HEALTH SCHEME

New Zealand Herald, Volume 78, Issue 24085, 2 October 1941, Page 12

HEALTH SCHEME

DOCTOBS AND STATE PROLONGED NEGOTIATIONS PROPOSALS BY PROFESSION Controversy regarding the provision of medical benefits in New Zealand did not begin with the proposals for a free general practitioner service, now before Parliament, nor did it date exclusively from tbe present Government's efforts to introduce a comprehensive scheme of social security. The whole matter of bealtli services has been under review at intervals for at least 14 years. Interest in the development of national health services beyond the high stage to which they had previously progressed first became really apparent in 1927 when the representative of New Zealand at the League of Nations signed ;i draft convention pledging the Dominion to introduce legislative discussion of a national health insurance scheme. Two years later the New Zealand Hospital Boards' Association began an investigation into the question and its draft scheme, after some discussion with the New Zealand branch of the British Medical Association, was tentatively issued in 1934. In 1935, a departmental committee tabled a report on health insurance in Parliament. Investigation by Doctors Up to that time, the medical profession in New Zealand had been chiefly interested in effecting improvements in the hospital svstem, but in February, 1935, the "New Zealand branch of the British Medical Association, at its annual conference, set up a committee to investigate the _ whole question of health insurance. This committee studied in detail the various systems in operation in other parts of the world and was at pains to consult personally with acknowledged authorities from Great Britain and elsewhere. The general conclusion reached by tbe committee at an early stage in its investigations was that conditions in New Zealand demanded the introduction of a special type of scheme. Before details could he fashioned, however, the 1935 general election was held. The three contending political parties on that occasion all advocated some form jof national health insurance and, although the Labour Party was successful, the medical profession continued to regard the matter of national health services from an entirely nonparty attitude. Its representatives waited on the Minister of Health in the new Government (the present Prime Minister. Mr. Fraser). a.s early as February, 193 ft, and offered him full co-operation in the shaping of a now national system. A Government Committee The next step was the appointment by the Government of an investigation committee, consisting exclusively of members of the Government party and headed by Dr. D. G. McMillan, M.P. Over a period of several months, this committee called evidence from interested parties and accepted representations. The medical profession put forward its own views to the committee, advocating greater attention to preventive medicine and research, better co-ordination of the hospital system, a complete service for those unable to obtain medical attention for themselves, and a contributory system of health insurance for all others. The Government's committee expressed itself as being disappointed with the doctors' plan and in March, 1937, the profession became convinced that the committee was working toward the recommendation of a universal and free medical service. Even at that stage it was admitted from the Government's side that the cost of medical service to the community, in the aggregate, was not too high. Medical Profession's Scheme Meanwhile, .the medical profession had been proceeding with the draft of its own detailed proposals. While this was under review, a visit was paid to the Dominion, at the invitation of the local branch of the British Medical Association, by a leading British authoritv on health insurance. Sir Henry "Brackenbury. The association was advised by Sir Henry on numerous points, and finally, in July, 1937. presented to the Government a scheme which had been endorsed by all the district divisions. In the main the scheme provided for a full and complete service, far more extensive than a general practitioner service, for all persons on the lower income levels; a full service, in return for low individual contributions, to all wage and salary earners, with their dependants, roughly on the basis of a family income of £5 a week for a man, his wife and two children; insurance for hospital, specialist and consultant services in respect of persons with higher incomes, up to £SOO a year; and individual payment for services by those with incomes over £SOO a year. . Endorsed by Expert It has been stated that Sir Henry Brackenburv prepared for the Government a memorandum which differed from the plan previously submitted by the medical profession in not a single point, "excepting phraseology and literary qhality." Frequent interviews were subsequently held between representatives of the profession and members of the j Government, and evidence was given by the profession before the Parliamentary Select Committee set up in April, 1938, to make preparations for the Government's social security legislation. This committee completed its deliberations, and two evenings before the original bill was introduced in Parliament representatives of the profession, summoned to discuss the position with the Minister of Finance, Mr. Nash, were informed that the Government was adopting the profession's system of administration, but applying it to universal scheme. The doctors then took their stand on,the questions of professional liberty and the standard of health services, which, under a universal scheme, they held, was bound to suffer. * Negotiations Resumed After the general election in 1938 the profession was requested by the Government to resume negotiations. No basis of agreement could be found, and the result was that, although mental hospital, maternity and hospital benefits were gradually brought into operation under the Social Security Act, the general practitioner service was lacking. The whole position, in the view of the medical profession, was complicated by the outbreak of war, as a result, of which many doctors left private practice for service with tbe armed forces. The Government, however, endeavoured to proceed with the scheme, and announced a capitation system under which the general public was invited to bring pressure to bear on the doctors to force them to provide general practitioner service for a payment of so much from the Social Security Fund in respect of each patient. The response, both by doctors and by the public, was negligible, and the present amending bill, providing for a compulsory service, is the result.