168 
MAJORITY REPORT. 
Tr —_———— 
381. Sanatorium benefit was, until 1921, administered by the 
Insurance Committees, but in that year was discontinued, the 
responsibility for the institutional treatment of tuberculous 
insured persons being transferred to the Local Authority, which 
already dealt with the uninsured, and the responsibility for 
domiciliary treatment remaining part of the content of medical 
benefit. 
MEDICAL BENEFIT. 
382. Taking the above five points in order, we have first to 
consider medical benefit. The normal arrangement by which 
medical benefit is made available to insured persons is that the 
Insurance Committee form a list of the doctors and a similar list 
of the chemists in the area who are willing to treat or to provide 
medicines for insured persons at a scale of remuneration and 
under conditions agreed upon by the Committee subject to the 
approval of the Minister. Tt was originally intended that these 
contracts should be framed locally, and that they might vary 
considerably in nature according to the particular conditions of 
the several areas. It was found, however, that in practice the 
whole of the arrangements leading up to the contracts had to be 
made centrally by discussion between the Departments and 
representative bodies of practitioners and chemists. The terms 
so agreed form the basis of the local contracts throughout 
the country. Tiocal modifications are of a comparatively unim- 
portant character (App. I, C, 35-36). 
383. Thus what might have been a very responsible and 
difficult piece of work has in fact so far as the Insurance 
Committees are concerned, been reduced to a routine capable 
of being performed by the local officials under a minimum of 
supervision by the Committees. The really responsible part of 
the duty is performed by the Central Departments. And once 
the lists are drawn up and the contracts signed, what remains 
for local action is merely the keeping of the index register up to 
date, keeping similarly the list of insured persons for whom each 
doctor is responsible, calculation and issue of the periodical pay- 
ments to doctors and chemists and issue of the medical cards—all 
of which are essentially matters of machinery. 
384. Another matter under this head in which the work of 
Insurance Committees has been substantially curtailed by the 
force of circumstances is the pricing of chemists’ prescriptions. 
Originally it was intended that each Committee should do this 
work for its own area. But in consequence of the uniform tariff 
agreed upon centrally, it was found much more convenient and 
much more economical to set up ** Pricing Bureaux » to do this 
work on a uniform method for large areas of the country. In 
England and Wales there are 15 of these bureaux; in Scotland 
one for the whole of that country. The duty of the Insurance 
Committees in this matter is thus reduced to the routine opera-