OZ 
MAJORITY REPORT. 
of the insurance medical service and speaking of the work of 
the insurance practitioner he says :— 
“ The work is carried out under certain disadvantages, 
chief among which is the lack of co-ordination between the 
services of the insurance doctor and those of workers who 
have devoted intensive study to special provinces of the 
great territory of medical practice. The inclusion of such 
consultant services becomes more and more requisite year 
by year and is one of the most pressing of present needs. 
When the insurance medical service shall have been com- 
pleted by being brought into organic relation with other 
branches of medical work as part of a comprehensive scheme 
of medical services, and not until then, will its full capacity 
for public usefulness be made manifest.’ 
66. We have devoted some space to this question, not only 
because we think it is of the highest importance in the Scheme 
as 1t stands and in relation to the various and widely different 
proposals for extension and reform which have been put forward, 
but also because we feel that it raises a cognate question of great 
difficulty. Tf medical benefit were thus extended for the present 
insured class, we are forced to consider the position of those 
persons of moderate means who are somewhat above the 
present income limit for insurance purposes but to whom 
the payment of a specialist’s or consultant’s fees is never- 
theless a serious matter. Tt is assumed, probably rightly, 
that such persons can reasonably be expected to meet 
charges for general practitioner treatment, and are there- 
fore properly excluded from the Scheme in its present form. But 
in respect of major operations and similar services, for which it 
is usually necessary that the patient should be an inmate of a 
hospital or similar institution, it might with reason be contended 
that the claim which could be advanced on behalf of some of 
these persons to be protected by some form of State insurance 
against the risks involved is scarcely, if at all, less valid than the 
claim of certain of the insured population, and that to provide a 
full specialist service for the insured, while leaving these adjacent 
classes to their own resources would bring about a position diffi- 
cult to justify on grounds of public policy. This point of view 
was put before us by the National Association of Trade Union 
Approved Societies, who submitted ‘‘ that if the difficulties con- 
nected with the collection of contributions can be surmounted, 
medical benefit should be available to persons not employed 
within the meaning of the Act, whose total income does not exceed 
£350 a year, and that medical benefit other than general prac- 
titioner treatment should be provided for persons whose income 
exceeds £350 a year, but does not exceed a higher figure to be 
determined later. . . . .” (App. XCII, 102.) We desire 
to emphasise in the present discussion of the scope of medical 
benefit the problem of specialist services for the non-insured of