Class-Distinction Bogey

Sun (Auckland), Volume II, Issue 552, 3 January 1929, Page 1

Class-Distinction Bogey

RICH AND POOR IN HOSPITALS

Payments of Patients

ARE persons able to pay more than the present charges utilising- the public wards unduly; and what provision should be made for them?”

The appendix to the annual report of the Department of Health propounds this question, and states: “It seems obvious that many people who cannot afford the high cost of private treatment are forced to use the public hospitals, but are in a position to pay more than £ 3 3s a week for their treatment and do not wish to add to the burden on the public funds.” Fees of all descriptions received by hospital boards during the year, including payments for inmates in charitable institutions and district nursing and excluding fees received from other boards and the Government amounted to £382,218 this year, as against £393,835 in 1926-27. The amount received per occupied bed in the general hospitals showed a slight increase from £63.7 in 1926-27, to £64.9, but the average for all hospitals and sanatoria administered by hos-, pital boards dropped from £67.6 to j

'■ £65.3. and the fees received by the department’s institutions dropped from £162 to £159.6. The average of all hospitals, board and departmental, fell from £77 to £74.1. INCREASING COST “Patients’ payments have now become a not inconsiderable portion of hospital revenue, constituting 20 per cent, of the total revenue of hospital boards and departmental boards,” states the report, “and it has shown a very much greater proportionate increase than hospital expenditure. In view of the increasing cost of hospital service, due to recent development in medical science and the increasing burden on public funds, the question is ever present of the adequacy of fees j charged and the necessity of those i able to do so paying the cost of treat-

j ment given them.” j Though the Hospital Boards’ Asso- ! cia.tion had recommended boards to ! raise their fees from 9s to 12s a daj', i this increase did not approximate the : full average cost of hospitals, and as | the institutions were no longer con- ■ fined to the destitute, the question of i ensuring that the full cost of treatment was recovered from those able to pay was still to be considered. Continuing, the report says: “In America they appear to have solved the problem of rich and poor, but not the middle-classes. The wealthy are freely catered for in the private Avards of many of their hospitals. In London. as in New Zealand, the needs j of the poor and the lower strata of the ! middle-class appear to have been fairly I well met; but the middle class proper {and the well-to-do generally are not | xjrovided for except by private hospitals. To provide treatment in public hospitals for everyone would j ine\'itably necessitate classification of | patients into those for public, interi mediate, and private Avards. If such ! classification Aver© not made it would ; inevitably follow that the fees collected would suffer-, and it is a ques- . tion noAV wkether many people do not evade payment for treatment in the j public wards who, if the public wards | were retained for those of poor ciri oumstances and those in somewhat | better circumstances were afforded i the choice of intermediate wards at a ; moderate charge, Avould not under - i take to pay such fees and enter such | wards. Having disclosed his circumi stances, to the extent of undertaking jto pay for treatment, he Avould have ! no excuse for avoiding payment.

j CLASSIFICATION At present, there being none other but the public ward, there is less inducement for him to disclose his circumstances and every inducement to plead inability to pay. It is hardly likely that many people in a position to pay the moderate fee for an intermediate ward would ! of choice enter the public v/ards.” “The class-distinction bogy has possibly been i*aised too much hi regard i.t* the classification of patients, though ; theer are possibly, not in XeAv Zea- ‘ land, a great many people who could be classed as destitute and unable, to ] pay an thing toAvard -heir treatment. and it is not easy to state definitely ; Avhether or not the distinction of pub- - ! lie Avards and pay Avards is required in New Zealand. If so, and better fees ! collection resulted therefrom, the obj jections of class distinction should not be allowed unduly to prejudice the decision. Class distinctions occur and 2 will occur, but there is no reason why * just as efficient service should net be ; rendered to the needy. Take, for example, the railways: class distinction is observed in that one can travel first or second, but both classes arrive at : their destination in the same degree of safety at precisely the same time.” : The appendix says, however, that classification would present difficulties, diet being an esesniial part of treatment, and surroundings having an i effect on patients-