OZ

MAJORITY REPORT.

of the insurance medical service and speaking of the work of
the insurance practitioner he says :—
“ The work is carried out under certain disadvantages,
chief among which is the lack of co-ordination between the
services of the insurance doctor and those of workers who
have devoted intensive study to special provinces of the
great territory of medical practice. The inclusion of such
consultant services becomes more and more requisite year
by year and is one of the most pressing of present needs.
When the insurance medical service shall have been completed
 by being brought into organic relation with other
branches of medical work as part of a comprehensive scheme
of medical services, and not until then, will its full capacity
for public usefulness be made manifest.’
66. We have devoted some space to this question, not only
because we think it is of the highest importance in the Scheme
as 1t stands and in relation to the various and widely different
proposals for extension and reform which have been put forward,
but also because we feel that it raises a cognate question of great
difficulty. Tf medical benefit were thus extended for the present
insured class, we are forced to consider the position of those
persons of moderate means who are somewhat above the
present income limit for insurance purposes but to whom
the payment of a specialist’s or consultant’s fees is nevertheless
 a serious matter. Tt is assumed, probably rightly,
that such persons can reasonably be expected to meet
charges for general practitioner treatment, and are therefore
 properly excluded from the Scheme in its present form. But
in respect of major operations and similar services, for which it
is usually necessary that the patient should be an inmate of a
hospital or similar institution, it might with reason be contended
that the claim which could be advanced on behalf of some of
these persons to be protected by some form of State insurance
against the risks involved is scarcely, if at all, less valid than the
claim of certain of the insured population, and that to provide a
full specialist service for the insured, while leaving these adjacent
classes to their own resources would bring about a position difficult
 to justify on grounds of public policy. This point of view
was put before us by the National Association of Trade Union
Approved Societies, who submitted ‘‘ that if the difficulties connected
 with the collection of contributions can be surmounted,
medical benefit should be available to persons not employed
within the meaning of the Act, whose total income does not exceed
£350 a year, and that medical benefit other than general practitioner
 treatment should be provided for persons whose income
exceeds £350 a year, but does not exceed a higher figure to be
determined later. . . . .” (App. XCII, 102.) We desire
to emphasise in the present discussion of the scope of medical
benefit the problem of specialist services for the non-insured of