SCALING-DOWN QUALITY

Evening Star, Issue 23861, 16 April 1941, Page 4

SCALING-DOWN QUALITY

MEDICAL BENEFITS SCHEME DOCTORS' POINT OF VIEW The final of four brief articles on the medical benefits scheme from the point of view of the doctors covers the question of medical work by contract. It reads: Pretence is made that it is not possible to follow the antipathy of the doctor to the whole of the practice of medicine being placed on a contract footing. Why, if it is applicable in certain instances and for a certain number, it is asked, can it not be efficient in all instances and for the whole people? Why is it that the officers of services and institutions can give good service and do progressive work? We do not underestimate so greatly the intelligence of these propagandists as not to understand that they know why perfectly well. They only wish to foster doubt in the mind of the people. As the history of the friendly societies in New Zealand shows, a limited amount of contract work under proper contract conditions in a doctor’s practice is not a bad thing. It brings medical service where required and otherwise unobtainable; it quite commonly provides a doctor with a foothold in professional life: it enlarges experience and interacts with his individual free practice to the benefit of each part. The contracting parties axe free agents, and past disputes have been never on the principle but simply on terms. The part-time contract places no limitation on what the doctor may do for his professional interest and advancement outside the contract. How different the universal so-called contract under the Government! The contracting parties, the patient and the doctor, are not free agents. _ Both put themselves under direct political control. The contract is not mutually binding. The Minister has power to alter the regulations governing it. Once accepting it, however, the doctor has no prospect of laying it down and resuming practice on the present basis. The contract is for unlimited service, except for anaesthetics, maternity service and “ medical services that involve the application, of special skill and ex-

perience of a degree or kind that general practitioners as a class cannot reasonably be expected to possess.” What are those last-named in this country? Again, whatever services are undertaken “ in a case of emergency,” no matter how arduous or skilful, “ shall bo deemed ” to be part of the contract. What is a case of emergency? Judging by telephone calls nearlv all are. And what contractor will include in his contract obligations the risk of every calamity which may occur in the run of his job? It cannot possibly be difficult to see why such a scheme must scale down the quality of medical work. Why should Dr A take thought and trouble when Dr B draws his 15s a head light-heart-edly ? The answer, of course, will be: “ For love of his profession.” So the people will still rely on charity, which Michael Savage said was “ cold as stone.” In the case of_ salaried officers in State services or institutions it is obvious that conditions are not comparable to the kind of contract under discussion. Such officers have chosen a career which offers defined duty, opportunities, advancement, and pension.

What is the reason that the medical benefits must be available universally, whereas the financial benefits are subject to a searching means test? There can be but one reason : that the Government has to find the latter, but the medical profession bears the former. Also, the medical profession is to be controlled.