HEALTH PLAN

New Zealand Herald, Volume LXXIII, Issue 22579, 18 November 1936, Page 17

HEALTH PLAN

STATE INSURANCE LONG QUESTIONNAIRE MEDICAL ASSOCIATION VIEW PROVISIONAL ANSWERS Tentative answers to an official questionnaire on' a national health insurance scheme such as the Government proposes hare been prepared by the council of the New Zealand branch pf the British Medical Association and circulated in a supplement to the New Zealand Medical Journal. The questionnaire was prepared by n sub-committee which has been set up to act in association with the Minister of Health, the Hon. P. Fraser, in collecting opinions and suggestions to guide the Government in drafting a health insurance scheme. Copies were sent to a wide variety of bodies who were considered to be directly or indirectly interested in the scheme. It was asked that replies be sent in not later than November 30. The- New Zealand council of the British Medical Association, drafted and circulated tentative answers to the questions. It has also requested the local divisions, nearly a dozen in number, to prepare answers independently. The chairman of the branch's health insurance committee lias been directed to visit all divisions preparatory to a special meeting this month, at which the recommendations of the divisions will be considered and final answers prepared. London Advice Sought The council also decided to request the London headquarters of the association to send a special representative, preferably Sir Henry Brackenbury, chairman of the council ana a member of the advisory committee to the British Ministry of Health, to assist the New Zealand branch in preparing to meet impending legislation. The tentative answers to tho questions were intended merely to stimulate thought, and may be completely reversed. The questionnaire did not invite opinions on either of two preliminary questions: (1) Whether a national health insurance scheme is desirable, or (2) whether it should make use of private practitioners or of a salaried State medical service. Accordingly the tentative answers do not deal with either of ■ these matters. Scqpe of Benefits The questionnaire is as follows, tho answers beiiig given in parentheses:— 1. Nature of scheme. (a) Should this scheme be contributory or non-contributory ? (Contributory.") (b) Should any class or classes of persons be exempted from contributions? (All, should be exempt who are not beneficiaries.) (c) If so, should minimum and maximum income limits be applied in determining such exemptions? (Yes, both minimum and maximum.) 2. Beneficiaries. (a) Should the benefits extend to dependants of the insured? If so, who are to be 'regarded as coming within this category? (Yes; legal dependants •to age 16.) (b) Should any class of person he entitled to benefits without having contributed therefor, e.g., old age pensioners and unemployed? (Yes, all below a minimum income to be decided.) (c) Should an insured person have his rights to benefits modified in respect of any period during which he is in receipt of payments tinder the Workers' Compensation Act ? (Medical services rendered under tho Workers' Compensation Act should not be covered by medical benefit under national health insurance.) Subdivision of Scheme 3. Benefits. Should any of the following benefits be excluded? (i) General medical practitioner services; (ii.) special and consultant services; (iii.) laboratory aids; (iv.) medicines and appliances; (v.) dental treatment; (vi.) ophthalmic treatment and optical appliances; (vii.) orthopaedic appliances; (viii.) nursing and massage services (non-institu-tional); (ix.) maternity services (if not provided under other headings); (x.) hospital and sanatorium treatment; (xi.) transport of patients; (.xii.) sickness benefit and disablement benefit, (i. to xi.: All these benefits should be provided for beneficiaries so far as cost permits, xii.: Sickness and disablement benefits should be separate from medical benefit.) Payment for Services 4. Contracts and third, parties.—Assuming that the relative benefits are included in the scheme: (a) What should be the basis of payment for medical services, that is: (i.) General practitioner ? (Per capita, with optional alternative methods, as in Britain.) (ii.) Specialist? (For services rendered .) (iii.) Consultant? (For services rendered.) (b) What should bo the general basis of arrangement ior tho supply

of: , (i.) Medicines? (Through approved pharmacies.) (ii.) Appliances? (Through approved

firms.) , . c (c) What should ho the jiasts of payment for dental treatment? (liefer to Dentists' Association.) . Oi) What should be the basis of payment for: (i.) Ophthalmic treatment, (ror seiviees rendered.) , (ii.) Optical appliances? (Ihrough approved firms.) , (e) Whitt should be the basis of payment for non-institutional nursing and massage services? (Refer to associations of nurses and masseurs.) (f) What should be the basis ot payment for non-institutional mateilhtv services? (13 y special fee.) (g) What is to be the basis of payment from the fund in respect of treatment in: ■ , . ■ a (i.) Public hospitals and sanatoria. (I'er day.) . (ii.) Private hospitals? (Per day.) (h) What is to be the basis of payment for ambulance and other transport services? - (Befer to ambulance and transport authorities.)

Administrative Matters 5. Administration. _ . <a) Should the administration ot ■fash benefits, such as sickness benefit, and disablement benefit, be separated from the administration of benefits in kind, such as medical and hospital benefits? (Yes; essential.) (b) What should be the form of central administration of the scheme, (i.)'. Should there ho a specially constituted central body with executive powers, and, if so, what should be its general constitution? (Control of medical services to bo by a commission of medical men in association with the Health Department.) (ii.) Alternatively, should the National Health Insurance administration be made the function of an existing department, or departments, enlarged for purpose?

(c) Should local administration be undertaken by specially constituted local insurance authorities? If so, what should be their constitution and functions? (Local administration by specially constituted authority of nominees of interests concerned. Local areas not to be numerous, might correspond roughly to health districts.) (d) To what extent should Friendly Societies and other bodies who are already administering voluntary insurance schemes be entrusted with responsibility under the general scheme? (To have no responsibility in regard to medical benefit.) (e) What provision should he made for consultation between the administrative bodies (central and local) and committees representative of doctors, pharmacists, dentists and others similarly affected as contractors for supply of services? (Liaison by nominee of central administration or local authority.) (f) What should be the principal method or methods ol payment and collection of income? (Refer to finance experts.) Should income from all sources be allocated to separate funds for certain benefits or groups of benefits, and each such fund or the National Health Insurance Fund as a whole bo kept actuarially sound? (Imiihl for medical benefit to be kept separate and actuarial! v sound.)