Report of the Royal Commission on National Health Insurance

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Monograph

Identifikator:: 1740277147

URN:: urn:nbn:de:zbw-retromon-132094

Document type:: Monograph

Title:: Report of the Royal Commission on National Health Insurance

Place of publication:: London

Publisher:: Stationery Office

Year of publication:: 1926

Scope:: XII, 394 S.

Digitisation:: 2020

Collection:: Economics Books

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Document type:: Monograph

Structure type:: Chapter

Title:: Chapter XII. Consideration of certain major problems

Collection:: Economics Books

189 MAJORITY REPORT. of medical benefit must depend to a very great extent upon the cordial acceptance of the financial terms of the contract by the medical profession and upon their approval of the Regulations under which their daily duty towards the insured persons is carried on. We will accordingly devote some space to a review of these matters. THE METHOD AND SCALE OF REMUNERATION. 420. A full account of the course of the arrangements for remunerating the insurance practitioners since the inception of the Scheme up to the present date will be found in paras. 105 to 142 of Section C of Appendix I to the Minutes of Evidence. The earlier parts of this are now mainly of historical interest but we may describe briefly the arrangements since the beginning of 1920, when the so-called ‘‘ floating sixpence ’’ was abolished, with the consequence that the discussion of the capitation fee became simplified by the elimination of the drug factor. On that footing the Insurance Acts Committee of the British Medical Association, acting on behalf of the general body of insurance practitioners, claimed that the fee should be 13s. 6d. The Minister, acting for the Insurance Committees, who, in fact, make the individual contracts, did not accept this figure but offered 11s. The difference was referred: to arbitrators who determined the latter figure and this remained in force from 1st January, 1920, to. the end of 1921. During 1922 and 1923, a reduction to 9s. 6d. was accepted by the Profession on the ground of the urgent necessity for national economy. On a further proposal by the Minister for the reduction of the fee to 8s. 6d. for three years, or 8s. for five years, there was again resort to arbitra- tion with the result that 9s. was determined for the three years ending 31st December. 1926. 421. New terms must be settled before the end of 1926 and, obviously, must take account of any change (whether resulting from our recommendations or otherwise) in the nature and volume of the services to be rendered by the practitioners under their contract. 422. Although the Minister's offer was for less, and the doctor’s claim for more than was, in fact, awarded at the last arbitration, and although the Approved Societies made at the time very strong representations for a more substantial reduc- tion of the fee, the award appears to have given, on the whole, as much satisfaction as is possible in such circumstances. In assessing the effect of the award upon the actual remuneration of practitioners with lists of various sizes, the existence of the large mileage grants must be kept in mind. These provide substantial additions to the capitation income of many rural practitioners. An account of the scale and methods of alloca-

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