HOSPITAL PROBLEMS

New Zealand Herald, Volume LXX, Issue 21470, 19 April 1933, Page 13

HOSPITAL PROBLEMS

NEW ZEALAND SYSTEM TREATMENT WITHOUT FEES PROFESSOR BELL'S CRITICISM [from our ow.\ correspondent] SYDNEY, April 13 Strong criticism of the free use of public hospitals by persons who are able to pay was the main point in the Syme oration, delivered at the opening of the Australian College of Surgeons by Professor F. Gordon Bell, professor of surgery at the University of Otago. He said that free treatment was a degredation to those able to pay who sought it. Professor Bell devoted practically the whole of his oration to hospital problems,- which, he said, are so numerous and obvious as to embarrass one in discussing them. They were similar in Australia and New Zealand, though in New Zealand the problems created by the large Australian cities did not exist. The world of surgeons had a vital interest in hospital matters as far as surgical efficiency and surgical education were concerned. As for the hospital system, a surgeon had to accept things as they were, though they might reasonably hope to exert their influence in a carefully considered policy which in due course must demand public recognition. No one could question the right and duty of surgeons to speak on hospital matters. The professor said that in New Zealand public hospitals Mere maintained by rates levied on the taxpayers and by Government contributions. Medical treatment, with two exceptions, was free. There was no great quarrel with the larger hospitals, but there were extravagance and inefficiency in the smaller institutions. The majority were controlled by full-time superintendents, responsible for both administrative and clinical work. They were known as "one-man hospitals" and the New Zealand College had directed attention to the pernicious system, but so far without great success. The evils of the small hospitals were two-fold —the surgical work was deprived of the healthy criticism of an honorary staff and of the benefits of consultation. He suggested that the great hospitals throughout the country should be graded. That would show the people that they could expect better treatment in the larger hospitals and would inspire the local boards to improve the grading of their institutions. New Conditions Public hospitals had departed from their original function of being for the use of indigent sick. The circumstances that the public hospitals served other sections of the community than the destitute sick deprived them of many of their advantages for educating the surgeon. The plain fact was that they were trying to put into the new conditions a system that had achieved magnificent work in the past. The system of charitable and free services from an honorary staff was right only under one condition —that it was restricted to the interests of persons who could pay for accommodation, but not for surgical attention. Otherwise it became a misguided charity, a degredation to those who sought it. In New Zealand persons who paid direct or indirect taxation toward the hospitals had a claim to admittance. Personally he paid his hospital levy, but he could not say that that entitled him to enter a public hospital. The surgeon was justified in stating this case without fear of being accused of self-interest. Education o 1 Surgeons Speaking of the education of surgeons, Professor Bell said there was a danger of breeding a race of surgical practitioners instead of doctors lowering the standard of surgery. He suggested the establishment of unn ersity hospitals and said he would especially like to see one, with about 200 beds, in Sydney. He hoped another generous person would come forward and make such, a hospital possible. Ho also considered that students should be compelled by law to undertake a fiyevear medical course in surgery after they had completed their six years medical course. A compulsory national insurance scheme against sickness vias also advocated by the professor. That would do much to relieve the financial position of the hospitals. However efficient Australian and !New Zealand hospitals might be in the treatment of the sick, thev compared unfavourably with those of other countries m the matter of research.