NATIONAL HEALTH

Wairarapa Times-Age, 3 May 1938, Page 7

NATIONAL HEALTH

and material necessary to the safeguarding of health and the efficient treatment of disease and should also include medical and nursing services for maternity cases. In addition to hospital services nursing services should be available for those parts of the country which are too far distant to benefit from Hospitals,and for such cases that may occur where removal to Hospital owing to the nature of the case is not practicable.

It is important that the benefits should be restricted to essentials as otherwise the scheme may become too heavy a charge particularly upon the smaller wage-earners. FINANCE.

The method of finance is a great importance, and the Farmers’ Union considers that it should be entirely financed by direct contributions. At the present .time although patients who are able to pay are expected to pay after treatment at Hospitals, it has been stated that only one in five of the patients at the Public Hospitals in New Zealand pay for treatment. As this liability fall on the patient at a time when sickness has reduced or eliminated his earning capacity it becomes to the more decent a worry and to the more careless a means of avoiding payment altogether. A satisfactory scheme would mean that provision was made for future illness by people while they were in health and employment. We suggest that there should be a charge at a flat rate per pound on the wages or incomes of all individuals (including Maoris) to finance the scheme. There should, however, be no charge on the income of Companies or other Corporate Bodies. The funds of the scheme should be vested in an independent Controlling Authority and not in the Government or the Crown, and should in no circumstances be available to the Government any more than those of other private corporation or individuals as they would be in fact the private property of the contributors. HOSPITAL FINANCE BURNING ISSUE WITH RURAL COMMUNITY. IMPOST ON RATEPAYERS. This is a burning question with the rural community of New Zealand, andthe present system of financing hospital expenditure involves a heavy impost on rural ratepayers that is a matter of great concern to them. The increased urban population, both actually and relatively to the rural population, has unavoidably increase hospital expenditure, and the point has been reached where the demand on the country districts is becoming so heavy that the system threatens to break down, or at least fail to provide foi Hospital facilities keeping pace with the growing needs of urban populations. While our towns and cities were small the present method of finance worked well enough and though no fair in its incidence it did not serious

ly penalise the country ratepayers. During this century, however, the position has changed materially with the rapid growth of the towns and cities, | and the hospital rate is now a serious I and very unfair charge on farmers. It must be stressed that the farmer cannot pass on any of his charges. He must sell in the world’s markets, but he must buy in New Zealand markets at high prices swelled largely as a result of public expenditure in the past. We have seen a worsening of the economic position of the farming industry over the last fifteen years. It must be stressed that this is due to a great extent to the fact that the farmers’ costs of production have increased and his net returns have tended to diminish. This process cannot continue, and every means by which it can be checked should be adopted. The incidence of hospital taxation | is one of the avenues by which relief can be given to the farmer, and when we realise that hospital expenditure has increased from approximately 10s per head in 1914-15 to approximately! 17s per head at the present time, it will be seen that the burden of rating for hospital upkeep must have increased very considerably. It may be argued that while a large proportion of this money is raised by rates from | rural districts, a large amount of it is | raised by rates on city properties. It must be pointed out. however, that, a great deal of this rating on city pio- > perties. i.e.. on those used for com-’ mcrcial purposes, is passed on to the : public in the form of a part of the i cost of the goods they consume. The; farming industries are the mam | sources of exportable products in ..et. . Zealand and are also large consumers. | Eventually a large portion of this in-. I creased cost is passed on to them rank-1 ing it difficult for them to compete I with rival countries such as the Argon- ■ tine. The effect of this has been ex-; perienced by members of my organi- | sation, and accounts for their making ’

continued representations to the Go l . - eminent of the day on this subject. During the last ten years the Annual Dominion Conference of the New Zea-

land Farmers’ Union has made repeated representations to the Government ■on the subject. At the present time it is estimated that rural ratepayers con-

tribute 53 per cent of Hospital levies, whereas city and town dwellers find 47 per cent. On a population basis urban dwellers would probably contribute approximately 69 per cent whilecountry people would contribute 40 per cent. It is claimed by my organisation that there should be some relation between the number of people availing themselves of the services of the Hospitals and the payment which is made by them for that purpose, i.e., the city people make much greater use of Hospital facilities than do countrypeople, and at the present time they contribute a lesser share of the cost. It is submitted that the flat rate levybasis of taxation on personal income for Hospital expenditure should provide the. funds for this purpose. The raising of part of the money by rating and through the Consolidated Fund would mean in effect that the farmer was still not receiving the relief from Hospital taxation to which he is justly entitled. It must be stressed that my organisation would not support a Nationl Insurance Scheme which was not financed by direct contributions and which gave no relief from the present inequitable system of taxation. GOVERNMENT’S PROPOSALS. Dealing in detail with the Government’s proposals—(a) Universal general practitioner service; (b) Hospital or Sanitorium treatment for all; (c) Mental Hospital care and treatment for the mentally afflicted; (d) Medicines; (e) Maternity treatment including the cost of maintenance in a Maternity Home. These are supported by the Farmers’ Union subject to the following observations:— (1) That there should be at all times free choice as between the doctor’ and patient: (2) That the present relationship between doctor and patient should continue unimpaired; (3) That the position of family doctor should be retained and encouraged; (4) That nothing is done that would make the medical profession State employees or interfere with their professional freedom; (5) That these services be financed entirely by direct contributions; (6) That some provision should be made in the scheme for the private and independent medical aid and Friendly Societies now in existence. These Societies have been a very useful and valuable part of our national life and we feel that they should be encouraged to keep in existence. We would stress this.

Hospital finance is now proving burdensome to the farming community as already indicated, and there is urgent necessity for some improvement in the method of financing, otherwise there is grave danger of the system breaking down. The bearing of the proposals of the Government on this question are not at all clearly indicated, but from the reference in the report of Mr Maddox where an allowance of £840,000 is made for hospital treatment on the basis of a grant of 6s a day per occup-

ied bed, it would seem that no direct relief is intended, but that additional payments for patients amounting to £570,000 is provided for, and to some extent that would be a relief to the burden of hospital rates. But it seems obvious that the operation of the scheme will call for largely increased capital expenditure for which no provision is made, and for a considerable increase in operating expenses which will, in a considerable measure, off-set the above gain so that the net result apparently will be to increase rather than diminish the burden of hospital rating upon the rural community. If this is a correct estimation of the position, my organisation must register a most emphatic protest to the ignoring of this most pressing matter and the failure of the Government to deal with the position. UNION’S ATTITUDE. We advocate: — (1.) That the scheme shall be controlled by a board consisting mainly of representatives of hospital boards, and medical practitioners, with representation for farmers, workers, and employers, and the Government, free from outside influence or control; (2) That the funds be vested in the board; (3) That the principle of the scheme be that of individual and family health insurance; (4) That contributions should be universal and benefits available to all contributors. A scheme on these lines would involve practically no interference with the present relationship between doctor and patient, and would avoid the necessity for elaborate administrative arrangements. Mr Mulholland continues: — A serious danger with a scheme in which all expenses for medical attention are met without a liability to the patient is that patients will tend to require an ever increasing amount of attention for trivial matters which otherwise would not require treatment at all. This may so overload both the scheme and the medical profession that proper attention is not given to cases of real illness. To guard against this, I suggest that the patient should be required to bear, say, the first £2 of the expenses for medical care. Owing to shortness of time allowed for consideration of the Govern-' ment’s proposals I have not the endorsement of my organisation for this suggestion, but I am confident that they will support it. In conclusion I wish to remark on the short time allowed for consideration of the Government’s proposals anc’ tt the paucity of information that has been available. In view of the complexity of the considerations involved and the farreaching possibilities of a health insurance scheme, I would urge that the Bill should contain the fullest details and that after it is printed ample time should be given for its full examination by all parties interested. At least three months should be allowed and during that time it should be submitted to the examination of experts in the various fields which it covers.

VIEWS OF FARMERS’ UNION ATTITUDE DEFINED. COMMENT ON GOVERNMENT'S PROPOSALS. (By Telegraph—Press Association.) WELLINGTON, This Day. The following statement was made today by the Dominion President of the Farmers’ Union, Mr W. W. Mulholland, to the Select Committee on National Health and Superannuation:— The attitude of the New Zealand Farmers’ Union with regard to National Health Insurance and Superannuation is expressed in the following resolution which was carried at our last annual conference in 1937: — “That the Government be asked to introduce a national scheme to cover sickness and old age which shall be (1) National; (2) Adult; (3) Contributory; (4) Absolutely protected.” The Farmers’ Union feels that the institution of a sound scheme of National Health Insurance would avoid much hardship and a good deal of the poverty which follows in the wake of a serious illness in a family of slender means. Freedom from worry on account of financial liabilities, and relief from anxiety, we feel would tend to hasten convalescence and reduce the danger of too early a return to work with the consequent liability to future trouble. There would also tend to be a reduction in the amount of serious sickness and a decrease in the period of invalidity because of early diagnosis. The main principles which my Union considers should guide the formation of a National Health Insurance policy are:— (1) The Finance and Administration of the Health and the Superannuation schemes should be entirely separate and each should Jje complete in itself. (2) The administration of the scheme should be carried out by an absolutely independent body entirely free from political control and having complete control of the funds which must be vested in that body. (3) That it be of universal application and all contributors should benefit. (4) That the contributions be compulsory on all adult individuals and that it be completely supported by the contributions of the beneficiaries. (5) That there should be the fullest freedom of choice as between doctor and patient. (6) That the control of the scheme should be as decentralised as it can possibly be consistent with the maintenance of uniformity in general policy. (7) That it should give relief from the present inequitable system of taxation for Hospital upkeep. (8) The scheme should be designed as far as possible so as to retain the keenness of the medical profession and to maintain the high professional standards now in existence in New Zealand. BENEFITS. Broadly, it is considered that the benefits of the scheme should be available to all contributors and their dependents, and it is considered that these should include facilities to obtain all medical and related services