H—3lb

RADIOLOGICAL AND PATHOLOGICAL SERVICES 45. The Committee did not enter into any detailed examination of the operation of these services. If the General Advisory Committee referred to in paragraph 52 of this report is set up, the Committee considered that this Committee should review the operation of these services after obtaining full information from the specialists concerned. PHARMACEUTICAL 46. The principal factors which in the opinion of the Committee have caused the heavy annual increase in the cost to the Fund of these benefits may be summarized as follows : (i) The general medical services benefits have encouraged the public to resort to doctors for trivial complaints, with the result that there has arisen a " patient-pressure " on the doctor which can only too easily be satisfied by prescribing medicine, towards the cost of which neither the patient nor the doctor contributes. This financial irresponsibility in the seeking of medical advice and the obtaining of prescriptions has undoubtedly led to a large measure of unnecessary and over prescribing : (ii) In recent years the use of new and expensive drugs has become much more general. (iii) There have been many instances of the unnecessary selection by doctors of the more expensive forms of medication, and there have likewise been instances of irresponsibility on the part of some practitioners in prescribing excessive quantities of drugs : (iv) There has been much unnecessary waste of medicine through loose methods of sanctioning repeats of prescriptions : (v) The wholesale cost of drugs has increased, and the greater duty and sales tax payable have resulted in proportionately increased prescription prices. In addition, the rate of sales tax has itself been increased : (vi) Many items previously bought over the counter from chemists are now prescribed. 47. It is apparent from the foregoing that a number of the factors contributing to the increased claims on the Fund for these benefits are matters in respect of which the medical profession can exercise no control. Apart from such factors, however, there remain a number of features leading to unnecessary or over prescribing in which both the public and the profession take some part. The Committee accordingly considered what recommendations it could make to act as a deterrent against unnecessary or over prescribing. 48. So far as the public is concerned, the Committee could see no method whereby the position could be improved other than the adoption of the principle of part payment by the patient of the cost of prescriptions. It is accordingly strongly recommended that, subject to exceptions in specific cases —e.g., the supply of insulin to a diabetic—the principle of part payment by the patient be adopted as the most effective measure to check the present trend. 49. So far as the profession is concerned, the Association recently drew the attention of all its members to the care which should be exercised in prescribing new and expensive drugs and the need generally for economy in prescribing. The Committee recommends (a) The revision and extension of the present Formulary issued by the Department with a view to its general adoption as a pattern for economy in prescribing. That would both lessen administrative costs and be an educative factor in diminishing costly prescribing.

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