HOSPITAL COMMISSION

Dominion, Volume 14, Issue 169, 13 April 1921, Page 8

HOSPITAL COMMISSION

FIRST SITTING IN WELLINGTON THE SUBSIDY SYSTEM ADDRESS BY MINISTER OF HEALTH Tho Royal Commission appointed recently to investigate tho hospital system of the Dominion met in (he Parliamentary Buildings yesterday. The ohrirmaii of tho commission, Mr. H. Vernon Reed, M.P., presided, and the members present were: The Hon. W. H. Triggs, M.L.C., Hon. A. F. Hawke, M.L.C., Dr. H. T. B. Acland, C.M.G., and Mr. G. Shtrtcliffe.

Dr. T. H. A. Valintine, Director of Public Health, represented the Hospital and Charitable Aid Department, Dr D. S. Wylie, Director of the Division of Hospitals, also attended on behalf of the Department. The matters that had been referred to the commission for inquiry were as follow :—

1. (a) The extent to which the Government should contribute towards the capital requirements of hospital boards, nnd the basis upon which such contributions should bo given, (b) Generally as to the best means of meeting the heavy cost of proposed capital works. 2. (a) The extent to which the Government should contribute towards the net maintenance requirements of hospital Iwards in the Dominion, (b) The basis of allocation of any such contributions amongst the individual boards. 3. The extent to which the Government should contribute towards the funds of separate institutions under the Hospital and Charitable Institutions Act. 5. The extent to which the Government should make grants in aid cf various charitable societies and institutions.

6. (a) The fees that should be charged for maintenance and treatment in public hospitals, (bl The establishment of paying or private wards in public hcspitals. 7. The present method of allocation of representation of contributory local authorities and the ratepayers on hospital boards, having regard also to tho nature of the suffrage.

8. The desirability or otherwise cf providing for Government representation upon hospital boards by means of nominated members. 9. The constitution and area cf the present hospital districts, and v).ether the present, grouping of local avlboritieg in the various districts is the best and fairest method of distributing the eost of the base hospitals throughout (he Dominion amongst the various local authorities.

10. To what extent economy might be effected by the adoption of stricter business methods, more especially in the purchase of medical and surgical supplies.

11. Generally as to any mailer in connection with hospitals or charitable aid which may he referred to it by the Minister of Health.

The chairman announced that he had asked witnesses who had already inili.mated their intention to give evidence to submit, in the firat p.lace, such evidence in writing, and then appear for cross-exa'mination. He thought that would clear the way considerably, and give the members of the commission foundation on which they could ask questions. In reply to Mr. Shirtcliffe, the chairman said that intimation of the setting up of the commission and other information had been sent to all hospital boards, and quite a large number of such boards had intimated tiheir intention to submit evidence.

Th© Minister of Health (Hon. C, J. Parr) addressed the commission. He said that it was called upon to investigate certain specific aspects of the working of the Department of Public Health and Hospitals, more especially with regard to tho hospital side of the work, but he took it that it would be quite open flo.the commission to survey the whole field of hospital management, and the relation of the State to hospitals and hospital control generally. He believed that! the system in force in New Zealand was peculiar to New Zealand. As the commission know, in most countries, even to-day hospitals were built, equipped and maintained large!}’ by voluntary contributions. Thai) might seem to us rather odd, but such was the case. In New Zealand wo Tiad departed from tho old voluntary principle; and as tho result of our legislation, which was begun in the year 1885, thoro was now a sort of partnership under which the State and the local authorities joined for She purpose of building hospitals for the sick and of maintaining them. The first statute which dealt with the matter was that passed in 1885. Nothing definite appeared in the Act of 1885 with regard to the relations of the local bodies and the Government, or of the contributions they should respectively make to the hospitals’ upkeep. It was not till 1908 that a new Act was passed which defined those relations pretty definitely. Certain incongruities appeared in tho Act of 1908, with the result that an Act was passed in the following year. The schedule of subsidies under that Act was tho main reason for the setting up of the commission. The schedule of subsidies had been found to work out unfairly and inequitably, with the result that the Government, at the suggestion of the various hospital boards and of tho Department, had been pressed to bring in a new schedule which would operate more fairly. 'Pho Minister suggested that the five main subjects for tho commission to consider were: — 1) The question of subsidies, including capital, maintenance, and voluntary contributions —in fact., the whole question, of subsidies. (3) Grants in aid of private institutions. (3) Patients’ payments. (4) Representation ; namely, whether the ratepayers should have definite representation on the boards, a.nd so forth; and as to the size of hospital districts. (5) Methods of purchase of supplies. Mr. Parr expressed hie personal opinion that the system iu New Zealand had worked satisfactorily. It was true that to-day they heard a great deal of talk about nationalisation, of hospitals. He desired to make two remarks with regard to that question. In the first place—apart altogether from tho principle of the thing—there was tho existing position just now that the Government could not possibly face the cost of nationalisation of all hospitals. Nationalisation meant that the Government would have to take over the whole expense of hospitals. At the present time there was obtained from local taxation a sum of close on .IiFXI.COO a year. The Government was unable to let that sum go at the present time. He had always been, and was to-day, strongly in favour of local control on as many matters of public import as possible. He suggested that the commission should take into consideration tho large issue as to whether the Government should undertake the whole burden.

The Miniater expressed the opinion that the Dominion could not undertake to provide free treatment for the eick in tho public hospitals. The cost of the treatment was very heavy, and a charge of £3 3s. per week for each patient barely covered the coat. He thought it should be recognised that people able to pay for their treatment should be required to pay. The Minister referred to the subsidy system, and said that he approved generally of the scheme that had been jilac- <<| Ix'fore Parliament last year. This scheme had possessed certain defects, however., and It bud been withdrawn in order that tho whole field might be surveyed by the commission. The increase in hospital expenditure in recent years had boon very heavy, and thm’ ono of the matters that required ooneidowv-

tion. The building programmes of the hospital boards in New Zealand at the present time involved a contemplated expenditure of over a million pounds. The Atinister admitted that many hospitals required a very large capital expenditure. The Secretary of the Health Department (Afr. E. Killick) then read a lengthy statement tracing the development of the present hospital and charitable aid system, and showing the relations that had existed in the past between the hospital Ixiards and the Government. His statement. contained a mass of detail, aud embodied’ various suggestions. After reading his statement, Air. Killick discussed the system with the inembere of the commission. The ccmmisrion adjeumed until 10 8..T0. to-day.