Report of the Royal Commission on National Health Insurance

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Monograph

Identifikator:: 1740277147

URN:: urn:nbn:de:zbw-retromon-132094

Document type:: Monograph

Title:: Report of the Royal Commission on National Health Insurance

Place of publication:: London

Publisher:: Stationery Office

Year of publication:: 1926

Scope:: XII, 394 S.

Digitisation:: 2020

Collection:: Economics Books

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Document type:: Monograph

Structure type:: Chapter

Title:: Chapter VIII. The approved society system

Collection:: Economics Books

100) MAJORITY REPORT. RE I 3 ~ benefits to which members of different Societies are entitled, and it is contended that these Inequalities are too great to be defensible in a State scheme of insurance based on compulsory contributions at a uniform rate. Thig result has been claimed, however, by others as an advantage of the system, in that it enables the insured to group themselves in such a way as to secure the maximum advantage from their contributions and so to neutralise whatever inequity would result from the applica- tion of a flat-rate contribution to all insured persons, regardless of the variations in their several risks as affected by occupation or environment, or in their economic condition either as classes or individuals. The Act contemplated the free formation of Societies empowered to recruit their membership on any basis they might see fit to adopt. In the result a considerable process of segregation took place, so that there are few Societies which can be regarded as being in any way microcosms of the insured population as a whole. Those which are predominantly built ub. on an occupational basis must inevitably reflect the health risks of the trade concerned: those whose membership is pre- dominantly centred in certain areas must be affected by the relative healthiness or unhealthiness of the districts in which the bulk of their members are to be found. And it follows by an extension of the same reasoning, that even when a Society ostensibly opens its membership to all without distinction, it may be far from representing a fair sample of the population taken as a whole. Such a Society may be stronger in one part of the country than in another ; even if its membership be spread over the whole country, it may not be uniformly strong as between urban and rural areas, or as between manual and non-manual workers. As a consequence the Approved Society system is made. up of Societies resting on a segregation, conscious or unconscious, of members of varying health experience and health prospects. And as the criticism is most pointedly put, the system is accused of giving additional benefits both in cash and kind to those who having the best health experience require these things least, while withholding them from those whose needs have been shown to be sorest. The Scottish Miners’ Federation, for instance, say that *‘ no one marvels at the volume of pardon- able misunderstanding and personal resentment of the insured person regarding the provision of additional benefits, He never can grasp the justice of an arrangement that gives 15s. worth of sickness benefit a week in one Society and 20s. a week in some other Society for the flat contribution of 10d. a week. . . He regards the question as incapable of intelligent explanation and despairingly concludes that these disparities are nothing more or less than the product of an invisible evil genius entertainingly piling up an insoluble insurance puzzle >’ (App. X, 14). Mr. Alban Gordon states that * it is against the public interest that a member of Society A should receive far greater

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