B.M.A. IGNORED

Otago Daily Times, Issue 23577, 13 August 1938, Page 9

B.M.A. IGNORED

SCHEME TURNED DOWN NOTABLE BENEFITS SOUGHT THE RICH AND THE POOR The B.M.A. scheme 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 service for the limited section of the population which is unable to provide it for themselves from their own resources. The Government scheme, on the other hand, is to ensure that the richest person shall receive treatment no different from that obtainable by the poorest, but shall pay a great deal more for it. In other words, it plans a partial service for all, irrespective of whether that service can be provided from people's own resources or not. In making the above statement to the press, Dr J. P. S. Jamieson, of Nelson, president of the New- Zealand branch of the British Medical Association, said that, according to Dr McMillan, M.P., the Government scheme was to provide a family doctor for everybody free. This was an easy thing to get, but what the B.M.A. desired to point out was that the Government was not providing these things which were difficult to get, such as specialist services, laboratory services, and radiological services. Endangering Present Efficiency "The 8.M.A.," said Dr Jamieson, "is definitely opposed to the Government's scheme, which provides a 'free' general practitioner service for everybody in the community irrespective of individual wishes or needs." "The association submits that the Government would have been better advised to have adopted the association's scheme, which is limited, and, without upsetting or endangering present efficiency, meets the only need that requires to be met, leaving it for improvements to be made in the future as they are found to be necessary. The association maintains that improvement in the health services of the community should be of an evolutionary character rather than that untried methods of unpredictable effect should be hastily introduced as is being done in the present instance. The Association's Plan "The plan submitted by the association to the Government provided for development along these lines, there being nothing in the health condition of the country to indicate the 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 on a limited scale. 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, though not necessarily free, to the whole community. We have grouped the population into four sections, following the above principle, thus:— SECTION I Old-age pensioners, unemployed and unemployable, part-time and casual workers, others of small earnings or income who are not dependents of other persons, and the dependents of all those where their earnings or total income (in the case of married people their com bined income} does not exceed oldage pension, unemployed or sustenance rates.

For those we suggest that complete 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, though not always on an understood free basis. Not being able to afford domiciliary medical attention, they tend to occupy hospital accommodation friY which hospital treatment is not required. They require more adequate service, especially in the direction of ordinary domiciliary medical and nursing service, the provision of which should give some relief in the matter of hospital accommodation Past experience has shown that (he local effects of oeriods 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 arranged on a more national basis tha at present, and that the State should provide domiciliary medical and nursing care. This, in our opinion, is the only section of the community which requires complete service solely at the expense of the public funds. The rest of the community can and should, either in whole or in part, provide for their own health services. SECTION II "Wage and salary-earners whose total income does not exceed: (a) 60s per week, gross, single: (b) 80s per week, gross, married, without children (combined income), 10s per week higher income for each child under 16 years being allowed to entitle inclusion " These income limits were suggested as a basis of discussion; but insistence by the Government on the "universal" principle has precluded any discussion op these lines "For this section we propose Uial they should be contributors for themselves and their dependents to a scheme whereby they would b«» provided 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 dp fray the cost of general practitioner service, and some of the cost of hospital service; but to furnish complete service, public funds would b» required to bear part of the costs. SECTION 111 "All having income not exceeding £SOO p.a. and not included in Section 11. " The sickness risk which presses on such people is not ordinarily domiciliary and consulting room medical attendance. It is the more serious illness involving hospitalisa-

tion, specialists' service, and costly diagnostic procedures. We suggest, therefore, that this section should make their own arrangements for themselves and their dependents for ordinary medical attendance, but should contribute to an insurance fund for hospital, specialist and consultant services, this fund to provide a cash benefit for those purposes. This should be on a compulsory and self-supporting basis. SECTION IV "Those with income exceeding £ 500 per annum. " This section is capable of providing all services for "themselves. There are opportunities for insurance against sickness risks open to them, if they like to avail themselves of them, and they could be admitted, if they choose, to the scheme suggested for Section 111. " The underlying idea of these suggestions is that the insurance principle should be brought in to assist people to meet 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. Where the circumstances are such that contributions cannot be made, or can bo made to only 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 the second section the individual covers part of his own risk by insurance contributions, the rest being borne by public funds. In the third section 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 is necessary to explain what is understood in that term. The health system as a whole embraces preventive medicine and curative medicine. The former is chiefly a departmental function, and we 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 putting their money on an extensive system of contract practice of curative medicine. "With the family doctor as the pivotal point, the complete service, as recommended by the association under this scheme, provides for (a) Genera] practitioner service; (b) Nursing service (home); (c) Anaesthetics; (d) Pharmaceutical services; (e) Consultant and specialist services; (f) Laboratory and radiology services; (g) Hospital services and ambush)' Maternity services; (i) Physiotherapy and massage services; (j) 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 B.M.A. behind it. It is also very much in line with the recommendations of that other body which has had experience of health servicenamely, the Hospital Boards' Association. Yet it has been rejected by the Government/and the profession is now being asked to carry out proposals which it does not approve of and regards as being dangerously experimental and prejudicial tc the general health and well-being of the people of New Zealand."