PATIENTS' FEES

Poverty Bay Herald, Volume LXIV, Issue 19378, 16 July 1937, Page 4

PATIENTS' FEES

NEW SCALE ADOPTED

ONE-THIRD INCREASE

TO MEET HIGHER COSTS

HOSPITAL BOARD DEBATE

By seven votes to four, the members of the Cook Hospital Board yesterday afternoon decided to increase the rates for adult patients' treatment in the hospital from 9s to 12s per day, the increase being urged as necessary io absorb part of the additional costs faced by tne board, and to relieve the ratepayers of town and country by collecting more from those able .to afford over 9s per day for treatment, m the course of a lengthy discussion, it was pointed out that the change would not afTed the indigent sick, for whom treatment would be on the .same basis as formerly.

Opening the discussion, Mr. S. T. Gray, in accordance with notice given, moved that the scale of in-patients' fees as laid down in by-law No. 430 be amended to 12s per day for adults, and tis per day for children under 14 years, tne change to be effective as I'vom August 1, 1937. "Duty to Patients and Ratepayers"

The board, said Mr. Gray, had a duty to the patients, and also a duty „o ' the ratepayers. That to the patients was being well discharged, ior they were well looked after in the institution, and those not able to pay tor treatment were not obliged to pay. ff the board raised the fees, tney would not be affected, their position oeing still the same.

The ratepayers, on the other hand, had no say in the matter of hospital costs except through their representatives on tne board, and he felt that ii the board raised the scale of fees for chose who could afford to pay, it »vould collect more money ana relieve the ratepayers in some measure.

Mr. Gray added that the course he proposed had been recommended to the board on an earlier occasion by die Director-General of Health. Most of the ratepayers were not wealthy men, and they were being asked now uO meet the additional costs of running the institution, and also the cost >l new buildings while still paying oil Che original hospital loans. Increasing Costs Per Day

The chairman, Mr. M. T. TrafTord, announced that he had changed his opinion on the matter of increasing the scale of fees since it was last debated. He had been through the board's accounts recently, and had found that the cost per day in 1935 was £l7O, whereas in 193 b it had risen to £lB4 per day, and in 1936-37 to £213 per day; and for-the joining year it probably would be from £225 to £230 per day, or he would be very much surprised. Costs had gone up in all directions, and in view of the additional charges .vhich the board had to meet, he saw no alternative to raising the scale o! fees.

Dr. J. C. Collins strongly opposed the motion, stating that the board must examine its operating costs and do its utmost to reduce costs before laying a further burden on the unfortunate sick of the district. Only a short time ago, the board had discussed a similar motion, and had turned it down.

He held that the contributing bodies had no cause for complaint, except insofar as they might criticise the board for not making a greater effort to economise.

The Board's Responsibility

Dr. Collins quoted at length from figures prepared by the managingsecretary, in support of his argument that the increase in the levies was not out or order, and that the contributory bodies could not reasonably criticise conditions over which the board had no control.

The board's responsibility, he claimed, was to show the public thai the increase in costs was reasonable, and if it could not show that, the blame would lie on members of the board, including himself.

Proportionate collections of fees charged in different departments of the hospital were also discussed by the speaker, who claimed that over £IOOO could have been saved by the board under careful supervision. He asked the contributing bodies to remember that the board was a charitable institution ,;md not expected to demand payment where payment was impossible. At the same time, it could not let costs run riot just because it had the contributing bodies to aid it.

The figures relating to the maintenance of the hospital, reduced to a basis of per bed, were amazing to him, he confessed; but he felt that it woulo be an unprogressive move to increase the patients' fees before overhauling the accounts, and he moved that a committee be set up for that purpose.

Mr. Gray commented that Dr. Collins seemed to infer that he had brought the matter up under instructions from the Cook County Council, which he assured the board was not the case.

Accepting the explanation, Dr. Collins expressed surprise that this proposal had been brought up in the middle of the financial year. The sick were the last who should be

asked to increase their contributions, he held. Ci: .). Tombleson considered that Ihe board, by raising the fees as suggested, would only be fairly dividing the increased costs between the patients who could afford to pay and the contributing bodies. Further Opposition To Motion

Speaking in opposition to the motion, Mr. D. W. Coleman, M.P., stated that it was estimated that the increase in fees might yield an extra £IOOO a year. Spread over ihc whole ol' the district, that relief would not be felt by the ratepayers. He felt with Dr. Collins that, this was not the right time to bring the matter up, as the board had arranged its finances for the year/ providing through levies for the additional costs to be laced.

No squealing was heard from the ratepayers, he maintained, and no candidate for a seat on the board had been returned at last election with an increase of lees figuring in his platform: whereas he, against whom a dead set had been made at the election, had strongly opposed an increase of fees in his platform addresses.

Nevertheless, he said, members of the board now came forward with a motion to penalise the sick. He felt that Dr. R. J. B. Hall would bear him out in the statement that an impending hospital bill was one influence which often retarded a patient's recovery. If the motion was carried, he felt it would be due mainly to the chairman's change of position. Mr. Trafford: I have only one vote. Mr. Coleman: Yes, but unfortunately it. was that vote which saved us from an increase before. I would also point out that Mr. 11. Ker.way, who was with us before, is absent to-day.

Appeal to Delay Decision "I earnestly appeal to members to wait until we see what trie Government proposes to do in its national health insurance scheme," added Mr. Coleman. Dr. Collins staled that if Mr. Coleman would move in that direction, he would withdraw his motion. Mr. Coleman appealed further to the board to await the Government's announcement, and at least, if a vote must be taken, to eliminate that part referring to charges upon children. Parents should be encouraged to bring their children to the hospital for early treatment, but if the charges were raised, it would be more difficult than ever to induce them to do so, where their means were slender. He moved that the board defer its decision until the Government's scheme was propounded. Mr. C. G. Bayliss seconded the amendment, which also received strong support from Mrs. Ada E. Beer, who held that the board's care was the sick of the district, and not primarily the pockets of the ratepayers. Relieving the Ratepayers "I do not. feel, that I am particularly hard-hearted in supporting Mr. Gray's motion," said Dr. H. Colliding Rice, who pointed out that the hospital catered not only for the poor of the district, but also for many who could well afford to pay a higher scale of fees. Expenses had gone up. and there was no reason why those who could afford it should not bear a part of the extra cost. The board would not collect any more from those whose means did not permit of payment, he added. The issue was being clouded by opponents of the motion.

Mr. 11. J. F. Tombleson agreed that it was fair to relieve the ratepayers as far as possible by collecting more from those* who could afford to pay. He cited his own experience in paying £3l for an operation in a private hospital, and £0 9s for the same operation at the Cook Hospital. If the operation was worth £3l in the private institution—and he believed it was—it should not be too much to ask, say, £8 for it in the public hospital. The comparison between the cost of levies to townspeople and country ratepayers was out of proportion, he held, and more should be collected from those patients who had the means. '•Hospital Too Attractive" Mr. 11. Adair also supported the motion, stating that complaints regard ins the hospital levies were widespread. Mr. Coleman drew attention to Mr. Adair's statement at the last meeting that "no one was squealing." That remark referred to the local bodies, explained Mr. Adair, and not to the ratepayers, who objected strongly enough at public meetings. If he thought it would mean additional cost to the poor he would not support the motion, but he was sure it would not. He agreed with Mr. Coleman, however, that children should not be charged for at an increased scale. The trouble seemed to be that the board had made the hospital too attractive, for people were [locking there to get the best of attention when they could afford to have treatment outside the institution. The chairman assured Mr. Coleman that he had not changed his mind without reason. The policy of the board would remain unchanged so far as he was concerned, and admission would be accorded to every sick person for whom a bed was available. However, a number of patients could afford to pay a higher scale, and the board would continue to write off.the accounts of those who showed their inability to meet the charges. The finance committee dissected each case thoroughly, he maintained.

How the Voting Went Mr. Coleman's amendment, put to the vole, was supported by Mrs. Beer and Dr. Collins, in addition to the mover and seconder, and was lost by seven votes to four. He then moved a further amendment, to delete from Mr. Gray's motion to increase in the children's scale, this amendment being supported by Mrs. Boer and Messrs. Bayliss, Adair, and Drs. Collins and Rice, and carried. Mr. Gray's motion, as amended, was then put to the meeting, those voting for it being the chairman and Messrs. 11. Adair, J, Tombleson, F. C. A. Leggelt, 11. J. F. Tombleson and S. T. Gray, and Dr. Rice; Mrs. Beer and Messrs. Coleman and Bayliss and Dr. Collins asking that their adverse votes be recorded.