THE HEALTH SERVICE

Evening Post, Volume CXXVI, Issue 84, 6 October 1938, Page 10

THE HEALTH SERVICE

ATTITUDE OF B.M.A.

POSITION IN BRITAIN

WIDENING OF LOCAL BREACH

"It has been freely represented during the present election campaign that the opposition by the New Zealand branch of the British Medical Association to the general practitioner service proposed in the Social Security Act is not to be taken seriously because : the British Medical Association at Home first opposed the introduction of the National Health Insurance Scheme, and then, when the Bill became law, worked it and has been working it successfully ever since. This is so misleading as to amount to a falsity," said Dr. J. P. S. Jamieson, president of the New Zealand branch,, today. The truth of what he had stated could be proved beyond question. "The actual fact," he said, "is that in its medical provisions the National Health Insurance Act, when it became law in December, 1911, was a very different measure from the Bill that was introduced in the House of Commons, and the reason for the difference was .that the Government consulted the British Medical Association and so largely accepted its advice. According to the original Bill, for instance, there was to be no free choice of doctor, and insurance service was not made open to any medical practitioner who wished to enter it. Approved societies were to administer the medical benefits. The Bill provided medical services, but said nothing of the conditions under which the services were to be given, except that the arrangements with the doctors were to be made by the approved societies for their members 'to receive attendance and treatment to the satisfaction of the Insurance Commissioners from such practitioners.' "THE BAD OLD 'CLUB' SYSTEM." "The Bill really would have perpetuated by statute the features of thebad old 'club' system, and on this account was opposed by the medical profession. "The British Medical Association, therefore, formulated its demands under the famous six cardinal points, which may be summarised as follows:-— 1. An income limit. 2. Free choice of doctor. 3. Medical benefits to be administered by local health committees. 4. Method of remuneration of medical practitioners adopted by each local health committee to be according to the preference of the majority of the medical profession of the district of that committee. 5. Adequate remuneration. 6. Adequate medical representation on the controlling bodies. Special provisions for exercising professional discipline and dealing with complaints against practitioners were also required. DEMANDS CONCEDED. "The British Government, unlike ours, was open to conviction. The measure was foreshadowed in April, 1909. Seven months were given to discussion and negotiation in 1911 before it was passed, and it did not come into operation until January, 1913. During this period the essentials of all the cardinal points of the association were acceded to by actual incorporation in the Act iand' subsequent concessions. The 'panel system,' as it is now known, did not owe its origin to the Government; there is nothing about it in the Bill as originally, introduced. It was pressed by the British Medical Association upon a Government which was sufficiently open-minded and tolerant to admit the I suggestions and accept the advice of knowledge and experience. The medical profession was listened to and met by the Government to a very large extent. The result was that when the Act was put into operation, although a proportion of the profession was still doubtful, between 80 and 90 per cent, of doctors engaged in industrial practice contracted to treat the insured population. These are the actual facts with nothing concealed. DIFFERENT TREATMENT IN NEW ZEALAND. "Contrast this with the present position in New Zealand," continued Dr. Jamieson. "Preconceived socio-politi-cal ideas have been forced on the statutes against all advice, and without regard fo their effects and practicability. Such were the unjustifiable haste and the ill-considered construction of the Social Security Bill that it may well be said of it, as was said of a certain Bill many years ago, that if the Minister had asked the House to pass the Koran or the Nautical Almanac as the Bill, he would have had as little difficulty. "The medical profession in New Zealand has consistently urged that the legislation should be for the promotion of health, to meet the special difficulties of sickness, and to level up the treatment of the poor to that obtainable by the rich. This has been all disregarded. Instead, it has been enacted that sickness is to be encouraged, its special difficulties left to the future, and its treatment brought down to a common level of mediocrity. "Yet," concluded Dr. Jatnieson, "it is represented to the people of New Zealand that they should not take the opposition of the doctors seriously. 'They will knuckle down to it just as they did at Home.' This attitude of mind may be due to ignorance or selfdeception; but it does not tend to lessen the breach between the Government and the profession."