Nelson Evening Mail Friday, January 14, 1938 NATIONAL HEALTH INSURANCE

Nelson Evening Mail, Volume LXXI, 14 January 1938, Page 4

Nelson Evening Mail Friday, January 14, 1938 NATIONAL HEALTH INSURANCE

IN view of projected legislation dealing with national health insurance and superannuation—details of which are being awaited with the keenest interest—it is timely to recall the attitude of the medical profession which is one of the organisations closely affected. That attitude was revealed last year not only by individual members of the profession in reported addresses, but in a report prepared by the National Health Insurance Committee of the New Zealand branch of the British Medical Association. The medical profession, while not opposed to the principle of national health insurance, advocates caution and the introduction of the scheme by degrees. This Committee, of which Dr. J. P. S. Jamieson is chairman, recommends a sectional beginning, with full service for persons unable to provide for themselves; full service for those who can contribute part of the cost; hospital, specialist and consultant services for those who can meet ordinary medical needs, but find serious illness burdensome; and, finally, the option of : entering an insurance scheme for those who can meet all illness costs. Emphasis was laid on the • fact that the association does not seek the institution of a “poor I man s service” or a system of poor relief, but desires to meet 'special difficulties where they arise so that complete health service may be equally attainable, though not necessarily free to the whole 1 community. This, however, is j merely a bare outline of a section of the report which furnishes a valuable basis for further consideration. The Government’s enquiries and the work of its own committee, of which Dr. McMillan is chairman, should enable it to announce whether it is determined to adhere to its intention to make the scheme universal; I whether contributions will be required of employer or employee, or of both and the State; whether contributions will be on a flat rate or be in proportion to income; and whether it is proposed to continue the unemployment tax and make it the basis of the funds for a health and superannuation scheme.—a course which is favoured by many. If contributions are to be in proportion to income, will the proposed benefits be uniform, or proportional to contributions? Of course these questions, on which the public is awaiting enlightenment, are distinct from that section of the scheme which directly affects the medical profession, which realises, as most people do, that health insurance will not in itself make the people healthier, although it will enable them to be ill with less worry about the expense. Health insurance systems have been in operation in varying degrees in some thirty countries for years !in Britain for over 25 years. Authoritative figures are available to prove that the system has produced frauds based on neurotic ailments due to hypochondriacal fancies—especially in weak characters. We have witnessed the admittedly grave abuse of our sustenance (without work) system m this direction; that system has been taken a mean advantage of and the Government has quite rightly adopted stern measures to minimise the abuse. It will have to take similar steps at the outset in regard to health insurance, and also to see that an undue strain is not put upon the medical profession. It is of prime importance that nothing should be done that might result in a lowering of the standard of medical efficiency. As Dr. T. D. M. Stout, President of the New Zealand branch of the British Medical Association, emphasised last year:

If anything is done to lower this standard by deterioration of the standard of practice, or by the introduction of an inferior type of practitioner, however theoretically ideal a scheme may be, it will inevitably lead, whatever the efficiency of the administration, to a poor type of medical service to the community. This warning should not pass unheeded. Exploitation of the medical services will lead to deterioration of the service rendered. Exploitation of the funds to be created must also be avoided. It is only human nature for political pressure to be brought to have original benefits extended. The ideal aimed at is one that meets with wide approval, but in seeking to achieve it, full regard must be paid to practical considerations—financial as well as others, some of which we have outlined. For these reasons it is essential that the Government’s plans should be placed before the country at the earliest possible moment. Cabinet is now considering these new proposals. It has a wonderful opportunity for sound, constructive effort. The task is a huge one where an open mind is the first essential. We trust the Government will enlist the services of all in assisting it soundly towards its great goal.