Full text : Report of the Royal Commission on National Health Insurance

243

APPENDIX A.

ET ——f————

with the standard is however of some significance. It appears to indicate
that in the earlier years of the period covered by the statement some
cause was operating to produce an abnormally low volume of claims
for disablement: benefit and that the trend throughout the period has
been towards the development of what may be regarded as normal
conditions. We are inclined to think that this is the case. It appears
to us that the very low disablement claims of the year 1919 were intimately
connected with the low sickness rates of the later years of the war period,
and were attributable to the same economic and other conditions which
produced those low rates. If this be so, the steady growth of disablement
claims for about a decade from the year 1914 (when this benefit first began
to he paid) which those concerned were dctuarially advised to expect,
was sharply interrupted by forces set up by the war, and has gradually
reasserted itself as those forces have abated. In the most recent years
of the period covered by the statement the growth of disablement claims
may, indeed, have been accelerated by economic forces of a directly
opposite kind. Widespread unemployment, so far as it influences the
sickness experience of Approved Societies, would be expected to have its
most pronounced effects on the weakly and debilitated class who supply
presumably the major part of the claims for disablement benefit. We are
however compelled to say that the recent growth in the cost of disablement
benefit has confronted us with serious difficulty in settling the provision
to be made for the future. We have suggested a theory to explain it,
but this is no more than a theory, and it affords no great assistance in
determining the probable weight of the charge when permanent conditions
have been reached.
16. Turning now to the Selected Societies Experience, the rates of sickness
 and disablement obtained will be found respectively in Table A (M.)
and Table B (M.) appended to this Report. In these tables are shown
for each quinary group of ages, the basic rate of sickness (in weeks of
claim per annum) at the central age of the group, the years of life
“ exposed to risk *’ in the group in each of the years 1921, 1922 and 1923,
the corresponding ‘¢ expected weeks of claim, the related actual weeks
of claim, and the proportion (per cent.) which the actual weeks hear to
those expected. The average proportion for the whole body of persons
imsured in these Societies is shown opposite the totals for each year. It
will be seen that so far as sickness benefit is concerned, there is a tendency
for the claims to be above the general average at the younger ages and
to be below it at the middle ages. This feature is not, however, of much
importance financially and the average percentages for all ages in each
of the three calendar years may be taken as representative. These
percentages, viz., 66 in 1921, 77 in 1922, and 71 in 1923, are not greatly
different from those shown above as representing the experience of the
whole of the insured male population. Such differences as exist may be
partly due to differences in the distribution of the respective populations
with reference to age, and partly to the fact that the statistical treatment
of the Selected Societies Experience is practically exact, while that of
the whole population is approximate, as explained in para. 13.
17. In regard to disablement benefit the Selected Societies Kxperience
while exhibiting, in the aggregate, the same close relation to the
experience of the whole insured male population as exists in the case of
sickness benefit, presents quite different features when the experience is
examined at the individual age-groups. The claims at the younger ages
far exceed the ¢ expectation,” but the ratio of actual to expected diminishes
steadily until an approximately constant minimum is reached at 50 and
all higher ages. Taking the year 1922, for example, the claims for disablement
 benefit at ages under 30 were about 150 per cent. of the expectation;
 the proportion steadily diminished, falling to 104 per cent. at ages
35 to 40, and to 77 per cent. in the next age-group; it continued to
fall, and was no more than 50 per cent. at ages 50 to 55; thereafter
it averaged about 54 per cent. This feature is not easily explained. We
            
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