308 
MINORITY REPORT. 
43. We submit that in so far as the incentive does exist it is 
inimical to the improvement of the standard of national health. 
In the main it only manifests itself in two ways: (1) by a 
judicious selection of good lives, and (2) by a reduction of expendi- 
ture on benefits. 
44. The absence of control by the insured persons is, in itself, 
to be deplored in a public scheme, but when it is remembered 
that the close interest of the members in the work of their 
Societies was designed to produce an incentive to efficient 
administration it will be realised that its absence assumes niuch 
greater importance. 
45. It has been claimed by many Society witnesses—and in 
certain parts of the Majority Report our colleagues appear to 
support the claim—that this incentive is a necessary and desirable 
feature of National Health Insurance. We propose therefore to 
examine the contention further. 
46. As we understand it, the theory is that the members of 
each Society would interest themselves in the management of 
the Society with a view to conserving the funds in order to 
produce a surplus at a valuation. 
47. The practice of rejecting applicants for membership who 
are thought to bring an abnormal risk means segregation of all 
good lives from all bad lives, with the consequent breakdown of 
the preventive and curative objects of the Act for those sections 
of the community which need them most. ** If by economical 
management is meant the exclusion by medical examination of 
those likely to be a charge upon Societies . . . . then the 
Union sees little virtue in it * (Medical Practitioners’ Union, App. 
NIL.VIIL, IS. 1). 
48. There is no doubt that witnesses have considered the main 
effect of the incentive to be the safeguarding of the funds against 
what they considered to be undue claims, and it is mostly in this 
respect that it has been effective. If the scheme were adminis- 
tered through a system which contained an element of uniformity 
the operation of such an incentive would be less undesirable, 
but when it is remembered that there is an almost complete 
absence of uniformity from the issue of a medical certificate to 
the payment of the benefit, the effect of an incentive with the 
purpose of economising on benefits is definitely vicious. Saving 
the funds by curtailing the benefits of the sick persons and forcing 
them back to work or otherwise leaving then to starve, is not a 
feature that is either economical in the long run, or moral in a 
State scheme, but that it is present there is no doubt whatever. 
““ Some of the Societies are inclined to apply too rigid a test when 
the alarming question of disablement benefit comes to their 
notice.’’ (Kinnear. 0.313)