THE OTAGO DAILY TIMES TUESDAY, FEBRUARY 4, 1930. THE HOSPITAL SYSTEM.

Otago Daily Times, Issue 20942, 4 February 1930, Page 8

THE OTAGO DAILY TIMES TUESDAY, FEBRUARY 4, 1930. THE HOSPITAL SYSTEM.

It has been decided by the Council of le New Zealand Branch of the British Medical Association that, at the annual conference which is to be held in Christchurch this month, the discussion on hospital policy should be reopened de novo. For some years the Branch has been committed 'to the policy of the adoption by our State hospitals of what is known as the community hospital system.- In the circumstances it has been natural to draw the conclusion that the medical profession in the Dominion is generally in favour of this proposal. A circular recently addressed to the profession by the Nelson Division of the B.M.A. makes it apparent, however, that among medical practitioners themselves a diversity of opinion exists on the subject, for the Nelson Division is strongly opposed to the view that the community hospital system could be advantageously introduced in New Zealand. The members of this division hold that the community hospital system cannot, for a number of reasons, be grafted on to the existing system under State control. In the first place, it is contended that public opinion is emphatically against the community hospital system. It may certainly be agreed that there has been no public demand for • the introduction of the system. Probafily the most serious objection to it from tlie' point of view of the tax payer is that the adoption of it would entail a heavy .expenditure in the erection of additional hospital wards. The objection has also raised that the effect of the system would be to create class distinctions. This is, no doubt, an argument that weighs with the man in the street, who seems to overlook the fact that class distinctions exist under the present hospital system, and the circumstance ‘ that it is only because a large proportion of the sick do not demand admission to' the public hospitals that huge expense in the extension of public hospital accommodation is avoided. The view is expressed by the Nelson Division of the B.M.A. that in regard to hospitals the duly of the State does not extend beyond-the necessary provision for infectious diseases and the indigent sick.. But it is not upon that basis that the hospital system as it exists in New Zealand has been developed, and it is a reactionary suggestion that its usefulness should thus be limited. Except in respect of the treatment of infectious diseases such a restriction would place the public hospitals on the footing of charitable institutions, with the result that a certain stigma might conceivably attach to persons who were admitted to them. In theory, at all events, the hospital policy of the country has been that the public hospitals should be available to all sufferers, irrespective of their worldly circumstances, who choose to take advantage of them, those who are indigent receiving accommodation and attention free, and others who are able to pay part or all of the maintenance charges doing so according to their means. In practice, however, the public hospitals provide accommodation only for patients who cannot be suitably attended to in their homes or who cannot —as a rule a,fford to become inmates of private hospitals. It is undoubtedly the case that on persons possessed of only moderate incomes the private hospital charges fall somewhat heavily, and if there were pay-wards in the public hospitals at which medical and surgical treatment could be assured at moderate charges patients of this description would be grateful for the opportunity of using them; It is an argument in favour of the community hospital that it would enable this class of patient to enjoy the advantages in the way of the elaborate equipment with which the public institutions are furnished The attitude of the Health Department towards the idea of the adoption of the community hospital system in New Zealand has been cautious, but the trend of its opinion, so far as it has been expressed, has been in favour of a change in the existing system in a direction that would cater for patients who would be prepared to pay for treatment in special wards. The Department has apparently taken the view, also, that the fees would have to be based on a scale that would prevent any of the cost, either capital or maintenance, from falling on the public funds. That savours, perhaps of a counsel of perfection. In such circumstances the popularity and success of the pay-ward system might bo distinctly doubtful.