British Doctor Looks At Our Free Medical Service

Chronicle (Levin), 11 August 1949, Page 9

British Doctor Looks At Our Free Medical Service

Received Wednesday, 7 p.m. LONDON, August 10. A strong reeommendation that in no circumstanees should the New Zealand method of paying doctors under the national health scheme, be, adopted in Britain, is made by Dr. E. W. Maples, O.B.E., LL.D., D.L., of Hereford. Dr'. Maples, who recently spent eight weeks in New Zealand during which he visited the niain centres and a number of larger provincial towns, has embodied his impressions of the Dominion's national health services, in a pamphlet which has jnst been published under . le auspices of the Nuffield Foundation by the Oxford University Press He is outspokenly eritical of the effects of the health scheme upon the earnings of specialists and of the disparity between the earnings of general practitioners and of doctors employed in public hospital and health services. This situation he attributes largely to the New Zealand system of paying the doctor a fee for each patient he attenJs. This system, Dr. Maples contends, has increased the earnings of many general practitioners out of all proportion to the services given. "It would appear that there has been, particularly among younger doctors, a considerable lowering of ethical standards," says Dr. Maples. "The temptation is very great for there is a. class of patients who seem to haunt the doctors' waiting rooms and who, provided they obtain the drug they desire, are perfectly satisfied. It would appear that it is possible for any young man, on obtaining the necessary qualifications, even without a period of hospital service, to set up his plate and within a very short period obtain an income of not less than £3000 yearly." Dr. Maples says he finds it diffieult to suggest any remedy for this state cf affairs other than a reversion to the capitation system of payment which is undoubtedly abhorrent to the medical profession in New Zealand. "Under the English system at any rate, we have the fact that a medical man received no greater remuneration because of numerous visits oi patients," he says. "Any attempt m England to revert to the system in operation in the Dominion, would be a serious mistake." Hospital Service Praised Discussing the standard of hospitai treatment in New Zealand, Dr. Maples says there is- no doubt the liospitals ■ ' ■ ' i — — i L.

V generally are performing J, wonderful service though in some smaller institutions operations of great complexitv, which in England would be performed by specialists, are being carried out in New Zealand by less qualified surgeons. He was very critical of the salaries paid to hospital doctors which he deseribes as "quite inadequate. " After eiting the recommendations of the Cleary committee which recommended certain measures to improve these salaries, Dr. Maples says: "Unless something of the kind is done there is likely to be a growing shortage of \iospital doctors. ' ' "It now pays every doctor in New tealand to go into private practice father than to specialise. Before 1941 the number of doctors in. New Zealana with high qualifications was very much greater than one would have expectect. As tnese give up practice there is no present spur to induce any of the younger men to obtain these qualifications. There is now no encouragement for a doctor to obtain further qualifications or to go in for any form of research. Under present conditions a good mein, a pleasant personality and possibly a little knowledge, receive the plums of medical service." Deseribing the growth in the demand for drugs under the New Zealand service as phenomenal, Dr. Maples says onc thing is certain and that is that iNew Zealand pharmacists are reaping a rich harvest. He says the New Zealand medical profession is disturbed by examples of a too free prescribing of drugs and predicts that the same difficulties will in due course oceur in Britain. The only possible remedy, he suggests, is that patients should be asked to pay a proportion of the cost of their preseriptions subjeet to the qualification that free issues should be made in cases like diabetes. Examining the cost of the New Zealand health services and of the socia'i security services generally, Dr. Maples expresses the .view that though it is possible to finance these services at present while the New Zealand economy is flourishing, it would appear that ' the monetary benefits could not he kept up i if there was any considerable decline in the level of wages. An aspect of the New Zealand health services which favourably impressed Dr. Maples was the school dental service. He explains the working of this in a special appendix to his pamphlet ' and strongly recommends that a dental s service on similar lines should be estabi lished at once in Britain.