MAJORITY REPORT. 
19¢€ 
avail themselves of such facilities. Beyond this, there is a 
certain amount of evidence that many insured persons are 
reluctant to go to the out-patient departments, as a charity, while 
they would not hesitate to avail themselves of the same specialist 
services if included in medical benefit, as they would then feel 
that they had a full legal and moral right to receive these services 
when needed. Some are deterred by the crowded state of the 
out-patient departments and the long time they may have to 
wait for attention. Others are deterred by the charges made. 
Again, some of the insured persons whose income brings them 
near the limit of insurability, prefer, when specialist advice is 
necessary, to emploly the specialist privately, thinking that in this 
way they will receive more careful attention than if they obtained 
gratuitous advice. 
975. It is clear that under existing conditions many insured 
persons do not obtain from the out-patient departments the 
specialist treatment that is needed, and, in respect of those who 
do, the attending practitioner frequently does not obtain the 
second opinion on diagnosis or treatment which is desirable in 
the interest of his patient. 
(GENERAL, CONDITIONS FOR THE NEW SCHEME. 
276. .1f expert out-patient services are to be provided as part 
of medical benefit, it is necessary, in the first place, that’ these 
services should be sufficiently accessible in all parts of the 
country, specialists being employed to attend at frequent intervals 
in central places in those districts in which there are at present 
no physicians or surgeons who possess the necessary qualifica- 
tions. Further, travelling expenses of insured persons referred 
to specialists under the scheme should be defrayed as part of the 
service. These two provisions would not add a relatively large 
amount to the cost of the scheme, and would remove the present 
deterrent effects of distance. 
277. Taking all these matters into consideration, we come to 
the conclusion that the new system should be built up, not by 
way of supplementation of the existing out-patient work of the 
hospitals, but as an independent scheme organised effectively 
throughout the whole country, providing for the closest consulta- 
tion and reciprocal communication between the general prac- 
tioner and the specialist, and giving the title to the service 
to all insured persons as part of the consideration for which they 
are paying their compulsory contributions. 
278. Under such a scheme, there would be laid upon the 
Insurance practitioner an obligation to refer a case for specialist 
advice and treatment when the circumstances rendered such a 
course appropriate. He would also have to furnish a statement 
of the history and the present condition of the patient, as known