PANEL SYSTEM

New Zealand Herald, Volume 78, Issue 24084, 1 October 1941, Page 9

PANEL SYSTEM

SERVICE IN BRITAIN DIFFERENCE IN PRINCIPLES DOCTORS' DUTIES AND RIGHTS Many points of difference exist between the general practitioner medical service proposed in New Zealand under the Social Security Amendment Bill, now before Parliament, and the panel system of medical service under the National Health Insurance Scheme which has been operated in Great Britain for the past 30 years. In*thc lirst place, the British scheme is limi. 'il in it.s application. 1 lie proposal in New Zealand is that general practitioner services should be free and universal —available to all members ot I the community without individual direct charge. In Britain, membership of the National Health Insurance scheme is confined to all manual workers, with certain exemptions and exceptions, and to non-manual workers whose incomes do not exceed £250 a year. In these cases membership is compulsory, with worker and employer contributing fixed weekly sums to the insurance fund, although voluntary membership, with limited rights, is available in certain other cases. Scope of Benefits The aim in Britain lias been to provide a general medical service for all people who might not, otherwise be able to afford the payment of doctors' fees. The standard benefit under the scheme consists of ordinary medical treatment by a general practitioner, together with the necessary medicines and appliances. It does not include the cost of specialist consultations, operations, rare drugs and expensive appliances, or anything outside the scope of the work of an ordinary general practitioner. The range and scope of benefits are very similar to those now proposed in New Zealand. Relations with the medical profession in Britain, however, are organised on an entirely different basis. Any duly qualified medical practitioner may have his name placed on the "medical list" prepared by the insurance committee of a particular district. He thus becomes an "insurance practitioner" and is required to provide treatment for all persons who have been accepted by him for inclusion on his list and who are entitled to medical benefit; all persons who have been assigned to him by the insurance committee; all persons for whom he may be required to provide treatment pending their acceptance by or assignment to another practitioner; and all insured persons who require treatment in case of accident or other sudden emergency. Limitation of Patients In general, a practitioner is not permitted to have on his list more than 2500 patients. He may have the name of any insured person removed from his list by giving due notice to the committee. The panel system in the main provides for consultations by insured persons in the doctor's own surgery, although, if the patient's condition requires it, there is an obligation on the doctor to visit and treat the patient at home. For his attendance on insured patients, the panel doctor is entitled to remuneration under any one of four methods which may be adopted in the formation of a scheme by the insurance committee and panel committee. They are:—A capitation system of a stated sum annually in respect of every person on the doctor's list: payment by reference to the attendances given and services rendered; a combined system of capitation and separate payment in respect of special classes of services; and any approved combination or modification of these systems. Charging Additional Fees Apart from such schemes for remuneration, a doctor is not permitted to demand or accept any fee from insured persons in respect of treatment which ho is required to give under the terms of service, although he is permitted to charge additional fees for extra services provided he furnishes particulars to his insurance committee. The right of private practice, however, remains. The panel doctor in Britain may. and frequently does, develop his own private practice among persons who are not covered by the National Health Insurance scheme. The fees which he charges for this work are entirely a matter between doctor and patient. In the main only workers are insured and their families are not entitled to medical benefits, but in most cases the panel doctor has members of an insured worker's family as private patients. The British scheme covers approximately 20,000.000 contributors and the cost of medical benefits alone is roughly £12.000,000 a year. Sickness, disablement and maternity benefits are also provided from the insurance fund.