PEOPLE'S HEALTH

New Zealand Herald, Volume LXXV, Issue 23115, 13 August 1938, Page 18

PEOPLE'S HEALTH

FULL SERVICE FOE ALL

FREE FOR THE POOREST ASSISTANCE FOR OTHERS THE REJECTED PROPOSALS [BY TELECR-ATII —SPECIAL REPORTERI WELLINGTON. Friday "The British Medical Association Bcheme is based on the desire to ensure that the poorest person receives the same treatment as the richest person by providing them with, or assisting them to obtain, the things that are difficult to get. In other words, it plans a complete servieo for the limited section of the population which is unable to provide it for themsolves from their own resources," stated Dr. J. P. S. Jamieson, of Nelson, president of tho New Zealand branch of tho British Medical Association, in outlining the * association's scheme. "There is nothing in the health condition of the country to indicate tho necessity for the immediate adoption of such revolutionary proposals as the Government has decided on and at so great a cost. The association's plan is based on what are judged to be the needs apparent at the present time, which may be met by a modified adoption of the insurance principle for incorporation in our system 011 a limited Bcale. In the formation of the scheme the- association desires to meet special difficulties where they arise, so that complete health service may be equally attainable, although not necessarily free, to the whole community. Small Earnings Group "We have grouped the population into four sections, following the above principle, thus: — "Section I. —Old-age pensioners, un- . employed and unemployable, part-time and casual workers, others of small earnings or income who are not dependents of other persqns, and the dependents of all those where their earnings or total income (in the case of married people their combined income) does not exceed old-age pension, unemployed or sustenance rates. For those we suggest that complote service might be provided, as hereinafter outlined, in order that they may be as advantageously placed as the rest of the community in respect of necessary health service. "This section of the population receives at present hospital services and other services attached to hospitals, although not always on an understood free basis. Not being able to afford domiciliary medical attention, they tend to occupy hospital accommodation for which hospital treatment is not required. They require more adequate service,, especially in the direction of ordinary domiciliary medical and nurs- . ing service, the provision of ]yhich should give some relief in the matter of _ hospital accommodation. • Domiciliary Care "Past experience has shown that the local effects of periods of stringency, and the shift of population which occurs at such periods, at times throw undue burden on local finance to the detriment of medical care of this section. We consider, therefore, that in order to equalise the incidence of costs and- maintain efficient care, the cost of services for this section should be ar>X~ ranged on a more national basis than at present, and that the State should ]: provide domiciliary medical and nursing care. This, in our opinion, is the only sec- | tion of the community which requires complete service solely at the expense of | the public funds. The rest of the comk mumty can and should, either in whole J or in part, provide for their own health . services. Contributing Group "Section ll.—Wage and salaryearners whose total income does not exJ- ceed: (a) 60s a week, gross, single; (b) % . 80s a week, gross, married, without 5 children (combined income), 10s a week ;; higher income for each child under 16 years being allowed to entitle inclusion. f.. These income limits were suggested as £ a basis of discussion; but insistence by the Government on the 'universal' principle has precluded any discussion . on these lines. "For this section, we propose that they should be contributors for thera- , selves and their dependants to a % scheme whereby they would be pro- „ vided with complete health service as in Section I. In the light of past experience, we think their contribution could be' made on such a scale as ■would defray the cost of general practitioner service, and some of the cost of hospital service; but to furnish complete service, public funds would be required to bear part of the costs. Self-supporting Basis "Section lII.—All having, income not ■' exceeding £SOO per annum and not in- « eluded in Section 11. The sickness risk S "which presses on such people is not %' ordinarily domiciliary and consulting room medical attendance. It is the £ more serious illness involving hospitalisation, specialists' service, and costly t diagnostic procedures-. We suggest, | therefore, that this section should mako their own arrangements for themI selves and their , dependants for | ordinary medical attendance, but f should contribute to an insurance fund I* I for hospital, specialist and consultant i services, this fund to provide a cash % benefit for those purposes. This should £ be on a compulsory and self-supporting * basis. v "Section IV. —Those with income exceeding £SOO per annum. This section ? is capable of providing all services for themselves. There are opportunities for " insurance against sickness risks open to J. them, if they like to avail themselves of them, and they could be admitted, if they choose, to the scheme suggested , for Section 111. Insurance Principle "The underlying idea of these suggestions is that the insurance principle should be brought in to assist people £ to m'cet their needs where those press most heavily, and that they should rely more and more on that principle as their circumstances permit them to use it," continued Dr. Jamieson. ;• "Where the circumstances are such that contributions cannot be made, or can bo made to only a small extent, public finance assists. Thus, in the first , section it is only insurance in the sense that the individual's contributions are paid from public funds. In tho second section, tho individual covers part of his own risk by insurance contributions, the rest being borne by public funds. In the third Bection, the individual's main, risks are covered in conformity with the insurance principle without other assistance. "The term 'complete health service' has been used in the foregoing, and it f is necessary to explain what, is understood in that term. The health system as a whole embraces preventive medi- .! cine and curative medicine. Tho former is chiefly a departmental function, and wo emphasise that the Government and the people are more likely to get a dividend by generous support of every aspect of preventive medicine than by •j putting money on an extensive system of contract practice of cutative

"With the family doctor as the pivotal point, the complete service, as recommended by the association under this scheme, provides for: —General practitioner service; nursing service (home); anaesthetics; pharmaceutical services; consultant and specialist ser« vices; laboratory and radiology services i hospital services and ambulance; maternity services; physiotherapy and massage services; dental service. "This," concluded Dr. Jamieson, "'is the scheme that was recommended to the Government by practical and experienced men. It is a fully considered and wholly practical scheme, which has the whole weight of the members of the British Medical Association behind it. l't is also very much in line with the recommendations of that other body which has had experience of health service, namely, the Hospital Boards Association. Yet it has been rejected by the Government, nnd the profession is now being asked to carry out proposals which it does not approve, and regards as being dangerously experimental and prejudicial to the general health and well-being of the people of New Zealand."