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:: Minority report

Collection:: Economics Books

308 MINORITY REPORT. 43. We submit that in so far as the incentive does exist it is inimical to the improvement of the standard of national health. In the main it only manifests itself in two ways: (1) by a judicious selection of good lives, and (2) by a reduction of expendi- ture on benefits. 44. The absence of control by the insured persons is, in itself, to be deplored in a public scheme, but when it is remembered that the close interest of the members in the work of their Societies was designed to produce an incentive to efficient administration it will be realised that its absence assumes niuch greater importance. 45. It has been claimed by many Society witnesses—and in certain parts of the Majority Report our colleagues appear to support the claim—that this incentive is a necessary and desirable feature of National Health Insurance. We propose therefore to examine the contention further. 46. As we understand it, the theory is that the members of each Society would interest themselves in the management of the Society with a view to conserving the funds in order to produce a surplus at a valuation. 47. The practice of rejecting applicants for membership who are thought to bring an abnormal risk means segregation of all good lives from all bad lives, with the consequent breakdown of the preventive and curative objects of the Act for those sections of the community which need them most. ** If by economical management is meant the exclusion by medical examination of those likely to be a charge upon Societies . . . . then the Union sees little virtue in it * (Medical Practitioners’ Union, App. NIL.VIIL, IS. 1). 48. There is no doubt that witnesses have considered the main effect of the incentive to be the safeguarding of the funds against what they considered to be undue claims, and it is mostly in this respect that it has been effective. If the scheme were adminis- tered through a system which contained an element of uniformity the operation of such an incentive would be less undesirable, but when it is remembered that there is an almost complete absence of uniformity from the issue of a medical certificate to the payment of the benefit, the effect of an incentive with the purpose of economising on benefits is definitely vicious. Saving the funds by curtailing the benefits of the sick persons and forcing them back to work or otherwise leaving then to starve, is not a feature that is either economical in the long run, or moral in a State scheme, but that it is present there is no doubt whatever. ““ Some of the Societies are inclined to apply too rigid a test when the alarming question of disablement benefit comes to their notice.’’ (Kinnear. 0.313)

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