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 X. Proposals for extending medical benefit

Collection:: Economics Books

128 MAJORITY REPORT. whatever it might be, would be responsible for the efficiency of the service provided, and probably they would feel it was necessary that the service should be under their direct control ” (Q. 23,834). ‘ Whenever this question has been discussed, particularly when it was discussed with representatives of the Medical Profession in 1919, the greatest possible importance was attached to communication between the practitioner and the consultant with regard to the case . . . That, I think, is one of the weaknesses of the present system that you cannot secure that kind of close co-operation, and it is doubtful whether you could ever get the co-operation carried out satisfactorily unless the consultant and the practitioner were both responsible directly to the same body’ (Q. 23,835). °° While it would be very desirable to utilise hospital premises by renting them wherever possible, the system could not be so satisfactorily worked by entering into contracts with the hospitals to provide the service *’ (Q. 25,833). AVAILABILITY OF OUT-PATIENT TREATMENT AT HOSPITALS. 272. It appears that the extent to which specialist treatment and advice are obtained at the hospitals varies greatly in different parts of the country, and even as between different medical men practising in the same area. These variations result from :— (1) differences in the accessibility of patients to hospitals; (2) the different customs of different hospitals, as a whole; (3) personal characteristics of particular members of the medical staffs of hospitals; (4) differences in the attitude of practitioners and in their relationships to particular consultants ; (5) differences of attitude of insured persons. 273. In the large centres of population, in the neighbourhood of the great hospitals attached to medical schools, there is little difficulty in obtaining specialist treatment. Second opinions are also readily obtained in the majority of cases by those practitioners who take a not unreasonable amount of trouble to obtain them. At some of these hospitals, great pains are taken to convey to the practitioner information as to treatment which has been given, or advice as fo diagnosis or treatment, even though he should have himself failed to send particulars of the case to the hospital. The position is on the whole less satis- factory in places in the immediate neighbourhood of large hospitals not attached to medical schools. In such cases the general practitioners have probably less confidence in the opinion of the staff of the hospital, which includes a considerable propor- tion of men who are themselves general practitioners and the former, therefore, are not so ready to seek the advice of the latter. 974. Distance from the hospital plays, obviously, a very important part in determining the extent to which insured persons

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