MEDICAL TREATMENT FOR THE MIDDLE CLASSES [To the Editor of
the SPECTATOR.] SIR,—You invite my opinion on a scheme of Insurance pro- posed by Mr. Latham, which, put shortly, is that a voluntary hospital should undertake to provide accommodation for anybody who subscribes 15 a year to its funds. There are many objections to such a scheme. I grant that the need for providing medical, especially surgical, help to what are called the middle classes is great. But Mr. Latham's solution is not the right one.
It must be done by a separate organization. The voluntary hospitals have more than they can do at present to meet the needs of those whom I will call for brevity's sake the lower middle classes and the sick poor. With 14,000 people in London alone waiting for a vacant bed in them we cannot extend our "field of operations," and we are all working at super-pressure.
To give the right of admission to a subscriber of £5 would be to upset one of our most sacred traditions—i.e., that the question as to who should, or should not, be admitted is one to he settled by our Medical Officer. He is guided to his decision by the urgency of the case, by his knowledge whether a cure is possible, and also whether the applicant is in a position to pay for the help he requires to an outside doctor or surgeon. Most hospitals have a wage limit: In London and in most provincial towns there exists an organization which in London is called the Hospital Savings Association. No one can be a member of this above a certain wage limit. The members of this Association subscribe 13s. a year to the Association. This gives no right of admission, but if a member is admitted frees him from all charges and secures free treatment for him. The Association pays the Hospital so much for every member treated.
• What is needed for the middle classes and poor gentry—I hate these classifications, but they will be understood—is a
hospital where for a fixed sum to cover everything they could get what they need. There would be a fixed tariff :
Appendicitis .. • . £35 Kidney removed • • .. £60 Duodenal Ulcer .. 160 and so on. Then a patient would know exactly what he could order off the menu, and what he had to pay. Patients would only be admitted by request of their own medical attendant, Who would of course only send patients to this hospital, and attend them there, whom they knew were unable to meet the ordinary fees. The medical attendant would be paid an agreed proportion of the tariff charge, the balance going to the upkeep of the hospital.
If I were younger I would start such a hospital, if only for the sake of doing justice to the wonderfully good young doctors and surgeons we have, to whom the early years of a consultant practice are intolerably difficult.
I do not pretend to have gone into the figures carefully.
The prices of what can be ordered off the menu may have to be altered. This is only an outline of a scheme which would I think meet the need and be of great service to the community : and a hospital on such lines could, I think, be .run on a commercial basis.—! am, Sir, &c.,
London Hospital, Whitechapel, E.1.
KNUTSFORD.
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