HOSPITAL COMMISSION

Dominion, Volume 14, Issue 171, 15 April 1921, Page 6

HOSPITAL COMMISSION

THIRD DAY’S SITTING

APPORTIONING EXPENDITURE SIDELIGHTS ON ADMINISTRATION The Hospital Commission continued its .sittings yesterday under the presidency of Mr. V. 11. Reed, M.P. The other members of the commission present! were the Hons. W. H. Trigge and A. F. Hawkes, Dr. Aciand and Mr. G. Shiijcliffe. Dr. Valintine (Director General of Health), Dr. Wylie (head of the Hospitals branch of the Department), and Mr. E. Killick (secretary) represent;, ed the Department. Evidence was given by Mr. M. Fraser, chairman of the Taranaki Hospital Board. He said that in view of the heavy capital expenditure which all hospital boards must incur to meet the ever-increasing demands on them, and keep abreast of modern medical science, his board was of opinion that nothing less than the amount of the present subsidy should be given. By this means non-rarepayers contributed a proportion of the cost. In view of the present stringency of the money market, the Taranaki board considered that'a scheme might be involved whereby the Government could advance the funds required for capital expenditure, on similar lines to State Advances to Local Bodies. Witness spoke in favour of the scheme of subsidy for maintenance, as drafted by the Department of Health, and approved at the Hospitals Conference, as being a more equable basis of subsidy than the present. In the board’s - opinion the present subsidy of 245. in the £ should be given for the following reasons:—(l) Voluntary donations were a source of revenue which should receive every encouragement; (2) the larger the subsidy offered the greater the inducement to give; (3) volun. tary donations wore chiefly made by persons who did not conitribute to hospitals in any other way. Another point | made by witness was that the cost of charitable aid relief should be borne by all in the Dominion, whether ratepayers or not. i Patients in Good Circumstances. In the opinion of the board it was inadvisable to alter the present system by which each individual board was once to fix patients’ fees on the bonus of cost of maintenance, for the following reasons:—(l) Admission to the hospital was open to alkrich. and poor; (2) many patients in good circumstances preferred to receive treatment at the hospital, not to escape doctor’s fees, but because the hospital was well equipped, had highly qualified surgeons in charge, had an X-ray dejgartment, and a staff of qualified' nurses. The. greater parr, of his board’s revenue came from this class of patients. / and it would be a great hardship to it if it could not charge the actual cost of maintenance; (3) the conditions under which hospitals in general were administered were so many and varied that it would he most unjust to alter tihe present system, whereby each board was guided by the local circumstances under which it was working. (4) tho financial resources of the various boards wore far from uniform; consequently a flat rate of charges was unworkable. Mr. Fraser went on to say that the Taranaki board thought that the establishment of paying or privaib wards in connection with public hospitals was entirely against the fundamental principles of the institution of such hospitals, and would end in friction, trouble, and class distinction. The question of finance was also ono that presented great difficulties. Considering that tho Government subsidised hospitals, it was justly entitled to be represented on boards. The constitution and area of hospital districts should be such that an up-to-date base hospital equid be maintained with all appointments that modern medical science recommended. This desirable end could not be reached under the present system of small hospital districts. In the opinion of his board a considerable saving could be made in hospital expenditure by better njethods of purchasing necessities than obtained at the present time. It failed .to to see why standardised lines in hospital requirements could not be bought in large quantities direct from the manufacturers and distributed to each hospital. His board had made considerable savings through purchasing from the Defence medical stores, and no doubt a satisfactory system could bo evolved on those lines. Views of Wellington Board. Mr. F. Castle, chairman of the Wellington Hospital Board, gave evidence in support of the following recommendations: —(1) That the Government should contribute, as at present, towards the capital requirements of boards on a basis of £ for £. (2) That the Government should contribute £ for £ on the net maintenance requirements of hospital boards in the Dominion and that it should be allocated amongst the individual boards on a proportional basis, as adopted at the recent conference of boards; (3) that the Government should continue to subsidise voluntary contributions at the present rate of 245. in the £; (4) that the fees charged for maintenance should be assessed on the actual cost of maintenance and a proportion of capital expenditure involved, with a maximum rate of 7s. 6d. per diem; (5) that no recommendation be made in regard to the method of allocation of representation of contributory local authorities and the ratepayers on hospital boards, and that they be elected as at present. In answer to questions, witness stated that changing medical opinions had the effect of increasing the need for additional expenditure on the part of the boards. Asian instance, he 1 cited tho case of the now fever hospital at Wellington which, when completed three years ago at a cost of £25,000, was pronounced by experts to be thoroughly up-to-date and properly equipped. Now, however, the board was faced with the necessity of approaching the Department for a further £3OOO for the provision of additional sanitary towers. lie was opposed to a flat rate covering patients’ fees. In this connection he approved of the principle laid down b" tho Department that ability of a patient to pay should be the underlying principle m fixing the amount of fees. ' He thought a minimum fee should lie fixed, and to this end no hospital board should be allowed to charge less than £2 2s. per week. To introduce the system of paying or private wards into public hospitals would, he felt sure, upset the whole hospital system of tho Dominion. At present, he took it that boards had no power to refuse admission to any patient on the score of their financial ability to obtain treatment elsewhere. The idea amongst the general public to-day was that tho hospital was a public utility, not a charitable aid institution, and by the payment of rates levied by local bodies they materially contributed to the cost thereof.

To the chairman: He failed to see what good could be accomplished by the appointment of Government nominees to hospital boards, to sit in conjunction with elected members. To Dr. Valintine: Ho agreed that through the Government nominees the Department would be enabled to keep more closely in touch with hospital affairs (han 'simply by correspondence, as at present. Dr. Valintine asked witness if be were aware that in Tasmania the Government had a majority of representation on all hospital boards in the country. Witness replied that this might be so, but personally ho was opposed to any alteration in the present basis of representation.

Wairarapa’s Experience

Mr. E. G. Eaton (chairman of the Wal-rara-fca Hospital Board), in putting forward the ,views of his board, stated, that tho present system of «£ for £ subsidy should he retained. The present basis of subsidy should also be retained. the board favoured tho ’present system of raising revenue by means of a levy local bodies and Government subsidy thereon. On maintenance requirements the subsidy should be the same as for capital, •£ for £• The suggested new proportional schedule should be adopted, as being a more equitable basis. Under the old schedule the Wairarapa Board received by way of subsidy 12s. 3d,, in the £ whereas under tho new scheme it would receive 19s. 6d. With regard to patients’ fees there was a considerable diversity of opinion on the subject. His board first had a sliding scale of from 4s. to 9s. per day, and later a fixed scale of 9s. .per day, which was subsequently changed to 6s. per day. The latter charge had been in operation during the past year, but witness considered that a universal fee should certainly be fixed The board had already before it proposals to establish paying or private wards at Pahiatua, and witness commended the idea. The present system of representation on boards appeared to be not altogether equitable and satisfactory They now had eighteen members, and he thought the total should be limited to, say, twelve. The Wairarapa board thought that the proposal to have Government representation on hospital boards was a good one, and it met in their approval. A great saving could be effected, witness thought, by direct importation and distribution of medical and surgical supplies, as well as other requirements in general use.

Suggestions From Melson. Air T. Neale, chairman of the Nelson Hospital Board, was the witness. He expressed the opinion that the Government should contribute for £ towards capital requirements both as applied to capital and interest; that main tenance should be contributed equally, Ind that a uniform rate of fees should be observed. He further stated that in the opinion of his board where boroughs were grouped with county councils, they should be elected under one suffrage, or that the borough, when qf sufficient importance, should be allocated a repiesentativ'e. He thought that it would be in the interests of both parties that the Government should have a representative on the board. Witness suggested that the commission should consider the question of granting power to any contributing body to rate itself for any particular local benefit; that was a benefit that did not touch the contributory bodies generally. Aesuniinv that the whole hospital system was based on an equal partnership between the Government and tho local bodi?*, then the Government and the ratepayers should contribute equally to the expenAir T F. Martin, secretary to toe Municipal Association, submitted copies of remits passed by the Municipal Conference in 19L9, providing fojjeprcyen ution of the Government and local bodies on hospital boards in approximate proportions to their respective The remits further set out that the present system of subsidy from the Consolidated Fund was arbitrary and, inequi - able.gjind shouliHie placed on a 1 ist and uniform basis. Sir James Wilson, chairman of the Palmerston North. Hospital Board also gave evidence. He considered that o capital expenditure the subsidy should be on tho .£ for £ .basis and distributed equally. Some provision should be made by the Government, outside of the Trust Office, for raising a special fund for loans to hospital boards to meet heavy capital expenditure. the same as was done in the case of the Local Bodies Loans Act. Sir James Wilson added |hal the whole basis of hospital taxation was wrong It should be taken oft the shoulders of the ratepayers and allocated among tho whole community. The commission adjourned till 10 o’clock this morning.