COMMUNITY HOSPITALS.

Otago Daily Times, Issue 19497, 4 June 1925, Page 3

COMMUNITY HOSPITALS.

WHAT THE SYSTEM INVOLVES. INTERVIEW WITH DR D. S. WYLIE. The conduct and control of our public hospitals is a matter in which considerable public interest is being taken at the present time, and a good deal is being said about the community hospital system which is practically universal in Canada and the United States. Those who speak of community hospitals are not always aware of the nature of these institutions, and an Otago Daily Times reporter took advantage of the' presence in Dunedin of Dr D. S. Wylie, C.M.G., F.R.C.S., to obtain from him an explanatory statement on the subject. Dr - Wylie lias been visiting Dunedin as one of the external examiners of tlie Otago Medical School. He is now in private practice in Palmerston North, but for two years and a-half ho was director of the division of hospitals for the Health Department, and he is in close touch with hospital problems and practice in North America. “A community hospital,” said Dr Wylie when approached on the subject, “is a term coined iby our Noth American cousins to designate a hospital which attends to the medical and surgical requirements of the whole community, the members of which on entering the hospital are required to pay for the services rendered to them in proportion to their means !ind according to the accommodation which they elect to occupy. The financial circumstances of the people entering these hospitals are scrutinised exceedingly carefully by a trained business staff, who have as their entire job the business running of the hospital, subject, of course, to the direction of a board of trustees. The term ‘community hospital,’ so far as I can gather, was used and has been used in order to arouse the interest of many sections of the community in the running of the hospitals by making it clear to them that the carrying on of an efficient hospital in their district is to the manifest advantage of that district, and by trying to make the community see that the administration of the hospital is a matter which should interest all sections of the community, who should work co-operatively together for efficiency. There is no doubt that within the last ten years the standard of hospital management and efficiency has tremendously improved in North America, owing very largely to the policy which has been pursued by the American College of Surgeons with reference to the inspection of hospitals and their proper standardisation. Ten years ago this was a step very necessary owing to the large number of comparatively inefficient hospitals which existed. These inefficient hospitals have, as the result of the work carried out by the American College of Surgeons, largely ceased to exist, owing to the fact that if a hospital remains inefficient its name does not get on the list of approved hospitals which is issued by the college. The absence of the name of any hospital from this list means that its existence is of short duration. “Community hospitals are universal throughout the States. Hospitals as they exist in Now ZealancJ, financed largely by the ratepayer and the taxpayer, do not exist in North America, with the exception, of course, of mental hospitals, and of a certain number of municipal hospitals which are run for the treatment of infectious disease mainly. The community hospital means concentration of effort. It means housing tlm hospital activities of a district under one. roof instead of having them diffused as they arc at the present time. In any hospital district in New Zealand you have a so-called ‘public’ hospital. and side by side a number of private hospitals of varying degrees of efficiency, the efficiency of these private hospitals being largely dependent upon the medical men who use them. If you had a properly developed community hospital system the private hospitals would, no doubt, in course of time disappear, with the possible exception of the large private hospitals now maintained in this country by religious bodies.” . Are these community hospitals self-sup-porting? Dr Wylie was asked. “In many instances they are self-support-ing. In many others they are not, the deficiency having to be made up by appeals to the public and by the enrolment of annual subscribers to the hospital who have the right of election from their number of representatives on the Board of Trustees. In many districts in Canada the community hospital so-called receives in respect of each occupied bed a daily grant, in some cases from the municipal authorities, in others from the State authorities, and in certain States from both. This daily grant does not merely cover the cost of maintenance, and is, I behove* made only to apply to those beds which are occupied by patients who either pay nothing towards their hospital maintenance or pay only a portion of Does the need for inquiry into the financial circumstances of patients cause any serious difficulty? ~ “No system works absolutely smoothly, Dr Wylie admitted. “I made particular inquiries on this point, however, in certain districts, and I was informed that the system worked pretty smoothly. Hie authorities and the community at largo are firmly imbued with the idea that the hospital services rendered to an individual should be paid for by that inividual according to his ability to do so. _ One aspect of the hospital position in New Zealand does not seem to be clearly enough realised by many people who talk on hospital matters, and that is that the maintenance rate charged by Hospital Boards—which nowadays, I suppose, averages 9s a day or three guineas a week —does not nearly cover the cost t f the bed occupied. In the majority of instances it costs Hospital Boards at present between £5 and £6 per week to maintain the lied for which the individual patient is asked to pay three guineas. It therefore follows that. every individual occupying a bed in the public hospital, even although he pays full rates for the services rendered to him, is receiving partly from the taxpayer and partly from the ratepayer financial assistance to the extent of at least £2 a week; and it is for the community to determine whether this form of financial relief to people able tc. afford full rates -of hospital maintenance should be allowed to continue. The rate charged is simply a maintenance rate and does not make any allowance for the payment of interest on capital moneys invested in buildings or in ground. , _ “The community hospital, so-called, is seen working very well at the Toronto General Hospital. The activities of the so-called ‘private’ wards which exist in a Jargo wing of the hospital result each year in a financial profit which is devoted to the maintenance of the remaining sections of the hospital.” . _ In reply to a further question Dr Wylie stated that the hospital policy of the British Medical Association favours the development, of hospital activities in Now Zealand upon the lines of the “community’' hospital, and this could bo perfectly well done by the establishment at each public hospital of wards or a wing wherein the principles of the system could be given full effect. Dr M'Eachern, one of the principal inspecting officers of the American College of Surgeons, is to visit Australia and New Zealand towards the end of this year. The visit will involve the inspection of the principal hospitals of New Zealand, and no doubt valuable expressions of opinion will be obtainable from Dr M‘Eachorn with reference to the relative advantages ami disadvantages of our system in New Zealand compared with the system now obtaining in North America. He will no doubt also be able to say how far in his opinion our hospitals are capable of being transformed into so-called “community” hospitals.