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 V. The development of the health services

Collection:: Economics Books

H4 MAJORITY REPORT. the £250 limit applies to non-manual workers : for the manual workers there is no limit whatever. But so far as medical benefit is concerned, Insurance Committees are empowered to prescribe an income limit applicable to all insured persons for whose medical benefit they are responsible. Where such an income limit is prescribed in any area, persons above that limit must make their own arrangements for receiving medical benefit, receiving the appropriate payment from the Committee’s Medical Benefit Fund in aid of their own expenditure. We are not aware that any Committees have exercised this power, so that a well paid manual worker would, under the present system, receive medical benefit on the capitation system and thus be quite free of any means test. 133. Another restriction of a similar type is to be found in the requirement that a voluntary contributor with over £250 a year is not entitled to medical benefit at all, either under the capita- tion system or under that known as ** own arrangements,”’ and pays a reduced contribution accordingly. Whether this restriction is effectively administered we do not know, but in any case voluntary contributors form a very small class. This provision—although it then related to a lower income limit— was inserted in the Act of 1913 to meet the objections entertained by the Medical Profession agamst extension of the sphere of contract practice to persons who, though initially within insur- able limits, might later pass beyond the range of income for which voluntary insurance was, in their view, designed. Tt may suffice to accord mention, in passing, to the somewhat similar provision governing the medical benefit of exempt persons. 134. These restrictions are significant as embodying in a very definite form the means test, even in a system which is in part— and so far as the voluntary contributor is concerned in a very large part—maintained by the contributions of the beneficiaries. 135. The medical service provided by the Poor Law authorities is an extreme form of the application of the means test. Closely akin is the medical treatment provided by the Education Authe. rities for school children though medical inspection is provided for all, just as elementary education itself is, irrespective of means. The treatment of physical defects and diseases is subject to strict inquiry into means and to proved inability of the parents to provide it themselves. 136. As exemplifying the opposite principle we may take the whole group of services which deal with what is known as "public health,” e.g., sanitation, provision for dealing with infectious diseases, venereal disease and tuberculosis and the Port sanitary service. The cost of these services is defrayed out of rates and taxes and no consideration in any form is given to the means of those most directly affected. The

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