The Grey River Argus FRIDAY, September 17, 1948. LOOPHOLES IN MEDICAL SERVICE

Grey River Argus, 17 September 1948, Page 4

The Grey River Argus FRIDAY, September 17, 1948. LOOPHOLES IN MEDICAL SERVICE

WHILE those at first hostile have mostly become upholders of the Social Security Act, it has, in operation, presented in the medical services some opportunity for critics to find fault. The recommendations of the Parliamentary Committee, especially regarding payments, should go to remove these objections. They provide for the onus being shifted from doctor to - patient in claiming the fee for service, and for part payment for pharmaceutical benefits by the patient. Another important recommendation is the establishment of disciplinary committees to investigate breaches of the regulations and complaints against doctors. Tile fact, remains, of course, that the State must still rely very largely on the ethical bona tides of the profession in perfecting the system. On its part the profession has the obligation of making the best of the service, and it may be judged from- the Committee’s report that it is responding to that, obligation. There has been a need for the extension of the benefits to cover specialist treatment, and this is proposed. Certain such benefits are provided for, and are to be implemented under a method by which the specialist will claim cn behalf of the patient from the fund a prescribed sum and apply it towards settling his charge for the particular service. Specialists would be recognised, and the fees arranged by the B.M.A. and the Minister. It is recommended that the “open hospital” system be adopted in staffing, -with visiting staffs of more young specialists, and with other financial provisions. Fifty more specialists are judged to be requisite, aifd most must meantime come from abroad. An increase from 7s 6d to 10s is proposed in the fee Tor a visit to a home, other payments to be: Attendance at doctor’s surgery or residence, 7s 6d; elsewhere, 10s; between 9 p.m. and 7 a.m. or on a holiday or Sunday, 12s 6d; 5s per additional half-hour; and telephone consultations, ss. The Committee does not believe that a capitation system is feasible, or any daily limit on the number of patients for a doctor, although an average of thirty attendances is' suggested. The Committee finds too many trivial complaints are referred to doctors, entailing too much medicine being prescribed, and latterly much more expensive drugs in the process, doctors not exercising due discretion, as the State pays every time. Waste of drugs, rises in price, and prescriptions where people formerly paid over the counter have all exploited the fund. Consequently part payment by patients should be a corrective. Standard prescriptions are suggested, also services for factory and school groups, and joint health and medical centres with the association of doctors in particular areas, as well as regional consultative committees. To improve contact between doctors and hospitals, it is suggested that there be clinical courses of instruction for general practitioners, with the fullest possible exchange of information regarding treatment of patients.

The Committee shows its approach clearly .by urging that there be a greater responsibility placed on the whole profession for ethical behaviour and for the quality of service. A salaried service is vetoed as unworkable, the proposed change in the fee-for-service method being to meet the doctors’ desire for the fullest doctor-patient relationship. Diseases so vary between individuals that treatment for the same complaint must often differ between one and another. The Committee is opposed to a. doctor simultaneously practising under both a capitation and foe-for-

service system, and holds that salaries are advisable only in areas where income has to be made up. The ■ only fee. method should be that of the doctor claiming on the fund on behalf of the patient, and the payments remain as at present, except for visits to homes. It is an important reform which is involved in the proposed abolition of fees for writing “repeat” on a prescription. The. refund system would be continued only as a transitional expedient.

The recommendations are obviously aimed at economy, but reasonable economy, attainable by closing up various loopholes for exploitation. It was inevitable that in so universal a scheme such loopholes would occur, but the great majority alike of doctors and patients are not disposed to exploit them. .. For that reason, remedial action can be taken and the report of the Committee clearly defines the course of that action.