PAYING PATIENTS.

Timaru Herald, Volume CXXIII, 30 April 1926, Page 3

PAYING PATIENTS.

“LANCET’S” FRANK STATEMENT

POSITION IN ENGLAND. I

The “Lancet,” the British medical journal, in a leading article, describes the movement towards paying patients in' fhe hospitals, and .rankly deals, with the situation. It states: — “There is a widespread dissatistaction with the cost of the private nursing homes in relation to tlio seivi’cos which they give; and, on the other hand, it is becoming more generally recognised that it :.s only the large modern hospital that can offer the full’ degree of technical efficiency necessary for the treatment of certain more serious and obseuro

tpves of disease. “Nursing homes cannot replace the amenities of a well-run hospital with its purposive architecture and its .special departments and laboratories, iln d—sometimes a most important point its resident medical olhcers capable of dealing with an emergency. . , “The demand for paying wards attached to general hospitals uheie laboratories and resident doctors ai.e available in convenient buildings is not'surprising; it is the logical issuo of the developments of medicine running concurrently with altered domestic amenities. That more and more general hospitals in London aie considering the provision of *coh wards and private rooms is wellknown to the majority of our readers, and the movement is spreading to the provincial towns. “We believe that this movement represents a great public benefit,, but obviously it is not without, its dangers, for it implies certain changes in the conditions, both of institutional and private practice that cannot he ■i fv considered. It is the large and increasing section of the compnrmtivelv Wcll-to-db who arc left without (lie 'best chances ,~of treatment ill serious conditions. THE CLAIMS OF THE MIDDLE

- CLASSES.. “The devoted attention of their medical advisers enables tho majority them to meet their adversities; it, constantly supplies them with a care which could only have its origin in individual knowledge, and 1 r which no' institutional treatment will form n substitute. But on the one le’iid. the patients cannot afford the drain upon their resources, /.ml, on the other, no acute and intimate knowledge of pathological conditions on the part of tho practitioner will ’change an adverse environment or supply costly material. Satisfactory environment and material have been called into existence primarily for tho cock poor: how to place them at the disposal’ of others without encroaching on funds subscribed' only lor chariaMo purposes is a problem of great complexity. “Admittedly it can only bo solv'd '■'til justice along»lines which will ensure that, side hv side with, the extension of the benefits the hospitals can offer, there shall he no restriction upon the great functions which called the voluntary hospitals into being and upon which they base I heir claims to public generosity. Considerable emphasis has been laid on (ho necuniarv benefit which tho general hospital should derive from this now venture. “This is a. matter open to doubt. A voluntary hospital, built upon a site which has been bequeathed to it,* equipped with costly appararus through the munificence of the diaritable, and staffed by men and .women wlin consent to give their services for negligible salaries, mnv be able for a relatively small weekly fee to give solendid service to sick persons of the middle classes, while showing cn its balance .sheet an appreciable annual profit.

HOSPITALS MEANT FOR THE • POOR. “But is is likely that, if a ward for paving patient,! is run on such a basis that adequate payments are made for the true rental ot the buildnur and the cost of the technical pmnts and laboratories, the just char-e to the paying patients will be fill- higher than is generally believed, granting the rights of the beneficiaries lor whom the charities were founded

') in* ro-spoetfd. “Tiro protection of these benefieiaries is a problem that has been complicated by a new factor. 1 hat the sick poor should, when aide; make some contribution to the cost cl thenupkeep in hospital is 'a pnncip e uimeuit to dispute. It <s one which lias been so famously followed out, individually or upon a group method, that many of our voluntary hospitals, placed among industrial communities, receive large annual incomes in this wav. But from the first the danger was seen that, the acceptance of that principle might lead to a change m the class of .sufferer treated in the wards of our voluntary hospitals.. Tile suggestion has neon made openly that the change is arriving, and that the sick poor are less olton to lie found in our great charitable institutions, their places having been taken by those equally sick but not so poor. . “Whether tin’s be so or not, us possibility makes every precaution necessary least the admission ot pavin<r patients lead to the catastrophe. The great need here will be tin- keeping of hospital accounts; and the work now being carried on to ensure that this is done on a uniform plan should be a cheek on abuse. r f lie large guidance that should bo received from accountancy should be remembered if a. readjustment of the part pfayed by the voluntary hospitals ill communal life is to be e nutable. “The private nursing heme banes its patients with a complete freedom of choice as regards the services of phvsieians and. surgeons; it is the practice for such patients to remain in the cure of their own practitioners, who call in a.osultaiit advice at Mich time as mnv ne deemed wise. What is to happ-'u in the private wards of ve'-’-’tary 'mvtab' <J _ “One of the pnncip es of these institutions In"- been Hie personal responsibility of (he honorary staff to

| vlte governors for all that coucenifi , the welfare of the patients. Is the l paving- patient to bo denied the services of his family medical adviser, who knows all about his circumstances and his ease, and who, out of that knowledge, has advised resort to the paying ward? The honorary staff of the hospital may not care to shoulder responsibility for treatment of patients whoso history is unknown save after consultation. “Further, one of tho principal reasons for the establishment of paying wards is the excellence of the technical attention received by the inmates of hospitals, and the paving patient will enter the ward expecting : to derive his share of those jidvan- , tages. The, payment of consultation fees can ho arranged, though it is a delicate matter, but, if the appropri- , ate medical duties are furnished by j house officers, arrangement for ndc- i <iuate remuneration of their services arises, and does not seem to have j received the contemplation that it j should. |

SPECIAL HOSPITALS FOR PAYING PATIENTS. “Tim general position is one of ; flux ; and at best the amalgamation of j paying with gratuitous patients will i be for "a time an experiment. If such a system cannot be perfected, hospitals founded for the nso of paying patients will arrive to meet the avowed necessities; in the meantime, existing situations have, to bo met. “Modern modicino and surgery are steadily being made available to every class of the community, but the prims reason for the existence of the vol- j itarv hospitals must not be lost sight of, nor the valuable relations between the public and their medical advisors bo weakened.”