Report of the Royal Commission on National Health Insurance

Bibliographic data

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

186 MAJORITY REPORT grounds. We were assured, however, that while this obvious consequence was present in the minds of those who advocated the scheme, this consideration did not furnish the justification for the proposal, which was defended on the ground of its own inherent equity (Q.11,612-11,617). We consider that if the exist- ence of large lists is still productive of evils (as it indubitably was in the earlier days of the Health Insurance Scheme) such an in- direct method of discouragement is not to be commended, and that preference should be given to the method (which has in fact been adopted) of definitely limiting the number of insured persons whom a doctor may accept. It is only right to add that we have: had no evidence to show that under present conditions any evils result from the existence of lists which can be regarded as unduly large. 433. Turning to the merits of the proposal, it can hardly be contended, and it was not in fact contended by Mr. Wood, who appeared for the National Federation of Rural Approved Societies, that the work involved increases otherwise than proportionately with the number of insured persons accepted. The only ground then on which the scheme can be advocated is the assumed saving in time and overhead charges which comes with an enlarged prac- tice. Th neither case do we consider that, so far as Health Insurance practice is concerned, there is a law of diminishing cost so markedly operative as to make it expedient to grade the remuneration of practitioners in the manner suggested. The fact that the attendance given under the Health Insurance Act is only a part of most doctors’ practices renders the reasoning of the Federation on this point inadmissible. A doctor with a small insurance practice may yet have a large practice otherwise, and may enjoy all the economies of time and of overhead expenses inherent in large scale practices. The doctor should receive remuneration primarily for work done, and only secondarily for time taken ; and when in exceptional circum- stances the time involved becomes a factor demanding considera- tion, the appropriate method of meeting the circumstances is by the grant of a mileage allowance. Apart from these fundamental difficulties the scheme would, we are satisfied, tend to many anomalous results ; it is unlikely that it would commend itself to the Medical Profession as a body, and we are therefore unable to recommend its adoption. Tar COMPLAINTS MACHINERY 434. We now turn to the more difficult question of the machinery for determining complaints against Insurance prac- titioners. 485. We have given very careful attention to the criticisms advanced by representatives of the medical profession on certain aspects of the present Regulations affecting the obligations of

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