1.5 
Re 
¢ 
MAJORITY REPORT. 
capitation rate is based on an experience which shows that 
roughly half the persons entitled to medical benefit do in fact 
receive some attendance during the year. It would probably be 
contended that practically all pregnant women would require 
attendance at some period during their pregnancy (apart from 
any attendance for the purpose of examination) and that the 
doctor’s obligation would be regarded as double the risk in ordinary 
cases. On this basis the fee for a general seven months’ liability 
would become 10s. 6d. This charge would not arise in the 
case of insured women, since the service is covered by the present 
medical benefit. 
339. The other medical service for which provision would have 
to be made would be the risk of the doctor being called in to 
attend at confinement in cases beyond the skill of the midwife. 
An estimate of a fair payment to cover the risk of having 
to attend at the confinement has been arrived at from informa- 
tion, obtained from Local Authorities, as to (1) the total number 
of cases in the areas of those authorities attended by midwives ; 
(2) the number of these in which doctors were called in by the 
midwives, under the Rules of the Central Midwives Board, and 
a fee claimed from the authority ; and (3) the total amounts paid 
in fees to those doctors. This, for various reasons, does not give 
the exact average cost, spread over all confinements, of the 
aggregate fees paid where doctors were called in. The. data 
for a precise adjustment do not exist. But the margins of 
possible error are not great, and it may fairly be inferred that a 
charge of 2s. 6d. per confinement attended by a midwife would 
yield a fund sufficient to defray all the doctors’ fees payable under 
existing conditions. Under a scheme of the kind under con- 
sideration, there would, however, be a large increase in the 
number of cases in which the doctors were called in, and to 
cover this increased risk of attendance a higher fee would have 
to be paid per case accepted. Probably 4s. would suffice, but 
to avoid an under-estimate it has been taken at 5s. 
340. There remains to be considered the amount to be allowed 
by way of cash benefit. Though much general evidence on the 
question of the absorption of the present maternity benefit by the 
doctor's or midwife’s fee has been received the figures supplied 
to us have varied within wide limits. The average fee now 
charged by midwives would seem to be about 30s. and the amount 
available for other purposes in the case of women entitled to 
only one maternity benefit would thus be about 10s. We feel, 
however, that this sum would be too small to be of much prac- 
tical value and we could not recommend a lower cash payment 
than 20s. 
341. On this basis the cost per case would work out as 
follows :—