MAJORITY REPORT.

261

MEDICAL INSTITUTIONS.

640. While the Insurance Act contemplated that Medical
Benefit should normally be provided by medical practitioners
under contract with Insurance Committees, it provided for two
possible deviations from the standard arrangements. In the first
place it authorised Insurance Committees where they saw fit,
to allow insured persons to make their own arrangements for
receiving Medical Benefit, and where the circumstances were
sufficiently exceptional to justify the adoption of this course a contribution
 was made towards defraying the cost of the Medical
Benefit so obtained. The second exception related to medical
institutions which had been providing medical attendance to the
working classes in the past, and provision was made, safeguarding
existing rights, whereby under certain conditions these institutions
 might be incorporated in the machinery for providing
Medical Benefit. It is with the second of these exceptions that
we are here concerned.

641. Under Section 15 (4) of the 1911 Act such systems or
institutions for the provision of medical attendance and treatment,
 as were in existence at the date of the passing
of the Act, might be approved by an Insurance Committee
and the Department for the purpose of providing Medical
Benefit. Insured persons who were members of these
approved institutions might then receive their medical benefit
through the institution, the actual cost of the treatment, or
the capitation fees in respect of members so treated, whichever
is the less, being paid to the institution out of insurance funds.
The majority of these institutions are bodies which were formed by
associations of the Friendly Societies for the purpose of providing
 medical attention and treatment to their members prior to
the passing of the 1911 Act.

642. We are informed (Brock and Smith Whitaker, Q. 24,009-24,012;
 British Medical Association, Q. 15,222) that the
treatment given to members of these institutions is as
a rule inferior in quality to that provided under the
normal panel arrangements, and we are also given to
understand (British Medical Association, Q. 15,221; Brock,
Q. 24,009) that administration and control by lay committees
has proved in many cases to be ineffective. ~ Any disciplinary
action taken by Insurance Committees following upon complaints
made by members of the Institutions cannot be brought to bear
directly on the individual doctors responsible as these are the
servants of the institutions. The Minister has power to withdraw
 approval in any case in which he is not satisfied that an
Institution is conducted in such a manner as to comply with
the terms of service of insurance doctors, but this would not
be an appropriate penalty in cases of complaint by an insured