The Press TUESDAY, JUNE 1, 1943. Hospital Rating

Press, Volume LXXIX, Issue 23962, 1 June 1943, Page 4

The Press TUESDAY, JUNE 1, 1943. Hospital Rating

The Counties Association, the Municipal Association, and the hospital boards obtained from the Prime Minister and the Minister of Health, about a year ago, a promise to consider a higher hospital benefit rate. Reminded of the promise recently, Mr Fraser said that the question was under consideration, “ along with other Govern“ment finance generally precedent “ to the introduction of the Budget.” The form of the statement hardly suggests that the question is being approached as it ought to be—that is, as one inseparable from the larger question of hospital policy and control; but at the present time it is perhaps impossible to hope for more than an interim measure of relief, accompanied by a clear indication that relief precedes reform. That indication is overdue. The hospital and charitable aid statistics, issued as an appendix to the annual report of the Department of Health, show how heavily the rating system is being loaded by hospital costs. In 1934-35 the total rate for hospitals was £601,715; m 1038-39, it was £944,070; the estimate for the current year is £1,317,945. In eight years the rate has increased by 115 per cent. The chief cause of the increase is the increased demand for hospital services, promoted by the operation of the Social Security Act, and the increased cost of maintaining them. Unquestionably, the Government’s payment of hospital benefit, 6s a day, has raised board revenues greatly; but the maximum theoretically payable at this rate is £llO a year for a bed. In two of the largest hospitals the annual cost of maintaining a bed is nearly £360. In only two of the 20 largest hospitals does the cost fall (slightly) below £2OO. A widening margin, as all material costs have increased, has become chargeable against the rates, plus the scale subsidy on rates for maintenance; and what that means was illustrated recently, when the Waitaki County Council received its new assessment from the Waitaki Hospital Board. The county’s share of the board’s rate was £10,289 out of £14,960. The increase was £2143, or more than 25 per cent. The county ratepayer will pay two thirds of the board s total rate increase; the borough ratepayer, one third. The major part of the burden falls oh the land. The situation is of course too bad to be rectified by any change in the hospitals benefit figure or in the scale of subsidies on maintenance rates, or even, as has been suggested, by the State’s assuming all capital liabilities, past and future. Higher subvention will give present relief where it is most needed; but it will not reform bad and wasteful organisation.- Worse than that, where hospital management is bad it will , be covered and encouraged by higher-subvention. It will be quite impossible to discriminate, in practice, between boards that need' relief and fully deserve it and boards that need the same measure of relief and deserve little or none. Sooner or later, and the sooner the better, the State must pursue the principle which it laid down when it accepted liability for the cost of hospital treatment. The State could have extended the subsidies basis of hospital finance; it chose instead, and Tightly, to introduce the financial principle of a national health and hospitals scheme. Second, there is no way out of the present difficulty over rating but right out of it. The national principle will not link workably with the local rating principle. Third, the Government, through the Department of Health, knows very well that it is dealing with far too many hospital authorities, the efficiency of which varies from relatively high to abysmally low. Resources are wastefully scattered and administered; reorganisation along the lines of centralisation and specialisation is disastrously retarded. That is the trouble. Bigger subsidies and benefits will not cure it. Finance and policy are two aspects of the same thing.