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APPENDIX A. 
THIRD REPORT OF THE DEPARTMENTAL 
ACTUARIAL COMMITTEE. 
To the Right Honourable Lord LAWRENCE OF KINGSGATE, 
Chairman of the Royal Commission on National Health Insurance. 
My Logbp, 
1. We have received from the Secretary to the Royal Commission a 
request to advise on the question of the cost which would be involved 
in replacing the present maternity benefit by a new service to include 
all necessary medical attendance during pregnancy, the services of a 
midwife and (where required) a doctor at confinement, ante-natal and 
post-natal examinations and a money payment. An estimate of the 
fees to be paid to doctors and midwives under various headings of the 
projected service has been prepared by the Ministry of Health, and we 
have taken these estimates, which we are, of course, not in a position 
to review, as the basis of our calculations. At the present stage we have 
deemed it sufficient to take the cash payment as £1. 
9. The problem is complicated by considerations as to the liability 
to be provided for in those cases in which both husband and wife are 
insured. The new services will only have to be provided in respect of 
one insurance and the question arises whether in the case where both 
are insured the provision should be made under the insurance of the 
husband or under that of the wife. Having regard to the amounts 
of the available margin in the respective contributions of men and of 
women, we have assumed that the liability would be placed upon the 
hushand’s insurance. 
3. A somewhat analogous question arises as to the cost of ordinary 
medical attendance during pregnancy. In this case a married woman 
who is herself insured is entitled to this service as part of medical 
benefit, and we assume it to be inexpedient that this arrangement should 
be disturbed. So far, therefore, as concerns this particular item in the 
services proposed to be given, we assume that a charge will only be 
imposed on the insurances of men to cover the cases in which the wives 
are not insured. 
4. The several items of the service, with their estimated cost which 
have been supplied to us, are as follows: — 
8. ds 
(1) Fee to midwife ... wre on Soe Po 2s «i 3000 
(2) Fees for antenatal and post-natal examinations ov HO C0 
(3) Fee for risk of doctor’s personal attendance on 
confinement ses va ave hs Pye ies wai 900 
(4) Fee for medical attendance during pregnancy ... Jo 100 
To these should be added : 
(5) Cash benefit, which is taken at 
oe wen 200 
5. The various combinations of these items which arise and the 
distribution of their cost are as follows: — 
(A) Husband insured: wife uninsured. 
The charge of £3 15s. 6d., comprising items (1) to (5), arises and 
falls on the husband’s society in lieu of the present provision of 
£9-—an additional liability of £1 15s. 6d.