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

188 MAJORITY REPORT. 439. The theory that competition for patients is sufficient by itself to secure a satisfactory service, clearly does not apply in those areas in which there is, in fact, no freedom of choice, and where, therefore, no competition exists. In many rural and semi- rural areas the geographical distribution of doctors is such that insured people have no real choice, while at the other end of the scale there are congested urban areas in which the number of available doctors is so limited that they want no more patients than they have already. But even in the areas in which there is a real freedom of choice, we see no sufficient grounds for assuming that the right of transfer would be by itself a sufficient protection to the patient. Before the Act came into operation there was unlimited freedom of choice in urban areas, but it can hardly be contended that the resulting competition produced a satis- factory level of service in the poorer areas, which had become accustomed to a low standard of professional work. 440. Apart from the special difficulty of the rural areas and the more congested and less attractive urban areas, we are not convinced that it is fair to assume, as a general proposition, thas patients who feel dissatisfied with their treatment will seek another doctor. We agree that a wise doctor will not seek to retain a patient who has lost faith in him, but it does not follow that a transfer is always made either pleasant or easy. In any case, the inertia of a large proportion of the insured population will operate to prevent persons from making a change, though they may have legitimate grounds for dissatisfaction. Hven with free choice, the percentage of changes at any time is, relatively, small, and it would be too large an assumption to suppose that among the vast majority who do not change there are none who have good reason for wishing to do so. 441. Even were the insured person in a better position than we believe him to be for securing the efficient discharge of his insurance practitioner's duties towards him, we consider that to place upon him, in effect, the entire responsibility in this matter, would be fundamentally inconsistent with the whole scheme of medical benefit, under which the Insurance Com- mittee is primarily responsible for securing efficiency of the medical service within its area, subject to the general respon- sibility of the Minister. We find nothing in the Act to justify excluding from the questions of efficiency of the service for which the Insurance Committee and the Minister are responsible questions of the kind which the British Medical Association desire to have excluded. If, therefore, such proposals were to be brought into operation, this could only be done, as it appears to us, through amending legislation which would be so incon- sistent with accepted principles of public administration and Parliamentary responsibility that we cannot recommend imita- tion.

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