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 XII. Consideration of certain major problems

Collection:: Economics Books

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 :—

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