MEDICAL BENEFITS

Otago Daily Times, Issue 24697, 28 August 1941, Page 6

MEDICAL BENEFITS

BILL PREPARED FEE FOR SERVICE BASIS COOPERATION; OF DOCTORS SOUGHT (P.A.) WELLINGTON, Aug. 27. The co-operation of the medical profession in ensuring a universal general medical practitioner scheme was sought by the Government when a deputation from the council of the British Medical Association to-dav met the Acting Prime Minister. Mr W. Nash, and the Minister of Health; Mr A. H Nordmeyer, at a meeting held at the Government’s request. The deputation was informed that a Bill providing for a fee for service had been prepared, but that the Government was prepared to consider any proposals so long as the introduction of the universe scheme was not delayed. . ; ' The principle only of the Bill was discussed, and after the conference .he council met to appoint a committee_to discuss the clauses in detail _ with Mr Nordmeyer. who said the Bill would be introduced probably -next Wednesday. Later, a long private conversation took place between' Mr Nordmeyer and the representatives of the counReceiving the deputation. Mr _Nash said that when the Minister of Health discussed with the other members of the Government the Bill in .connection with the medical practitioner proposals he (Mr Nash) thought and hoped that the Government might still have an opportunity of working co-operatively with the doctors. , ... Coercion Repugnant

“We have been trying now for five years to achieve something along the lines we wanted,” Mr Nash said. “ We have the maternity proposals working, and there are a number of doctors, registered under the capitation scheme. I <io not want to refer to it in general, but I feel that the profession or its representatives should know how we see it. I personally hate the idea of coercion, even if it is. practicable.” The Bill prepared by Mr Nordmeyei provided for a fee for service, Mr Nash continued.. He did not. want to go into the details of the Bill, but the provisions could be discussed with the. profession privately. The Government wanted to find a way. if practicable, of bringing into being a general practitioner scheme available to everyone. The Government had gone a long wa> to see if some agreement could be reached. Because of the profession s justifiable argument that some of its members were overseas, the Government had immediately undertaken to protect every man overseas, and it would continue to protect them. No Change of Principle “It is no use considering delaying action.” Mr Nash said. “The proposal is to introduce the Bill. We cussed it and worked- it out for a long time. We would sooner have an agreement than anvthing else. We will still refer it to the Health Committee and. if you still desire to do so at that point. you can give evidence on the provisions of the Bill.” •*, - Mr Nash added that the Government had, not changed on the principle, although it had changed many things along the road. The whole Dominion was clamouring against the' defiance shown. He candidly felt that results could be obtained only by co-operation, between the profession and the Government; •' , , . ■ . “If we introduce the fee-for : service orocedure and you work inside the law then what we want will be done”, he said. "Inside of giving away oil the fundamental principle of the Government’s bolicy. we will pretty well agree to anything to achieve co-opera-tion. We have worked on it, for years now to see if we >ould get co-operative work, and I think that if the profession decided that it was going to cooperate with the Government we would have a totally different feeling in a verv short time and a healthy com-; munity within that time.” ■ ' Doctors Overseas Sir Donald McGavin said, the deputation was not entirely in agreement with what Mr Nash had said, . The profession’s view was that the change, if it had to be made, should be left until after the war. Two hundred doctors were overseas and others were engaged on military work. It was not fair to make arrangements on which tbe doctors overseas could not be consulted. - ■ “ We, have assisted the Government in everything,” Sir Donald said. “We are as anxious as the Government to come to some mutually satisfactory arrangement. Although harassed by legislation and upset by a feeling of frustration at not knowing what is, going to happen to them, the medical profession has done more in the war than any other section of the community. and it has felt that the suggestion of coercion is not very appropriate to a profession working something like an 80-hour week, hours which will become worse.” If the war was used as an argument, then the Government’s measure should only be temporary, Sir Donald added. Replying to a question by Dr J P. S. Jamieson, chairman of the National Health Insurance Committee, Mr Nash said that the Government was unanimous in adopting the capitation scheme already offered to the profession, but it would discuss the fee-fbr-service proposal and was working. out a salary system under which the service could be given and which would embrace the doctors overseas as .they returned to the Dominion. He wanted some agreement on the universal scheme and then the details of the Bill could be discussed. They would decide on one of three formulae; Capitation, fee-for-ser-vice, or salary freedom. From the professional viewpoint the doctors would be safeguarded. Adherence to Universal Basis Answering a further question by Dr Jamieson Mr Nash said that by the fundamental principle, he meant universal attention, because everyone needed it irrespective of the money in their pockets. It meant that the profession’s organisation would -be responsible for the maintenance of the community’s health and curing of its ills. It was imperative that the people should have attention without financial worries as in the pi'e-war period, but he agreed that in the question of how the service should be made available the profession should have a large say. Mr Nordmeyer said that in, spite of the Government’s stated preference for the capitation scheme, there was no objection to an alternative scheme acceptable to the profession as a whole or any group within the profession. He thought it fair to say that it was impossible to get a real consensus of. opinion so far as the profession was concerned, and the Government would have no objection to the medical men in any area agreeing among themselves to work such a scheme as was acceptable to them. He understood from the records that at one meeting of the council of the B.M.A. the majority favoured consideration of the fee-for-ser-vice proposal and its recommendation to the Government. Those present in the deputation would know that that offer had not been made. Whatever decision was arrived at, it had not been communicated to the Government, which had been prepared to consider any alternative proposals put forward. 1 Appointment of Committee “Further, if you can suggest that some things about the capitation scheme, are not acceptable and can be remedied while giving the service we want to give, I shall be happy to consider the profession’s suggestions,” Mr Nordmeyer said. He then suggested the appointment of a committee to discuss the details of the Bill with himself and the Director-general of Health. Dr M. H. Watt. Answering Sir Donald McGavin, Mr Nash said the Government would discuss with the doctors proposals for

a definite fee for definite service, irrespective of the quantum of ■ the ’ pool. The Government was anxious to achieve that agreement, which he believed was imperative. Sir Donald McGavin; That is a new ' view which the profession did not know the Government entertained. Dr P. P. Lynch said that one new point was that the Government we*, prepared to consider some scheme for a salaried medical service. i Dr L. J. Drury asked if the Govern- - ment planned an extension of the scheme to include specialists. i . Mr Nash replied that his dreamjva* that medical attention of the best, type should be available to everyone. ~ . "A Bunch of Carrots’' The deputation agreed to the appointment of a committee as stated. “ I can assure you, Mr Nash,” remarked Dr Jamieson, “that ybtt cannot get an ounce more work, out " of the medical profession either with. a stock whip or a bunch of carrots.” ,