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

1’ 
Ud 
MAJORITY REPORT. 
of continued approval of Societies. While some witnesses have 
expressed the view that it is neither practicable nor desirable tc 
impose any such minimum limit, others have suggested a limit 
varying from 500 (Independent Order of Rechabites, Q. 6178- 
6179) to 100,000 (National Conference of Industrial Assurance 
Approved Societies, Q. 4990). We have been informed that some 
of the defects in administration which are manifested from time 
to time are attributable in certain cases to smallness of member- 
ship, and in particular to the fact that it may not be possible, 
within the amount available for expenditure on administration, 
to secure the services of competent officers (Kinnear, Q. 537,589). 
On the other hand we are assured that the efficiency of a Society 
does not vary in direct proportion to its membership, and that 
there are small Societies whose administration is entirely satis- 
factory as well as large Societies where this is far from being the 
case (Kinnear, Q. 23,562, 23,587). We are also informed that 
from the point of view of actuarial soundness and financial 
stability, a large membership is not essential (Kinnear, Q. 535; 
Leishman, Q. 1892). Moreover, we feel that the present wide- 
spread system of local administration through small units has the 
advantage of providing a closer touch between the individual 
insured person and his Society, and enables a very large number 
(estimated to be as high as 100,000) of working men and women 
to gain some experience of public work and social administration, 
with results which cannot fail to be for the general good. If is, 
moreover, in the Societies of this type that the tradition of 
voluntary and public spirited service is often best maintained. 
The disappearance of this tradition could not, in our opinion, 
be viewed otherwise than with regret. 
230. We feel, therefore, that it would be inexpedient to place 
any arbitrary restriction on the size of Societies without regard to 
the quality of their administration and their effectiveness as self- 
contained insurance units. At the same time we think that 
there should be adequate provision for dealing with Societies 
whose administration is deficient in any respect. This is, how- 
ever, not a matter which can be confined to small Societies, and 
we shall return to it later in relation to Approved Societies in 
general. 
CONTROL BY MEMBERS. 
231. The next point of criticism of the Approved Society 
system as it now exists is that, although one of the main reasons 
advanced in support of the adoption of the system was that it 
would place the management and control of National Health 
Insurance business in the hands of the insured persons themselves, 
yet in actual practice this has not been the result, so far, at any 
rate, as many millions of insured persons are concerned. We 
have had ample evidence (National Conference of Industrial 
Assurance Approved Societies, Q. 4568-4743) that in some of the
	        
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