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. {S0) — especially that of the British Medical Association, has been for the capitation method ; and we cannot believe that a system that has been in successful operation in practically all parts of the country for 13 years can be open to serious criticism. It embodies the salutary principle that it is to the interest of the doctor that his patients should remain in good health, or be restored to good health as quickly as possible. It directs attention to the preventive side of the work at an early stage. We have had no evidence to show that the system has induced members of the profession to scamp their duty to their patients or to treat them with want of sympathy or attention. We have received evidence from those in favour of the attendance system which is operative only in Man- chester and Salford; but we have come to the conclusion that that system has in practice become so hedged about with restric- tions to prevent over-attendance and with adjustments to meet the general interests of the whole body of doctors working it, that —apart from the complicated nature of the machinery which it necessitates and the inexactness of the results attained—it really differs in essence very little from the capitation system. As to the case value system, we refer to Appendix XCI for a descrip- tion of this ; but we do not feel that at this stage in the develop- ent of insurance practice it could or should be introduced as a universally obligatory system. We need not go into the argu- ments for or against a salaried service. The fact that the pro- fession is almost unanimously against this method is sufficient to make it impracticable. Mr. Brock’s reply to a question on a somewhat larger issue is equally applicable here. ‘‘ No public medical service embracing four-fifths of the population and requiring the co-operation of the great majority of general prac- titioners could be effectively worked unless the remuneration and conditions of service were such as to be acceptable to the majority of the profession.” (Q. 24,178.) 432. To one other suggested modification in the method of Iémunerating insurance practitioners it is perhaps desirable to refer at somewhat greater length as it involves a point of some novelty. The National Federation of Rural Approved Societies recommend that doctors be remunerated for their services according to a graduated scale, instead of by a uniform capitation Payment as at present (App. XXIX, 11-13). Under such an arrangement it is suggested that the highest rate should be paid in respect of the first 500 insured persons accepted, a lower rate or rates being paid in respect of the remainder. In examination it was made clear that this proposal was put forward Primarily on the alleged ground that a list of 1,000 does not Involve twice as much time and expense as a list of 500. A System of remuneration, in which the capitation fee decreased at Successive stages with an increase in the number of insured Persons accepted, would obviously operate to discourage the exist- ence of unduly large lists, and it might be advocated on these FE 4.70) i v4

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