HOSPITAL EXPENDITURE

Otago Witness, Issue 3882, 7 August 1928, Page 16

HOSPITAL EXPENDITURE

EXPLANATION OF INCREASE.

GROWING NUMBER OF PATIENTS,

r WELLINGTON, August 3. Hie Executive Committee of the Hos-. pitar Boards’ Association concluded its mectiug to-day. Mr William Wallace (Auckland) presided.

An intimation was received from the Minister of Health (Mr J. A. Young) stating that an endeavour would be made c^ow . n this session an amendment of the Hospitals and Charitable Institutrtms Act embodying most of the proposals put forward by the association, including provision to assume a minimum subsidy of 14s per £ of levies, power to dispose of unclaimed property, and provision that time spent in semi-public charitable institutions shall not count in establishing residence in the hospital district under section 92. A proposal that contributions through medical and nursing associations should carry a subsidy, even though the contributors received concessions in charges for treatment could not be agreed to. It was resolved to make immediate res presenattions combating the proposals made by certain local bodies that members of hospital boards should be appointed by the contributing local authorities in lieu of the present system by which the electors of local authorities also elect repres sentatives of the district on the hospital board.

It was resolved to draw attention tq the increasing number of vehicular accL dent cases treated in hospital, and to urge that provision should be made for payment of public hospital expenses in connection with the proposed compulsory third part, insurance cover. Renewed repre sentations are also to be made with a view to ensuring that c.mpensation in respect of hospital expenses in industrial accident cases should be paid over to the hospital authorities.

A series of recommendations was sub-: mitted by the Council of 2Jatrons. Ono dealing with the introduction of central linen stocks, and one relating to nursing staff hours of duty, were endorsed. A proposal that a fourth year course of training be made compulsory, another that pupil nurses in small training schools should have sixe months in a grade I or II hospital, and one that provision be made, if possible, for trainees to take a short period at district nursing were re» ferred to the forthcoming conference. A similar course was adopted in respect to the suggestions that nurses in private hospitals should be given an opportunity of obtaining refresher courses.

It was decided to recommenu to the next general conference that hospital boards should adopt a uniform charge for ordinary maintenance and treatment iu general hospitals of 12s per diem for adults and 6s per diem for children. The executive determined upon March 12, 1929, for the next general conference, which is to be held at Palmerston North, remits being asked for by December 10. Mr Wallace gave reasons for the increases in hospital expenditure. The immediate explanation of the largelyincreased burden of expenditure, he said, lies in the growing number of patients obtaining treatment. In 1921-22 the daily charge for treatment in general hospitals was in very few instances more than 7s 6d per diem for adults, and in the majority of instances it was 6s per diem. During the following year the majority of the boards adopted the charge c. 9s per diem. A few more came into line in 1923-24, and in 1924-25 there were only nine general hospitals charging less than 9s per diem. The cost per occupied bed per annum was £190.5 in 1921-22, and £199.8 in 1926-27—an increase per cent, of 4.9. The fees receivable per occupied bed increased from £121.1 in 1921-22 to £167.7 in 1926-27, or by 38.5 per cent., whilst the fees received per occupied bed have also risen steadilv from £46.7 in 1921-22 to £63.5 in 1926-27, the increase per cent, being 36.0. It should be pointed out that both the amount of fees receivable and of fees received include out-patients’ fees, and are therefore not properly expressed in relation to occupied beds. Making due allowance for this, it is still clear that both the fees charged and the fees collected have distinctly advanced out of proportion to the increase in the cost per bed. A further speeding-up in this direction appears, nevertheless, desirable. In considering the scale of charges which should be adopted by public hospitals, it is necessary to bear in mind that as regards the daily fee for ordinary maintenance and treatment the aim is to fix a uniform charge for each of the respective classes of hospitals, e.g., general hospitals, maternity hospitals, etc. It is, in fact, neither desirable nor practicable to differentiate charges in the various general hospitals according to respective costs. A difficulty arises as soon as an endeavour is made to fix fees which, on the average approximate the cost, in that it is eeessary in the case of some hospitals to charge less and in others to charge more than the actual cost. Herein lies the chief obstacle to the adoption of a scale of fees and charges, which, if all were paid, would return an amount approximating the cost of the public hospital services. Nevertheless, there is room for an all-round increase in the fees without hospital boards being placed in the position of making a profit out of the sick.