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Hokitika Guardian, 22 December 1924, Page 2

A nosi’iT.u. problem, the treatment of well-to-do patients, lias la?on advanced a stage bv what is known as the Palmerston North ease. This was a triangular situation, in which the principals were the patient, the Hospital Board and the Medical men. The outcome is that the institutions are in the first instance free to all, but where a patient requires private or special treatment as nominally a private patient domiciled at an institution, then by arrangement the patient must pay extra. This is probably the natural outcome of the matter. The institutions are partly Government and partly local body, so that the ratepayers contribute Doth through general and local taxation for the upkeep of the institutions. To bar a person who is believed to be wealthy, while he is a ratepayer, makes a distinction which is at once not equitable. People of means naturally do not rush hospitals for the pleasure or pain of being there. Circumstances drive fhem there, and that they have the right to go is now

settled beyond question. The matter of payment is another aspect, and for that the Hospital Board must use its official machinery discreetly. There can be no free department in the general sense, but where patients are unable to pay tbe Board’s officers must deal with the instances on their merits. On the other ha-nd where patients are fmancial, the claim for payment should he pressed. Hospital finance is a matter requiring the constant attention of Boards, and while it is necessary to carefully watch and control expenditure, it is no less essential to keep a close guard on the sources of income. There is year by year in all public institutions a great leakage in patients’ fees. There is a branch of the finance which should have the closest attention. It is hut fair that those who have occasion to use the well-found and equipped hospitals of the Dominion, should he prepared to pay ill return for the upkeep. Patients fees go hut a very short way towards the total cost of maintenance. and it would he a prohibitive charge altogether were the hoards to try to balance accounts hy the fees charged. In the circumstances patients ale well treated, and it should he their endeavour to meet the payments so reasonably charged. The case for the medical men is on a different fooling—and this is so particularly in relation to the larger hospitals. Here, a reasonable arrangement between the Board and the medical officer has met the position without strain, and as far as is known, the arrangement is working satisfactorily. It is of advantage to a patient to he where he can receive expert attention and that is provided at a hospital. Tn such instances it is preferable to he treated at a hospital instead <f at home, and the advantage to those who can pay for treatment in a private ward is fully worth the extra cost, ft is not possible from an economic point of view to treat all cases in private wards, but. as far as possible extreme cases have that advantage. Hospital administration in tbe Dominion lias grown into very large figures. Tbo staffing and equipment is now at a high standard, while in most cases all buildings arc modernised, and represent a large capital outlay to place them in tbo particular condition in which they are found. Invariably the fees charged are low. Often they are not based on average cost of maintenance where tbe buildings and equipment arc to lie taken into account, the fees would he much higher—in fact prohibitive. So it is that a largo share of the burden of the cost falls on the (lovcrnment and the local bodies, which means that the general taxpayer has to contribute largely to the cost. Tn some districts special hospital rates have to he struck to meet the demands. Such being the case those who have or. casino to use the icsth ot ions should not begrudge payment. Patients receive the best treatment possible and in circumstances calculated to ensure the best results. Hood professional men are invariably at call in charge cl the institutions. and the medical officers never spare themselves when humanity calls. There is an obligation upon those who esc thi' institution to contribute towards their upkeep while inmates, vet it is surprising the number who -cel; to evade payment. It is not a pVa-ant task for Boards to press for payment, but it is necessary if institutions arc to be financed on equitable lines, ami without unduly pressing on the (on eminent and local bodies, which means the general taxpayer.