MAJORITY REPORT. 
{S0) 
— 
especially that of the British Medical Association, has been for 
the capitation method ; and we cannot believe that a system that 
has been in successful operation in practically all parts of the 
country for 13 years can be open to serious criticism. It embodies 
the salutary principle that it is to the interest of the doctor that 
his patients should remain in good health, or be restored to good 
health as quickly as possible. It directs attention to the preventive 
side of the work at an early stage. We have had no evidence to 
show that the system has induced members of the profession to 
scamp their duty to their patients or to treat them with want of 
sympathy or attention. We have received evidence from those in 
favour of the attendance system which is operative only in Man- 
chester and Salford; but we have come to the conclusion that 
that system has in practice become so hedged about with restric- 
tions to prevent over-attendance and with adjustments to meet 
the general interests of the whole body of doctors working it, that 
—apart from the complicated nature of the machinery which it 
necessitates and the inexactness of the results attained—it really 
differs in essence very little from the capitation system. As to 
the case value system, we refer to Appendix XCI for a descrip- 
tion of this ; but we do not feel that at this stage in the develop- 
ent of insurance practice it could or should be introduced as a 
universally obligatory system. We need not go into the argu- 
ments for or against a salaried service. The fact that the pro- 
fession is almost unanimously against this method is sufficient 
to make it impracticable. Mr. Brock’s reply to a question on 
a somewhat larger issue is equally applicable here. ‘‘ No public 
medical service embracing four-fifths of the population and 
requiring the co-operation of the great majority of general prac- 
titioners could be effectively worked unless the remuneration and 
conditions of service were such as to be acceptable to the majority 
of the profession.” (Q. 24,178.) 
432. To one other suggested modification in the method of 
Iémunerating insurance practitioners it is perhaps desirable to 
refer at somewhat greater length as it involves a point of some 
novelty. The National Federation of Rural Approved Societies 
recommend that doctors be remunerated for their services 
according to a graduated scale, instead of by a uniform capitation 
Payment as at present (App. XXIX, 11-13). Under such 
an arrangement it is suggested that the highest rate should 
be paid in respect of the first 500 insured persons accepted, a 
lower rate or rates being paid in respect of the remainder. In 
examination it was made clear that this proposal was put forward 
Primarily on the alleged ground that a list of 1,000 does not 
Involve twice as much time and expense as a list of 500. A 
System of remuneration, in which the capitation fee decreased at 
Successive stages with an increase in the number of insured 
Persons accepted, would obviously operate to discourage the exist- 
ence of unduly large lists, and it might be advocated on these 
FE 
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