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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APPENDIX A. 51917, do not think—it is not necessary to elaborate the reasons for our opinion— that it is due to war disabilities. It is probably due, at least in part, to the absence of the customary measures of controlling admission to member- ship, including medical examination, which were practised in the system of voluntary insurance, the experience of which supplied the financial basis of National Health Insurance. It is, however, by no means certain that this is the whole explanation ; in this connection we would draw attention to the study of the Selected Societies Experience contained in the Memorandum appended, which has been prepared by the Government Actuary’s Depart- ment. It appears to us that questions of considerable administrative importance as to the control of the claims upon Approved Societies are raised by this Memorandum, and pending an examination of these ques- tions by the responsible department we feel precluded from incorporating in the permanent basis of the system a feature which may prove to be capable of reduction 'by administrative action. Our reluctance to do so is increased by the difficulty which presents itself in the rising cost of disablement benefit to which we have drawn attention in para. 15. For- tunately an alternative course presents itself. The essential thing is to provide at each age for a total outgo in sickness and disablement benefit of an amount which, while it may be approached in actual experience, is not likely to be exceeded in any material degree. On the facts brought out we think that a reasonable provision for sickness benefit would be 80 per cent. of the present provision, and that as regards disablement benefit an ultimate level 33% per cent. above the average of the Selected Societies in the three years 1921-23 might he assumed. On these bases the aggregate outgo at each age would be closely approximate to that shown by the unloaded Manchester Unity Experience (1893-97) at all ages under 45, and somewhat below it at ages between 45 and 65. Having regard to these features and to the advantages inherent in utilising an authoritative standard table, we propose to adopt this basis, namely, the Manchester Unity (1893-97) without loading. If, as the result of the administrative enquiries which we advise, the cost of sickness and disablement benefits can he reduced below this standard, some moderate provision for new services in excess of that which we shall now find ourselves able to recommend may be possible at a future day. If, on the other hand, the cost of benefits cannot be influenced by the particular administrative steps to which we refer, the total expenditure should still be within the provision which we propose to make for it, and such further adjustment of the basis as may be desirable hereafter will have no further effect than the trans- ference to the heading of disablement benefit of some part of the provision which we are assigning to sickness benefit. From this point of view it is important to realise that, while an experience of disablement benefit under which the claims are 150 per cent. of the standard must in all circumstances call for attention, it will not in fact occasion loss upon the estimates at a young age if against it can be set a saving of 5 to 10 per cent. on the provision made for sickness benefit. Thus at age 27 the rate of sickness, according to the present standard, is ‘78 of a week, while the rate of disablement is -19 of a week; an excess of 50 per cent. on the expected cost of disablement benefit would thus be balanced by a saving of 6 per cent. on the expected cost of sickness benefit, bearing in mind the fact that disablement benefit is only payable at half the sickness rate. This compensatory influence is in full operation at the Present time, and the basis which we propose to adopt will require its continuance should it be found impossible to bring the claims for disable- ment benefit under closer control. 18. Women.—On referring to the statement in para. 13 above, it will be seen that, unlike the corresponding experience in the case of men. the

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