The Private Patient
By WARREN POSTBRIDGE EVERYONE in a .sense is a private patient, in that he is a private person Who may at any moment become a patient and can then, under the National Health Service Act, go to his doctor and get any treatment that may be appropriate with- out payment. More properly, I suppose, a private patient is one who prefers not to take advantage of the Act, but pays his doctor for services rendered—perhaps assuming, probably erroneously, that he gets better served that way. All that is pretty clearly under- stood. The Health Act has been in operation long enough for most people to be famliiar with its working, at any rate as between doctor and registered patient. But when a hospital is involved the case is different. For there are differentia here between private and " public " patients which many potential private patients have not yet grasped ; it is worth while getting the position clear before they become actual patients.
One purpose of the Health Service Act, of course, was to ensure that every member of the community should be able to receive, completely free, whatever treatment, in hospital or out of it, his condition might require. But that free treatment is given only in the general, or public, wards, each containing anything from twenty to thirty beds. From the patient's point of view there are arguments for and against the public ward. There is, of course, no real privacy, though some hospitals have fitting curtains, which can be drawn at will, round each bed. Suffering, sometimes death, is present. The night is not always silent. Patients are "got up" at five or five-thirty in the morning ; visiting hours and the number of visitors are restricted ; there are no such amenities as telephones. On the other hand, patients get good attention, for a nurse, or more than one, is always in the ward, and many people prefer illness in company to illness in the solitude of a private room. And, of course, there is nothing to pay. For that reason more and -more Professional people and their families, of those middle classes which in many ways suffer more from financial stringency than wage- earners, are occupying beds in general wards rather than in private
It is a question of what is worth paying for, and how much. There are many people to whom privacy, particularly during illness, especially perhaps during recovery from a serious operation, means a great deal. For these -a certain number of private rooms are available, and it is usually easier to get into one of these than into a general ward, for which there are long waiting lists. Now comes the question of payment. The private patient is at a double disadvantage as compared with the " public " patient. He must pay for his room, which is reasonable enough ; the price may vary from fourteen guineas a week to twenty-three or more, according to the hospital and the character of the room. And he must also, unlike the " public " patient, pay for whatever surgical or medical services he needs.
The conditions regulating this payment are, I find, by no means generally understood, though they are set out clearly enough in the National Health Service Act and in the Regulations regarding pay-bed accommodation in hospitals issued under it. The Act itself prescribes that "accommodation in single rooms or small wards" may be made available for patients who undertake to pay the due charges for such accommodation. That refers to the room alone. It might be supposed that the patient, once installed, would be entitled to the same medical services as if he had gone into a general ward. There are some reasons why that should not be so ; at any rate, it is far from being the case.
Actually the Regulations create a double regime, laying it down that in respect of 85 per cent. of the private patients' beds no more than specified medical or surgical fees, as elaborately set out in seven pages of schedules, may be charged. For example, the max4rnum fee for minor operations is £10, for intermediate opera- tions £25, and for major operations (all listed-in detail) £50. There are various possible additions—for consultant physician, radiologist, anaesthetist, etc.—but in no circumstances can patients in any of these beds be charged more than 75 guineas all-in. The cost of a major operation, therefore, may amount to that sum, coupled with the cost of the room according to the period fot which it is occupied.
But that applies, as I have said, to only 85 per cent. of the private rooms. In regard. to the other 15 per cent. the patient makes his own arrangements with the physician or surgeon, the idea being that some patients, particularly if they are well-to-do, may be anxious for the services of some medical man who would not feel 75 guineas adequate remunnation. In that case the fee may be what it would be if no National Health Service existed. Fairly recently. two patients, known to each other, had the same operation performed. in- the same London hospital. The first of them paid 75 guineas ; the second, who (through certain fortuitous circum-
stances) found himself in one of the " unrestricted " rooms, paid 260 guineas, together, of course, in each case with the cost of the room. The fee for the same operation in a particular nursing home lately was 200 guineas.
In the main the unrestricted rooms may be ignored. No patient should need to find himself in one of them unless he deliberately _ enlists the services of a specialist whose fees are habitually above the level' permitted in the 85 per cent. of _the accommodation avail- able. Assuming therefore a major operation, and four or five weeks as an in-patient, the maximum cost may be reckoned at not much more than about £150. That is a quite sufficient burden for the middle-class patient, but it can be considerably lightened by mem- bership of one of the various provident associations which for. a moderate premium cover a large part of such hospital and other costs.
But an important question remains. Ought the gap between treatment in a public ward and in a private room amount to as much as £150? The Act definitely intended that it should. There was no particular desire to be tender to private patients. Nor indeed is there any reason for tenderness. But the private patient is taxed for the provision of the National Health Service as much as the public patient. Why should he not be entitled to the same medical and surgical services free as the general-ward patient gets free, paying simply a fair price for the room he occupies ? The answer to that question is admittedly not simple. The distribution of overhead costs is difficult. Moreover, if a private room could be secured at cost price, instead of at cost price plus 15 guineas, the demand would increase and far outrun the supply. (There are, in fact, a very few "amenity beds" in single or double rooms for which only a small fee-is charged and treatment is free.)
It may be argued that as public wards go in good hospitals today no one needs a private room. In fact, there are all sorts of reasons why one should—reasons of temperament, telephone to maintain business or professional and personal contacts, freedom to receive visitors at any time, room for one's possessions. People who think those amenities worth paying for should be allowed to enjoy them. But whether a condition of enjoying them should be payment for medical services which in all other cases the National Health Service Act provides free is a question that ought to be seriously considered when the Act is next amended.