AMERICAN HOSPITALS

Southland Times, Issue 19102, 21 November 1923, Page 7

AMERICAN HOSPITALS

THEIR SYSTEM OF CONTROL.

DR. D. McD. WILSON’S REPORT.

Dr. D. MacDonald Wilson (formerly superintendent of Invercargill Hospital), who recently visited America in order to inquire into the hospital systems there on behalf of the Wellington Hospital Board, furnished that body with a lengthy and valuable report in which the following interesting information relative to American administration and control is cont ained: THE CONTROL. I may here state that throughout North America, the government or local authority has not taken upon itself the whole responsibility of providing bed accommodation for the sick. There is no “State Control” of hospitals similar to New Zealand. In the U.S.A, although the local authorities (i.e., municipal or county) provide for charity cases, yet if private organisations did not also provide accommodation to almost the same extent, the bed accommodation would not meet the demand. In the U.S.A, there are extremes of wealth, and fortunately many of the wealthy have provided money for hospitals, and thus relieved the local community from heavier taxation. Each State, like our own provinces, is divided into counties. In the large centres I visited the county usually consisted of the city with a certain suburban area. The county, or to use our own term “local authority,” is responsible for providing accommodation for the sick. These hospitals are called county hospitals, and cater for charity cases only. The controlling body, or commissioners, may be elected by popular vote, as our own Hospital Boards. When a municipality is governed by a Mayor and one or two supervisors they may control the hospital as one of the municipal undertakings, just as they control the lighting department, tramways, markets, or other □ranches of civic enterprise. These hospitals are supported by taxation or rates, but there is no definite “hospital rate.” Those in charge of the municipal finances apportion «o much to “health” work. Out of this appropriation the hospital is maintained and also all public health activities of the city or county area. This controls the cost of hospital maintenance, but only too often the hospital is stinted in funds as money is wanted for other departments. Hence as a rule I found that these county hospitals were not so well equipped as other types of hospitals described below. The “county” hospitals are intended for “charity” cases only, and great care is taken that only such cases are admitted. A “charity case” is not necessarily a person absolutely poverty-stricken, but includes a member of a working man’s family who cannot afford treatment elsewhere. There is another type of hospital similar to the county hospitals regarding control and maintenance, only the local authority not only provides beds for free patients, but also “semi-private” and “private” wards. Thus all classes of the community are catered for by the local authority. From my observations I would consider that some of the best institutions in the country are those which cater for all classes of the community. NOT FOR PROFIT. Hospitals are also founded or incorporated “Not for Profit.*’—Probably the greater number of hospitals in the U.S.A, are of this type, and are doing most of the hospital work in the States. Such a hospital is built by funds supplied by some generous donor or by people interested in hospitals incorporating themselves into hospital trustees, and so forming an “Incorporated Board of Hospital Trustees.” Similar hospitals are built and maintained by various sectarian bodies—Presbyterian, Catholic, Anglican, Methodist, etc. These hospitals rely for their maintenance in. the main on fees received from patients. The control is usually in the hands of a board, which may be elected annually by subscribers, or, in the case of an incorporated institution, is often self-appointed and self re-elected. Without wealthy philanthropic individuals the present system in the States could hardly exist, and the State would be called upon to meet greater obligations. Again, without a large population able to pay heavy fees and thus cover the cost of free patients, many of these hospitals would be constantly in debt. Already some of them not well endowed have difficulty is meeting expqensee.

COST OF HOSPITAL MAINTENANCE. How does cost of maintenance compare in North America with Wellington Hospital? The per capita maintenance cost per diem varies greatly in hospitals throughout North America. The county or municipal hospitals providing “free” treatment and tax supported are usually maintained at less cost than the other hospitals. There is a wide devergence even amongst these hospitals of similar size. The average cost varies from 3 to 5 dollars or more per diem per capita—that is, the least cost is approximately £250 per annum per patient, compared with £lBO in Wellington. Most of the hospitals are more than this. Those hospitals having “private” and “semiprivate” wards cost more per diem, but private rooms and a more elaborate diet may be served. These hospitals may cost 6 to 8 dollars or more per diem. SCALE OF FEES. In the county “free” hospitals, once a patient has been admitted after examination of his finance he* may not be asked for any payment. Certain institutions, however, may fix a maintenance charge of 14 to 3 dollars, and collect whatever percentage is possible, just as we have a maintenance charge of 9s and collect only a small percentage. This fee would cover all board and treatment. As elsewhere stated, most hospitals rely on paying expenses by collecting fees from “private” and “serai-private” patients. The charges for the latter vary from 3 to 6 dollars per diem, and for the former 5 to 20 dollars. These fees, however, only cover cost of bed and ordinary nursing. The hospital collects extra fees for all special examinations, articles of diet if ordered by patient, special nurses, charges for use of operation theatre and anaesthetics. As these patients are private patients, the fees charged for actual operation is a matter of arrangement between patient and doctor. Thus it is apparent that these hospitals rely for their maintenance on a comparatively wealthy community able to pay charges which would be considered in New Zealand exceedingly heavy. But the paying patients help to support the “non-paying” patients, and.it must be remembered these hospitals are not maintained for profit.

Each State as a whole is not responsible for the care of the general sick and injured, but like our own Mentarl Hospitals Department, for the insane only. COLLECTION FROM PATIENTS. ' The whole method of fee collection in North America is the very reverse of the system obtaining in New Zealand. In New Zealand the general principle is to admit any patient who presents a recommendation from a local practitioner without any inquiry into his finances. No inquiry is made into his ability to pay until discharged, no matter how long he may be in hospital. The American method is on a more “businesslike” footing. Those hospitals maintained by taxation are for the indigent only, and unless an urgent case, a patient before admission is put through a searching inquiry to determine if he is a case entitled to free treatment. Those other hospitals relying on collection of fees for meeting expenses are anxious to avoid all bad debts. Hence, before admission to a “private” or “semiprivate” ward the patient must give evidence of ability to pay, and even pay one or two weeks in advance. If a patient does not keep up with his payments and can give no further guarantee, he may be transferred to the “free” wards or even to the county “charity” hospital. Needless to say those in authority are guided by humanitarian principles.