PEOPLE’S HEALTH

Dominion, Volume 28, Issue 103, 25 January 1935, Page 12

PEOPLE’S HEALTH

Compulsory National Insurance SUGGESTED SCHEME ' Hospital and Sickness Benefits Proposals for a compulsory national health insurance scheme for New Zealand have been formulated by tlie executive of the Hospital Boards’ Association, with the co-operation of several mciftbers of tlie New Zealand branch of the British Medical Association. These will be placed before the general conferences of the hospital boards and the British Medical Association. Should the members of the two organisations reach unanimity in agreeing upon a practical scheme, no doubt representations will be made to the Government with a, view to its adoption ami the introduction of legislation. There is reason to believe that official quarters are impressed witli the advantages of national health insurance. A summary of the proposals is as follows :— 1. That a national health insurance scheme js desirable. 2. That such a scheme should be compulsory. 3. That it should apply to. all in receipt of salary and wages below the present income tax limits. 4. That it should fppb' to all persons in receipt of salaries or wages within the limit prescribed between tho ages of 16 to 65. 5. That it should provide a complete medical service and should include a general practitioner service, hospital benefit, consultant and specialist services, maternity benefit, dental benefit, home nursing and surii other types of medical care as seem desirable. 6. That it should include the dependants of the insured. 7. That the scheme should be a contributory one, and that tbe contributions should lie at a rate regarded as suitable from an actuarial point of view. 8. That the payment of the doctor should be at a fiat rate so far as the general practitioner service is concerned and according to the work done for specialist and consultive services. 9. That freedom of choice as between ddetor and patient, which is such an important part of the scheme in England, should be incorporated in any New Zealand scheme. 10. That an insurance scheme could bo fitted into our existing machinery aud that in the Health Department and the hospital boards we have suitable agencies to represent central government and local insurance committees. Genesis of Proposals. At Hie general conference of hospital boards at Palmerston North in 1929 the executive of the association was urged to investigate the practicability of a scheme for free hospital treatment of wage-earners and dependants, the cost of it to be met by a compulsory levy on wages payable through employers direct to tlie hospital board of the district concerned. The first inquiry undertaken was directed more particularly to the question of instituting a voluntary contributory scheme or a number of separate voluntary schemes for hospital benefit only. This investigation convinced tlie executive that a voluntary scheme or a number of such schemes could not have very general application in New Zealand owing to its distribution of population. It was considered that voluntary schemes working here more or less in competition with and superimposed on the existing hospital benefit schemes of friendly societies and medical associations would not be of great national benefit. The idea of a voluntary'contributory scheme was therefore abandoned and the executive decided to give attention to the question of a compulsory scheme. It also formed the opinion that a compulsory scheme should cover not only hospital expenses of contributors but all medical expenses. It was considered that the administrative machinery of a compulsory contributory scheme in New Zealand would hardly be justified if hospital benefit alone were to be provided. Meeting With Doctors. The proposal for a national health insurance scheme was advanced a stage further when the executive met in conference with several practitioners in December, 1933. After general discussion. a committee consisting of three members of the British Medical Association —Dr. T. Duncan Stout, Dr. D. Macdonald Wilson and Dr. G. F. V. Anson—and three members of tlie executive of tlie Hospital Boards’ Association —Messrs. IV. Wallace, F. Castle and J. K. Hornbloxv was appointed to draw up a report on the proposal. The report of this committee was fully considered at a meeting of Hie executive of tlie Hospital Boards association witli several members of tlie British Medical Association. The report was adopted without alteration, and it is to lie placed before the next general conferences of hospital boards and tlie British Medical zkssociation. Tlie conference of tlie first-named association takes place at Napier on Marell 5, and that of the B.M.A. at the end of February. PROPOSALS IN DETAIL i Limitation on Classes of Contributors The authors of the report to be submitted to the forthcoming conferences of the hospital boards and the British Medical Association have modelled their proposals largely along the lines of the British National Health insurance .s'cheme with modifications to meet New Zealand requirements. 'l'hey point out that at least 20 countries are already administering such schemes, while there are several otbei countries administering compulsory contributory schemes for invalidity and old age and widows’ pensions. Afler enumerating the objectives and advantages of a scheme of national health insurance to provide hospital and sickness benefit for those upon tlie lower scale, the committee, in its report, says it is strongly of opinion that steps should be taken with a view to tlie ultimate introduction of a compulsory contributory scheme.

“The scheme co litem pin ted." the report continues, “is one limited as to Hie (’lasses of persons becoming contributors in order to coniine file benefits to those more generally in need of them. A universal scheme would needlessly include

many who ara able to make reasonable provision for medical and hospital expenses, would unduly increase the initial direct expenditure and would involve unduly heavy financial adjustments as well as seriously and unnecessarily interfering with private enterprise. It is suggested that the scheme should be applied to all employed persons, between the ages of 16 anil 65 years, whose annual salary or wages after deducting £5O for each dependant (wife, child or widowed mother), is below, say, £260. ‘•The question of applying the scheme to all persons in receipt of income whether as employees or otherwise has been considered, but the Committee is. of the opinion that undue administrative expense would be involved in applying a compulsory scheme to those in business on their own account whilst in general this class is not in as much need of the benefits of a scheme as are wage earners. The benefits of the scheme should be available to the dependants ot insured contributors." Suggested Benefits. The committee suggests that benefits should be provided as follow: — (1) Medical Benefit. — (a) Services of general practitioners: This service, nke that under the Briti.di scheme, should consist of all proper and necessary attention other than that involving skill and experience of a degree not expected of general practitioners as a class., (b) Consultative and specialist services: ihis would comprise work supplementary to that of general practitioners, including advice as to diagnosis, advice as to treatment which general practitioners may undertake and treatment which only a specialist can. give (that requiring special skill or equipment). (c) Laboratory aids: This to include microscopical, bacteriological and chemical examinations for diagnostic purposes, (d) Medicines and appliances: This to include such for ordinary supply, but. as under the British scheme, limited so as not to. include, for instance, trusses, artificial limbs or surgical boots, (e) Dental treatment. This to comprise simple and necessary interventions carried out by practising dentists, that is to say dental treatment for directly relieving diseases of tne teeth, extractions, and conservative work where required by rhe condition ot ie patient, (f) Ophthalmic treatment and optical appliances: As part of the medical benefit this would include treatment, prescribing mid supplying of appliances (2) Hospital benefit— This would include treatment in general and speei* hospitals and sanatoria hut not mcludi’.g treatment in mental hospitals. "The actual scope of benefits to be pi< vided.” adds the report “is of course a matter for determination only after■ ear. ful investigation and with due regan the scale of contributions required, Jd’ e contributions will require to be j'Ctuartly determined. This, it is suggested wll be a task to bo undertaken b .v the Goier.i ment Actuary. It is suggested t.mt the existing machinery ot the Health Lpartment and hospital boards would be suitable agencies to control the operations centrally and locally respectively. . lae existin’' organisation of friendly societies would doubtless be availed of in some de'"v section of the report is devoted to an analysis of the expenditure involved in mving effect to a scheme on the basis outlined. The total annual cxpenditu’-e in providing the medical benefit is es imated at £1.041.000 and that of the iXital benefit nt £720 000 Tim committee considers that an inquiry would of necessity have to bo undertaken ny the Government and that the scope of such inquiry should include: (a) the scone of a national compulsory health insurance scheme and the class of persons eligible: (b) the machinery for administration: (c) the method of collection and rate of contributions and (d) the hour fits.