Full text: Report of the Royal Commission on National Health Insurance

MAJORITY REPORT. 
107 
benefits than his next-door neighbour who pays the same con- 
tribution but is unfortunate enough to be a member of Society B, 
which gives little or no additional benefits. Grave and increas- 
ing discontent will be caused if this distinction is continued or 
intensified ’ (App. XIII, 24). 
EVIDENCE oF EFFICIENCY. 
219. As against these criticisms we have, however, received a 
large body of evidence in support of the advantages claimed to 
be inherent in the present system and in favour of its retention. 
It was represented to us. that the Societies are carrying out their 
work with a very fair standard of efficiency, that the contribu- 
tions are being collected and the benefits administered in a 
satisfactory manner, and that there is no evidence of any con- 
siderable volume of opinion antagonistic to the system as such on 
the part of insured persons (Kinnear, Q. 23,543-23,546 ; Leish- 
man, Q. 24,346). It was also urged that the present arrangement, 
under which every Society stands to gain or lose as the result 
of its own experience and standard of administration, conduces 
to careful supervision of claims and tends to economy and avoid- 
ance cf over-expenditure on benefits (Ancient Order of Foresters, 
App. Vv, 24; National Conference of Industrial Assurance 
Approved Societies, App. VI, 25). Further, it was stated with 
much truth that the variety of types of Societies and the freedom 
of the insured person to choose among them are particularly well 
suited to the administration of a Scheme affecting many millions 
of the community of all types and classes and supported by a 
flat rate of contribution. 
CONTINUATION OF THE SYSTEM RECOMMENDED. 
220. We come, therefore, to the question whether the Ap- 
proved Society system should be continued. This question must 
be examined from two points of view. The first is that of the 
maintenance of a system under which the Scheme is administered 
by self-governing organisations responsible for their own finance, 
and all that this implies in regard to additional benefits; or its 
supersession by a centralised system with a common fund, the 
benefits being administered, possibly, by local agencies but subject 
to close control and direction from the central governing body. 
The second point of view is that of the criticisms which have been 
directed against the methods and procedure of the Approved 
Societies as such, and the possibility that if these criticisms are 
so weighty as to indicate the desirability of abolishing the 
Societies, some other form of organisation, short of complete 
centralisation, can be found to take their place. 
221. To the first of these problems we have given careful 
thought. We feel that if a centralised system were adopted it 
would compel the dissolution of the Approved Societies, since 
the reduction of the Societies to mere paying agencies would
	        
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