SOCIAL SECURITY FUND

Timaru Herald, Volume CLVIII, Issue 23324, 6 October 1945, Page 4

SOCIAL SECURITY FUND

MEDICAL AND OTHER BENEFITS Attention Drawn To Abuses

Department Alert (N.Z.P.A.) WELLINGTON, Oct. 5. Speaking to the Social Security Fund (medical, hospital, etc., benefits) veto of £5,192,000 in the House this afternoon, Mr J. Acland (National, Temuka) asked what was the Minister going to do in regard to misdemeanours by some medical practitioners and abuses by patients of benefits. How would doctors be checked from making unnecessary calls?

Mrs Hilda Ross (National, Hamilton) asked what steps the Minister would take to provide a week-end night service by doctors, and could hot some system be devised so that hospital outpatients need not wait all day to receive attention?

The Hon. A. H. Nordmeyer, replying, said that in some districts it was particularly difficult to obtain service during week-ends and nights, but in oilier areas the doctors had organised

themselves to provide a service for emergency calls". There was nothing to stop doctors doing that generally, and it was for them to organise rather than the Department. On the question of outpatients, Mr Nordmeyer agreed that some had to wait too long, but that was a matter for hospital boards to arrange some system on the appointment principle. He would be glad to take the matter up on a Dominion-wide basis. Hard To Prove It was tremendously hard for the Department to prove over-visiting against doctors, continued the Minister. It was possible to suspect cases of over-visiting, and the Department did have suspicions in a number of cases. It was a matter of conscience so far as the doctor was concerned. In view of the abuses of the fee for service scheme, the Government was seriously contemplating whether that system should continue. Discissions were to take' place next week with the B.M.A. For a long time there had been a disinclination on the part of the Association to riieet the Government. Doctors had taken up the attitude when the scheme was introduced that it was inimical to their interests, but he thought they realised topw that such was not the case. Dealing with over-prescribing, the Minister said the doctors themselves were the only ones to decide if a patient needed a prescription. Many doctors would not prescribe unduly. It was true that some doctors not only over-prescribed but prescribed unnecessarily expensive ingredients. One prescription had come to the Department showing ingredients to the value of £ll. The Department had taken measures to discipline doctors whose prescriptions appeared to indicate that they had over-prescribed or had prescribed unnecessarily expensive ingredients.

The Rev. Clyde Carr (Government, Timaru) said some doctors were “driving a coach .and six through the Act." Mr W. J. Polson (National, Stratford) said it was inevitable that the volume of medical services should have Increased when doctors’ services became free to patients. It was all to the good that people should have recourse to doctors whenever necessary, but the weakness in the Act was that it had led to over-hosnitalisation. Too many people were sent to hospital who should be treated by clinics or by district nurses or in their own homes. If the Government, instead of proceeding with an expensive hospital building programme and crowding people into hospitals, would encourage patients to be treated in their own homes, the country would pet a much more economic service. The problem was creating a great deal of concern in the minds of ratepayers and taxpayers who had to find the extra money for hospitals. Mr M. H. Oram (National, Manawatu) said it was interesting to hear the Minister say the fee for service scheme had not been entirely satisfactory. The Opposition had been saying that for a long time, also that the pharmaceutloal service was not entirely satisfactory. Profession Defended

Mr H. T. Morton (National, Waitemata) said he wished to protest against the suggestion of the Minister and others that doctors were paying more visits than were necessary. Our doctors had been doing an enormously difficult job of work with the utmost efficiency under exceedingly difficult circumstances. The profession never had been more overworked than it was at present and it ill-behoved any member of the House to say that

doctors had failed to fulfil their mission under the Social Security Act. One doctor he knew of was treating an average of 70 patients a day. He knew that was too many and treated them not for money—because beyond a certain number lie netted only 9d a patient —but out of a sense of responsibility and service to the community.

Mr A. E. Armstrong (Government. Napier) said he supported Mr Morton in deploring any heresay hunt against doctors whose wartime service, with their numbers overseas, had been wonderful. It was unfair to make allegations against a group of men who were unable to reply. It was unsportsmanlike to make attacks on the medical profession, some of whom were paying as much as 17/- in the £ on the increase in their earnings above the 1939 level.

Mrs Ross urged an improvement of the salaries of nurses and voluntary aids. She said the only people who could really afford to send their daughters into hospital nursing at 18 years of age were those who could assist them financially. Mr Acland said that many members of the B.M.A. had forecast many of the difficulties the Department would encounter under the scheme. The B.M.A. wanted to see the nation get the best possible health service and also wanted to see the standards of the medical profession raised. It did not consider the present scheme advanced those ends.

The Minister of Supply (the Hon. D. G. Sullivan) said the increase in the cost of .pharmaceutical benefits was partly due to the fact that whereas doctors previously prescribed drugs according to the pocket of their patients, they were now able to prescribe more powerful and efficient remedies which cost more. This was another benefit that had resulted flora the Social Security scheme —people were now assured of the best medicines irrespective of cost.

Mr Nordmeyer said that attention had been drawn to the fact that some of the disease existing in New Zealand was occupational disease. He agreed with Mr Acland that Government factories, as Dr. Davidson had suggested in his recent report, should not be exempt from inspection and should set a standard of factory hygiene at least equal to the best of nrivate employers. “When, as is intended, a division of the Health Department is set up to deal with this matter. Government factories will not be excluded from inspection,” said the Minister. Hospital Charges Mr Nordmeyer emphasised that the increase in hospital charges on the fund was largely due to the raising of the payments to Hospital Boards, two years ago, from 6/- a patient a day to 9/-. So far as pharmaceutical benefits were concerned, it was interesting that in 1941 50 per cent, of all doctors’ prescriptions cost less than 2/-, but in 1944 that percentage had fallen to 10.7 d. In 1941 only .44 of the prescriptions cost between 10/- and £l, but in 1944 that percentage was 5.1. Those figures indicated the substantial increases which had taken place in the actual costs of prescriptions, largely due to price increases in overseas ingredients. Mr Nordmeyer said that at present there was nothing to prevent any doctor in New Zealand from calling himself a specialist, but he thought it desirable that certain standards should be complied with before a man had the right to set himself up as a specialist, and he was going to discuss the matter with the representatives of the medical profession. The Government intended to do everything possible to encourage patients to be treated in their own homes when possible. He hoped that many nurses on their discharge from the Services would be available to care for people in'their homes. Answering Mrs Ross concerning nurses’ salaries, the Minister said he understood that negotiations between the Nurses’ Association and the Hospital Boards’ Association had resulted in an agreement on a new scale of salaries providing certain increases, and that the scale was now before the Stabilisation Commission. The Government last year had agreed to subsidise such organisations as the W.D.F.U., which were providing domestic assistance in homes. A plan was at present before the Government —and he hoped that a Cabinet decision would be reached early next week—which would extend this scheme considerably and would make a certain Government Department responsible for administering it and for its extension, at any rate in the cities and the larger towns. Mr Nordmeyer told the House that 865 doctors were paid from the Social Security Fund last year. There were also about 200 doctors in the full-time employment of Hospital Boards. It was estimated that about 1100 doctors were practising in New Zealand at present. He was unable to say how many were still overseas, but many of them would do post-graduate work on their return and would not re-enter practice immediately.

Abuse by Patients Mr W. M. Denham (Govt., Invercargill), instancing abuse of the scheme by some patients, said that recently a certain doctor received an urgent call to discover that the patient—a woman —had been to a very sad picture the previous night. All the doctor could do was to advise her not to go to any more sad pictures, but the visit cost the State 12 6. The only remedy he could see for the abuse of the scheme was an extension of the nursing service such as was practised in the Hokianga district where, under the grant of £l. a patient for the 8000 people in the district, a full medical nursing, hospital and specialist service had been provided. Nurses dealt with minor cases, relieving calls upon the doctors. He thought the Government should extend this system throughout the country. It would save tens of thousands of pounds. The doctor responsible for the Hokianga scheme had declared that there were too many doctors in New Zealand, and by the work being done there he was proving the truth of his words. The vote was passed.