H.—3l.

In respect of treatment in a maternity hospital maintained by a Hospital Board, payment is made from the Social Security Fund to the Hospital Board at rates prescribed by regulations of the 21st April, 1939. The rate of payment is £2 ss. for the day or days of labour, and 12s. 6d. per day for the fourteen days following the date of birth of the child. Where medical attendance is afforded at confinement by a Medical Officer in the Board's employ an additional £2 is payable from the Fund to the Board. The amount so paid to the Board must be accepted in full satisfaction of its claims in respect of the services to which the payment relates. Treatment in the State St. Helens Maternity Hospitals is similarly free of charge so far as the patient is concerned. Benefits in respect of treatment in licensed private maternity hospitals are governed by the contracts with the licensees. In every case payment is made from the Fund at the rate of £2 ss. in respect of day or days of labour and at the rate of I2s. 6d. a day for each of the fourteen days succeeding the date' of birth of the child. Of the 189 private maternity hospitals in the Dominion, 186 had at the date of this report entered into contracts to provide benefits. In some cases the licensees' contract requires them to accept such payments in full satisfaction of their claims in respect of the period mentioned, and in other cases they are permitted under their particular contract to make a specified additional charge on the patient. Of the 186 under contract at present there are 32 who have agreed to accept fees from the Fund in full satisfaction, 121 who are permitted to make an additional charge in all cases, and 33 who accept payment from the fund in full satisfaction for certain accommodation and are permitted to make an additional charge for other accommodation. Maternity benefits in respect of the services of obstetric nurses in the home are also subject to contracts with individual maternity nurses and midwives. For nursing attention at confinement, the fees payable from the Fund are set out in the contract as follows :— " (a) For services on the day or days of labour, the fee for a registered midwife, acting in the capacity of a midwife shall be two pounds (£2), and the fee for an obstetric nurse acting in the capacity of a maternity nurse (whether registered as a midwife or as a maternity nurse) shall be one pound (£1). " (b) For services during the confinement period, subsequent to the birth, of the child, the fees shall be — " (i) For a visiting obstetric nurse, five shillings (55.) a day for each of the fourteen days immediately succeeding the date of birth of the child. " (ii) For any obstetric nurse (not being a visiting obstetric nurse), thirteen shillings (135.) a day for each of the fourteen days subsequent to the birth of the child during which, in accordance with the contract, she resides on the same premises as the patient." In addition to fees for nursing services, provision is also made in the contract for the payment from the Fund of actual and reasonable locomotion expenses incurred by the nurse in affording the services. The normal fee for nursing attendance on a full-time domiciliary basis covering the full confinement period ending fourteen days after the date of birth of the child is £11 2s. where an obstetric nurse acts in the capacity of midwife (that is, without a doctor in attendance), and £10 2s. for an obstetric nurse acting in the capacity of a maternity nurse only. The normal fee payable to a part-time visiting nurse is £5 10s. or £4 10s. dependent on the capacity in which she attends the patient. These payments from the Fund must be accepted by the obstetric nurse in full satisfaction of her claim for nursing services in relation to maternity benefits. The number of obstetric nurses who at this date had entered into contracts to provide maternity benefits is 290. The general arrangements for medical services in relation to maternity benefits contemplated by the Social Security Act, 1938, involved the completion of contracts with individual medical practitioners. Offers of contract were circulated to practitioners on the 22nd April, 1939. In the ensuing three months only some thirty practitioners had notified acceptance. As the result of further negotiations with representatives of the New Zealand Branch of the British Medical Association, new arrangements affecting these medical services were proposed by them. These proposals wore ultimately given statutory effect, the relevant legislation being contained in sections 11 to 15 of the Social Security Amendment Act, 1939. The main details of the arrangements which came into operation on the Ist October, 1939, are as follows :— (i) In respect of medical services in relation to maternity benefits a scale of fees has been fixed by agreement between the Minister and the Council of the New Zealand Branch of the British Medical Association : (ii) Except in the circumstances explained in the three succeeding paragraphs, every doctor affording services covered by the scale of fees must accept the fees from the Fund in full satisfaction of his claim for the services : (iii) Any practitioner who formally notifies the Minister of his unwillingness to provide services in relation to benefits is ipso facto excluded from the arrangements. No payments may be made from the Fund to any such practitioner, and his fees are a liability of his patients. (Only six practitioners had at the date of this report notified their unwillingness to provide services in relation tb benefits.) The names of such practitioners are listed for public information at post-offices and departmental offices : (iv) Any practitioner officially recognized as an obstetric specialist is entitled to charge the patient an additional fee over and above that payable from the Fund. (At the date of this report twenty-two practitioners had been officially recognized as obstetric specialists.) Their names are listed at local post-offices, &c., for public information ;

7