HOSPITAL AND MEDICAL BENEFITS

Nelson Evening Mail, Volume LXXII, 8 September 1938, Page 13

HOSPITAL AND MEDICAL BENEFITS

FREE HEALTH SERVICE FOR EVERYBODY When it came to the section dealing with hospital and medical benefits, Mr Kyle said that he had heard that the Government proposed to allow a good many German Jews to take part in the scheme in the event of the Government not being able to come to some arrangement with the British Medical Association. The Leader of the Opposition questioned the necessity of taxing the community to provide a free health service for those who could well afford to pay their way and would prefer to do so. He thought that probably two-thirds of the community were in that category. The Opposition seriously questioned the wisdom of making a partial health service available to everyone in New Zealand but recognised that there was a call for a good health service for those who could not afford it. It was not social security to give a free health service to a man on £IOOO a year. The Minister: He is paying £SO a year for it. Mr Hamilton: He will be paying a lot more than that in indirect taxation. He will want to be free to make his own provision. There is a personal connection between a patient and a doctor that is valuable. IMAGINARY DIFFICULTIES The Minister of Health (the Hon. P. Fraser) said that he was interested in Mr Hamilton’s point of view but it was difficult to understand it. Under the Bill everyone would have the right to select his or her own doctor, and the doctor would have the right to reject patients he did not wish to treat. The only restriction he could conceive, said Mr Fraser, was that the number of people who went to a popular doctor might be more than he could deal with. “I can assure hon. members that these difficulties ar e imaginary and that the medical profession does not anticipate any difficulty in regard to this part of the scheme,” said Mr Fraser. Furthermore, if the difficulties were there at all, they would still apply to a limited scheme. He understood that Mr Hamilton was prepared to support a scheme based on income limits. What incomes would he suggest? Mr Hamliton: The whole Bill is practically limited to a means test. Mr Fraser: Supposing you fix £350 or £4OO as the limit of income of those to benefit, what about those on £351 or £4Ol paying the same amount and getting no benefit? Are the Opposition prepared to say they will limit the scheme to certain incomes? That is a straightout issue. NEGOTIATIONS WITH MEDICAL PROFESSION From the medical point of view he was not going to say that agreement had been reached on every detail because there had not been time, Mr Fraser added. That would be discussed later on. It was, however, correct to say that, apart from the difference of opinion between the Government and the medical profession on the scope of the scheme on the question of incomes, there was no great difficulty to anticipate. The Bill would go through and he supposed that negotiations would have to be opened again with the profession. Mr Hamilton opened the discussion on the section dealing with medical benefits by asking whether the Government would provide the very best service under the Bill. Would it not be much better to give a full service to those who could not afford it instead of a partial service to those who did not want it? he asked. The Minister of Health: A full service for everybody. Mr Hamilton remarked that with the free service people would go running to the doctor with the slightest pain. The Minister of Health asked Mr Hamilton if he did not think that advisable. “I agree that some people will be running to the doctor all the time,” he added, “but we have to leave it to the doctor to prevent that.” “SPECIAL SKILL” Mr Hamilton referred to the “special skill” proviso in clause 84, and asked the difference between a partial and a full service. What was special skill? The Minister of Finance said that the doctors themselves would determine what was special skill, and the Minister would have some representation

on the appropriate committee. That was the British procedure which had Deen operating for many years. “That might be one reason that might justify an ‘all-in’ scheme for everybody,” he commented. “I think there should be a full service for everybody, but there are limits to what can b: afforded for the time being.” COUNTRY SERVICE In reply to a further question regarding country service, Mr Nash said that there must be some payment to doctors for mileage. Mr Poison: The far-distant patients should not be penalised. Mr Nash: I agree with that. The procedure being worked out will provide that h e will get medical attention of the best, whatever the distance. Mr S. G. Holland (National, Christchurch North) said that under the contracts between the doctors and the State they would have to provide a service that any qualified person could perform. That meant that they were going to bring the standard of service down to the standard of the least qualified person. The Government would have to lay down the class of work to be done in the contract. He asked what was the position of part-time specialists. Could they charge for their services? Mr Hamilton said that a lot of the medical services would still have to be paid for, apart from the BilL Mr Nash said that specialist services in public hospitals would be free. Mr Kyle doubted whether there was a sufficient number of doctors in the country to give the complete service the Government anticipated. At 12.50 a.m. when the clauses dealing with the pharmaceutical benefits had been disposed of Mr Hamilton asked what was intended regarding the adjournment of the House, seeing that fairly good progress had been made. The Acting-Leader of the House (the Hon. P. Fraser) said that he would suggest that the clauses relating to hospital benefits be passed before the House adjourned. This course was agreed to, leaving 45 clauses still to be considered.

THE FINANCIAL CLAUSES Mr Fraser said that the financial clauses, which were probably the most important in the Bill, would come up for consideration this afternoon, and it was the Government’s intention, with a little help from the Opposition, that the Bill should go right through the Committee stages whatever hour it might be necessary to sit to tomorrow morning. Mr Broadfoot said that the Bill was apparently making a complete overhaul of the hospital system, and he considered that the method of hospital taxation should be reorganised. At present £600,000 was being collected from run holders and people owning farms. It was manifestly unfair that the taxation should not be according to the individual. Mr Poison said he had discovered that in anticipation of the increased number of beds required the hospital board in New Plymouth was spending £IOO,OOO in extra accommodation. Mr T. H. McCombs (Government, Lyttelton): Oh, no, they are not. That was inspired. VERY SERIOUS CHARGE ON THE COUNTRY Mr Poison: Inspired or not, they are going to do it and they estimate that the increased expenditure will be in the vicinity of £26,000 a year. It is a verv serious charge on the country and it is time the Government took that aspect of the question into consideration. Mi’ Na sh pointed out that the proposed payment of 6s per occupied bed per day to hospital boards was considerably more than they were getting today. “INTOLERABLE BURDEN ON RATEPAYERS” Mr Sexton said he agreed that the operation of the Bill might very well put an intolerable burden on ratepayers. Most of the benefits and payments to be made were fixed, but the payment to hospital boards was at the Minister’s discretion and it was in his power to reduce the State’s liability if the burden of the other payments became too heavy. The unfortunate boards and ratepayers would then have to foot the bill. Mr Bodkin said that the hospital authorities should be indemnified in respect of the charges they would have to incur to give the treatment necessary. The effect of the Bill would be to strain the resources of the country hospitals. The amount suggested was quite unreasonable. After approving the first clause of the maternity benefits section, the House reported progress and adjourned at 1.20 o'clock this morning. 4