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

MAJORITY REPORT.

107

benefits than his next-door neighbour who pays the same contribution
 but is unfortunate enough to be a member of Society B,
which gives little or no additional benefits. Grave and increasing
 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 contributions
 are being collected and the benefits administered in a
satisfactory manner, and that there is no evidence of any considerable
 volume of opinion antagonistic to the system as such on
the part of insured persons (Kinnear, Q. 23,543-23,546 ; Leishman,
 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 avoidance
 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 Approved
 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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