be established in a locality where they may be a. paying proposition ; the profit on a private hospital at £6 a week often represents practically little more than the salary of the matron; public hospitals'have to keep a certain percentage of vacant beds to meet periods when sickness is greater than at others, whereas the private hospital would plan to bo always full, it being, in fact, a good advertisement to have to turn patients away at times; the private hospital provides neither the equipment nor staff of a public hospital—there is no stipendiary medical staff, drugs and dressings are not given free, and the nursing staff is not to be compared with that of a public hospital either numerically or in point of view of training, whilst their board and quartering are often not to be compared with that of a well-regu-lated public hospital. Doubtless the public wards of a public hospital could be run at a smaller cost than at present, but not to such a great extent as would bo the case if they were run purely as business concerns with no cognisance of the needs of the community. “The opinion of many business men with considerable hospital experience is that it would ho a difficult task to

make private wards pay at the fees usually charged by private hospitals. Apparently it would cost at least £8 8s a iveek to cover the full cost, including all overhead charges, in view of the eight-hour system for nurses and other factors to bo taken into consideration, and this only if the wards were constantly full and there were no bad debts. THE DETROIT HOSPITAL. “ Even a hospital designed for paying patients by such a skilled administrator as Henry Ford does not appear to be able to pay its way at less than the above rates. It is understood that Mr Ford does not desire to obtain any interest on the capital outlay of his hospital at Detroit, but merely that the patients shall pay sufficient to cover current expenses. The room charges for board and nursing vary from 4. 1d0l to Bdol a day, according to whether the patient shares a room with others or lias a private room with a bat)7. In addition, he pays from 21dol to 70dol a week for medical service, according to the nature of his case; and there are other charges for X-ray, radium, and special nursing if required. The above charge would not include any fees for medical attention, and on the assumption that freedom of choice M’ould be left to the patients to avail themselves of the services of the stipendiary staff of the hospital or to engage their own medical attendants, provision would require to bo made for a scale of fees in addition to meet the cost of the medical service rendered by the hospital. “It will be noted, therefore, that the cost of treatment for a person of but moderate means would be somewhat stiff, and the idea universally behind the establishment of private wards is not so much to .provide facilities only for the wealthy, but also for those who, though not substantially well off, are willing to pay for the full cost qi their treatment, which, in the public wards, they would not do. The suggestion that the fees in the private wards should be made high enough to provide sufficient profit to pay the loss on the public wards seems illogical, as it would mean that the cost would _be spread over quite a small proportion of the community, and M’ould be borne by those already unfortunate enough to have to face the expense of sickness of their own, whilst the person of means Mmo has no hospital bill to meet M'ould escape all contribution.’