HOSPITAL EXPENSES.

Shannon News, 15 February 1929, Page 4

HOSPITAL EXPENSES.

PRESENT COST TO COUNTY £4OOO A YEAR. PRESSING NEED FOE MORE EQUITABLE TAXATION SYSTEM. ECONOMICAL MANAGEMENT OF PALMERSTON INSTITUTION.

The passing of accounts, at the meeting of the Horowhenua County Council, on Saturday, gave rise to a discussion on the hospital levy, which amounted.to £1053 5s 4d for the quarter. Cr. Gimiblett drew attention to the ■item. He said that three of the Councillors were also members of the Hospital Board, but when the account came forward each quarter the Council didnot have much say in the matter of whether it should be paid or not; it was just handed on to them, and the County had to pay it... There were pther bodies interesting themselves as to the cost, and they said it was-going to be a tax on the land; "When Board members stated that there was a likelihood of an increase in that account, this Council should, if possible, take a stand and not go on agreeing to pay without some protest. It was getting beyond a joke,, and they 'should do something. He would like the County chairman, as a member of the Board, to give the Council a little information as to what was being done. Counties Alive to tie Situation,

' The chairman stated that the County Councils generally had taken a very live interest in the question of hospital levies. In the first place the Board were administering an Act, and it was only by fresh legislation that an .alteration of the methods could be

secured. The Board's revenue was * made up partly by fees collected from patients, partly by a levy on loca) bodies, and partly by a subsidy from the Government. This district was

paying one of the lowest levies in any hospital' district in the Dominion; this was because it was a fairly rich district and therefore its subsidy from the Government was actually less than it Would be if this were a large, scattered and poor; district. The subsidy to hospitals varied from 14s 3d to £1 6s to the £, and, the Palmerston North Board received a subsidy of 15s 3d; but the higher the levy on the local body, per £ of -capital value, the higher was the subsidy, and this went to show that the levy district, per capita, must be one of the lowest in the Dominion, per £1 of capital value. It was proved by the low rate of subsidy they .got. If the hospital rate in this district were increased, the sub- : sidy from the Government would be increased also. They had no control over that aspect of th'e matter. The Department worked out the subsidies before' the end of the year so that the . whole > t of the .subsidies paid over the DoMmion-by ,the Government amounted -to £1 foT £L Some Boards Teceived exactly £l, others less, and others more. Jf.at the end of the year the money was overdrawn, as it often was, there had to be a refund pro rata on the capital value of the Hospital Boards of the Dominion, equal to the amount overdrawn. One year the Palmerston Board received a subsidy of 14s 3d, but had to pay back £BOO, thus reducing the Government/subsidy below the minimum allowed by the Act. As the Act was - amended last session, thiscould not happen again; a Board could; not now be ealled upon for a refund if such would reduce its subsidy below the prescribed minimum. What this: Council had done, as a local body and as a member of the Counties Association, was this: The levy at present was on the capital value, and they had asked, in fairness to the country districts, which did not receive the benefit that the towns did, that instead of the levy being made wholly on the capital value, it should be made half on the capital value and half on the population. Cr. Gimblett: That would reduce our levy? The chairman: It would depend on our population. It would increase Palmerston North's levy. That is what the Board has asked for and is fighting for to-day. In some districts there are hundreds of thousands ef acres of native land that do not pay anything, so that, although the levy is on the capital value of the county, half 'thr. county has to pay it. That does not affect us, as most of our, natives arc ratepayers. As far as the Council ifconcerned,'the ratepayers can rest; assured that we are doing all we possibly can, but to get'any relief we must have an. alteration of the Act. With regard to the Board, I would like to say that the Official records show that our hospital; is- one of the most economically conducted hospitals in the Dominion.

Burden of Charitable Aid. The chairman explained that, us the subjeet had been raised at short notice, he had no figures with him, but he would be pleased to give them on some future occasion. He added that, whilst the Board were endeavouring to keep down expenses at a time when the number of patients was growing rapidly, they were faced with another factor—one which was general and over which they had no control —and that was the huge increase in charitable aid. Cr. Gimbfett: That is why I feel that we' are so interested. The chairman: We as a local body have very little to do with that aspect of it. Cr. Kilsby: It is due to. unemployment? The chairman: Yes. We have no . hope unless there is an alteration of the legislation pertaining to the levies. ~ We must expect an increase during the next year, for this reason. We have more patients to cater for and have to . make greater provision for accommodation, and-we shall require to have more

nurses and more accommodation for them. We have had to raise considerable money to establish additional accommodation for the nurses and the gatients. Our interest bill will be greater and our maintenance account greater, despite the fact that we have raised the patients' fees. Closer supervision is being given to this matter; we are collecting a greater proportion of. the patients' fees. Not only has this local body been alive to the increasing levies and the ( fact that some alteration is wanted, but we have justified an existence as representatives on the Board by seeing that things are done as economically as possible while caring for the sick and those who are unable to cafe for themselves. €r. Catley said that, as a representative of the county ratepayers, on tho Hospital Board, he could support the chairman when he said that the hospital was one- of the most economically administered in the Dominion—a fact that could be proved beyond dispute. He asked,if Cr. Gimblett had seen the balance-sheet of the Board.

Cr. Gimblett: No. .; Cr. Catley said he had one of the balance-sheets in his possession and it was very illuminating. He went on to quote figures published in the Press in answer to a correspondent who sought imformation relative to the costs oi. various hospitals. The figures gaVe the costs of 13 hospitals in New Zealand, setting out the numbers of occupied beds, cost per occupied bed, and cost per patient. They showed that Napier and Palmerston North stood out by themselves for low hospital costs. Cr. Catley said that the great bugbear .to; day was charitable aid, and he referred to the recently published report of the expenditure by.the Auckland Board, which was about £7OOO above the estimate for the year. He also stated that the Wellington Board last year put £26,000 for this purpose on the estimates last year and was straining every nerve to make that amount see it through. Cr. Catley gave some interesting figures concerning the growth of charitable relief since 1874. In that vear, in Wellington, when the population wa"s 10,547 ? the cost was £284 19s; now, with a population ten times as great, it was difficult to meet the situation with a vote of £26,000. The ratio of increase was 10 for the population and 91 for the charitable aid. Pursuit of Patients' Fees. ,

-Or. Catley added that the levy in this district was going to be greater this year than last year. In charitable aid last year the ■ Board over-expended £llOO, and the secretary thought, that at the end of this financial year the amount would be £BOO over the estimate. The only fault which the speak er had to find with the Palmerston Board was that he did not think sufficient steps were taken to collect the patients' fees. This was a big■ problem,, and the district under the Board's control was a large one, extending from the Waikanae River to Apiti. How was. it possible for an officer to determine, whether or not a patient was able co pay, without some help- being given the officer by the representatives who ■tat at the table? Mr. Phillips (the managing secretary) during the latter part of last year took some steps in this ilirection, visiting places where there were representatives and bringing \#th him files relating to people who had been inmates of the hospital. About September he camo to Levin, and the local representatives spent five hours with him. Mr. Phillipps brought 1000 files, representing £4OOO owing by patients between Shannon and the Waikanae River. The representatives went through three or four hundred of the accounts for subsequent consideration. Certain .recommendations were forwarded to Mr. Phillipps who afterwards told him that they had been of vqry great value and he had been able to collect a greater number of those outstanding accounts than he would otherwise have done. In concluding, Or. Catley said that there should be hopes in the future of more of such accounts being collected. At the last two meetings of the Board it was shown that the tees collected wore a little more than had been estimated as collectable. The secretary's work with local representatives was beginning to bear fruit. Numbers and. Costs of Cases. Cr.. Kilsby asked the chairman if he had an idea of the total number of patients who went tlrrougb the hospital last year. . The chairman: The average is about 190 ■ to-day. Forty-three per cent, of I them came from Palmerston North.

■':■■ Cr, Catley stated that for the. previous year the average number of occupied beds was lt>3. Cr. Ryder: There arc many ratepayers who possibly have an idea that the three representatives are not very live men. Tory little goes out to the Press, and they don't get much, in-, formation. I can assure Cr. Gimblett that we are finythJng but dead men. One of the biggest stumbling-blocks in any district is charitable aid and the hospital rate. I don't know how it is going to be kept <ip in future; it is ;onc of the greatest problems before the country to-day. People of the working elass think -hey have a perfect right to go-.into a lovely hospital, get attention, and let the man ou the land 'pay. I am pleased that the chairman t.as shown us how many patients come out of the borough of Palmorston North. •The country people do not make use of the hospitals to th 3 "XU.nt that the people of the towns do.

Cr. Jensen asked what was the average cost per patient per day. The chairman said he did not have the information with him; but ha could state that the cost per occupied bed per annum was £163. Cr. Gimblett: That question will be discussed at the conference to be called shortly.

Cr. Jensen: The charge should not be below what it actually costs. The chairman stated that the charge was 2s per day, while the cost per, day

was 9s 7d, including children, for whom only 6s per day was charged. Cr. .Gimblett: Does that include buildings and everything? The chairman: No.

Cr. Jensen said that, in order to provide accommodation for all the people who needed attention, it -would be necessary to increase the hospitals two or three, times. He expressed the opinion that the people who were.best able to pay were encouraged not to go to hospitals. As long as;jthat was so, it might be expected that the hospitals would have to be run at a loss. Cr. Gimblett thanked the chairman for the information he had supplied. He added that he was not making a charge of extravagance against the Board, but was opposing the present system of levying the taxation. The counties would have to take a stand. Chiropractic Suggested.

Cr. Ryder said that for some time past he had been endeavouring to have chiropractors admitted to practise in hospitals, but at present this was. impossible. It would not eventuate until legislation was secured for the purpose; and he was sure that it would be a big factor in bringing, down the costs-in the hospitals of the country. Recently a. ease was turned out as a hopeless wreck, but with a month's chiropractic treatment the patient was able to go back to work. ' Cr. Kilsby: What would the B.M.A. say about it?

Cr. Ryder: Never mind. Cr. Catley mentioned that while Palmerston North supplied over forty per cent, of the patients, it only paid. 20 per cent, of the levy, and had more bad debts than the country districts. What would be the county's position to-day if it were associated with Wellington? Advantage of Centralisation. ,

The chairman: As regards our association with Palmerston, it is not so bad. By having our hospital there, we. have the advantage of the bestmedical men of this district who are dwelling there, many of whom are honorary surgeons or physicians to the hospital. The discussion then ended, the account being passed, with the adoption of the Finance 'Committee's report.