The Daily News WEDNESDAY, APRIL 30, 1929. NATIONAL MEDICINE.

Taranaki Daily News, 30 April 1930, Page 8

The Daily News WEDNESDAY, APRIL 30, 1929. NATIONAL MEDICINE.

The scheme put forward in the Old Country by the Council of the British Medical Association is likely to attract attention throughout the Empire. In New Zealand the controversy on the subject of special wards in hospitals, where people of ample means could be treated in return for special fees charged, is of too recent a date to need recapitulation, but none the Jess will interest be taken in the latest’ Home proposals. Although the hospitals in the Motherland are supported by voluntary subscriptions and donations, while those in the Dominion are erected and maintained by tjje taxpayers, there ..are certain fundamentals common to both systems. One is that, apart from all considerations of colour, race, or creed, these humanitarian institutions are for the treatment of all classes in the State, the one great need being relief from physical suffering. From an ethical point of view there is very little difference between the scheme to provide for medical- service by means of a national contributory insurance scheme, including a compulsory basis, as suggested by the British Medical Association, and that adopted in the Dominion ■ —compulsory contributions ■ to hospital and charitable aid boards by means of direct taxation. At the same time great differences exist between the two systems. Tn the Old Country there- is no connection between hospital treatment and .charitable relief, except that the poor are admitted to the voluntary general, hospitals . and to most of the special hospitals either as a matter of course or on the recommendation of one of the large donors to such institutions, all of which are managed by boards of governors. The relief of the unemployed and thh mass of destitute people is a State responsibility, formerly delegated to the Poor Law Board, now administered by local authorities, the funds being derived from the taxpayers. The muin point in the association’s scheme appears to be the complete separation of the duties attendant on provision for the needy and the treatment of the sick and suffering. ' For the latter it is suggested there should be instituted a comprehensive system of national contributory insurance, which would include not only all insured persons as at present defined but also all dependents of such persons, all voluntary insured persons and their dependents, and other persons of small means at present outside the insured system, as well .as patients formerly treated under the poor law—probably embracing those cases remitted to -mental hospitals and’ other special institutions. It is, however, particularly provided that hospital service shall not be included in the compulsory insurance scheme, the necessary funds for that service still being derived from voluntary subscriptions. From the association’s point of view that method is . doubtless preferable to all others, as it frees hospital administration from both State and locally elected control. It is necessary to note that, in accordance with the association’s declared policy, payment of all visiting staffs of hospitals, specialists, consultants, surgeons and doctors, is insisted upon. Hitherto some of those in the front rank of the profession, who have attained that position largely as the result of study and experience gained in the principal hospitals, have cheerfully and gratuitously placed their services at the disposal of hospital patients without regard to their worldly circumstances. Under the new policy, it is suggested, the hospitals would be increasingly used by all classes of patients, and the effect of the payment of specialists for hospital work would be to reduce fees for private work. The leading practitioners certainly would be able to reduce their charges for private work if they were assured of payment for hospital service. If, however, the hospitals were to receive more patients their finances perhaps would be strained so severely as to prevent them paying the fees demanded by the association. It is at this point that the scheme becomes confused. The natural result of the new provision for medical attention to sick people in their homes surely should be to relieve the hospitals. If that assumption is justified, there is a good deal to be said in favour of the association’s ideas.