186 
MAJORITY REPORT 
grounds. We were assured, however, that while this obvious 
consequence was present in the minds of those who advocated 
the scheme, this consideration did not furnish the justification 
for the proposal, which was defended on the ground of its own 
inherent equity (Q.11,612-11,617). We consider that if the exist- 
ence of large lists is still productive of evils (as it indubitably was 
in the earlier days of the Health Insurance Scheme) such an in- 
direct method of discouragement is not to be commended, and that 
preference should be given to the method (which has in fact been 
adopted) of definitely limiting the number of insured persons 
whom a doctor may accept. It is only right to add that we have: 
had no evidence to show that under present conditions any evils 
result from the existence of lists which can be regarded as 
unduly large. 
433. Turning to the merits of the proposal, it can hardly be 
contended, and it was not in fact contended by Mr. Wood, who 
appeared for the National Federation of Rural Approved Societies, 
that the work involved increases otherwise than proportionately 
with the number of insured persons accepted. The only ground 
then on which the scheme can be advocated is the assumed saving 
in time and overhead charges which comes with an enlarged prac- 
tice. Th neither case do we consider that, so far as Health 
Insurance practice is concerned, there is a law of diminishing 
cost so markedly operative as to make it expedient to grade the 
remuneration of practitioners in the manner suggested. The 
fact that the attendance given under the Health Insurance Act 
is only a part of most doctors’ practices renders the reasoning of 
the Federation on this point inadmissible. A doctor with 
a small insurance practice may yet have a large practice 
otherwise, and may enjoy all the economies of time 
and of overhead expenses inherent in large scale practices. The 
doctor should receive remuneration primarily for work done, and 
only secondarily for time taken ; and when in exceptional circum- 
stances the time involved becomes a factor demanding considera- 
tion, the appropriate method of meeting the circumstances is by 
the grant of a mileage allowance. Apart from these fundamental 
difficulties the scheme would, we are satisfied, tend to many 
anomalous results ; it is unlikely that it would commend itself to 
the Medical Profession as a body, and we are therefore unable to 
recommend its adoption. 
Tar COMPLAINTS MACHINERY 
434. We now turn to the more difficult question of the 
machinery for determining complaints against Insurance prac- 
titioners. 
485. We have given very careful attention to the criticisms 
advanced by representatives of the medical profession on certain 
aspects of the present Regulations affecting the obligations of