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 V. The development of the health services

Collection:: Economics Books

MAJORITY REPORT. 9 a general practitioner. The definition given in the Regulations now in force is as follows :(— “ The treatment which a practitioner is required to give to his patients comprises all proper and necessary medical services other than those involving the application of special skill and experience of a degree or kind -which general practitioners as a class cannot reasonably be expected to possess.”’ (Clause 8 (1) of Part I of the First Schedule to the Medical Benefit Consolidated Regulations, 1924). 59. We were so much impressed by this limitation—imposed as it was by regulations and not explicitly in the Act itself—that we examined the official witnesses of the Ministry of Health on the point at some length. We were told (Brock, Q. 995) that the apparently narrow view taken was based on the advice given to the Insurance Commissioners by their legal advisers at the inception of the Scheme. This was to the effect that the pro- visions of Section 24 of the 1924 Act (Section 15 of the 1911 Act) were not consistent with anly other view. The Act gave every duly qualified medical practitioner a right to come upon the medical list, and it contemplated that every insured person would have one medical attendant but not more than one at a time, and that if the insured person did not himself choose a doctor, he might after a certain time be allocated to a doctor by the local Insurance Committee. Thus the effect of the provisions of the Act was that the insured person was entitled to receive from one doctor, and from one doctor only, the whole of ““ medical benefit >’ whatever that phrase might mean. In these circumstances it appeared to the legal advisers and to the Department that the scope of medical benefit must be construed as limited to services within the competence of the average general practitioner. Further, though the medical lists included a certain number of men with special experience, whose competence in certain directions was therefore above the average, it was felt that if all doctors were to receive the same rate of remuneration, as practical considerations were found to require, a uniform obligation and a uniform con- tent of service were implied; and that it would not be equitable to require one man, because he happened to possess some special skill, to render a wider range of service than was required from the majority of his fellow practitioners engaged under the insurance contract. 60. Though this limitation of the service has been from time to time commented upon (see Brock and Smith Whitaker, Q. 1080-1101) and though on all sides a fuller conception of medical benefit has been urged upon us by witnesses, no attempt to challenge it in the Courts has ever been made during the 13 years of its operation. We may fairly assume, therefore, that it is valid on legal grounds and we recognise the general and

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