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

MAJORITY REPORT. 15% pr —S of some general rules which would determine the order of priority. A recommendatory benefit is open to the administrative objection that it creates expectations which can only be pat- tially fulfilled and is, therefore, likely to give rise to a continuous agitation for increased financial provision. 356. But, apart from the administrative or social objections, the proposal seems to us open to criticism on medical grounds. The fundamental difficulty is that the selection has to be made by lay administrators on the basis of reports by doctors who are each reporting on their own patients and necessarily can have no opportunity of considering the cases in relation to one another. It must in practice be extremely difficult for any committee, even with expert guidance, to arrive at any true estimate of the relative needs of a number of cases on the basis of reports which in the nature of things cannot be rela- tive. Further any system of priority must tend to give a preference to the cases in which the need for treatment is most obvious because they have been so long neglected. In practice it would mean that most of the money would be spent on the treatment of <* end-results,”’ and however long such a scheme re- mained in operation the dental state of the younger insured people at the end of the time would be nearly as bad as at the beginning. 357. So long as Approved Societies are administering an addi- tional benefit with only a limited amount of money available, the selection of cases on the basis of urgency is justifiable, and Societies could not be blamed for adopting the method of selection which promises most immediate reduction of their sickness benefit claims. But the establishment, as a permanent part of the insurance system, of a dental benefit which made no provision for conservative treatment would be open to grave criticism. Theoretically this difficulty could be avoided by a suitably devised table of priority, but in practice this would be very difficult to frame, and the tendency of any system of selection must be, as already explained, to concentrate the expenditure on the cases least hopeful from a medical point of view. It has to be remem- bered also that a statutory benefit is judged by a standard very different from that applied to additional benefits. An additional benefit is in the nature of a windfall ; it is befter than nothing, and the insured person thinks himself lucky to get it. But a statutory benefit is on a different footing, and is subject to far more critical scrutiny. A selective benefit which makes no adequate provision for the treatment of early cases would be in our opinion a most unfortunate policy to adopt. CoST OF A RESTRICTED SERVICE. 358. As already indicated, an unrestricted dental service could not be provided for less than 4s. a head per annum. Indeed, it

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