NATIONAL HEALTH INSURANCE

Press, Volume LXXIII, Issue 22017, 15 February 1937, Page 11

NATIONAL HEALTH INSURANCE

I.—OVERSEAS SYSTEMS EXAMINED

One of the most far-reaching proposals contemplated by the Government Is the introduction of a form of national health • insurance, legislation concerning which will probably be placed before Parliament this year. This is one of the most complex social services that can be undertaken by any nation, and its introduction will affect the life of every member of the community in one way or another. Health insurance, in its various forms, has been in operation in various countries, including Great Britain, for a number of years, and the purpose of these articles is to show what the proposal involves and how it operates. They are based on an address given by Dr. J. P. S. Jamieson, of Nelson, before the conference of the Australian , and New Zealand Assoclatipn for the Advancement of Science, held in Auckland recently. TBy DR. S. P. S. JAMIESON] National health insurance is the name which has come into common use among English-speaking people for the statutory systems used in many countries whereby it is sought to minimise the loss due to unemployment arising from sickness, and to defray the cost of medical service to certain classes of people for whom the wage loss is a very serious matter, and who would be unable to pay for those services. The word "insurance" is used in its commercial sense, and does not mean "protection from;" but "indemnification for." Further, the indemnification sought is primarily for the economic results of loss of earning power due to sickness and the medical service included is really a secondary provision, with the object of shortening the period of incapacity. Historical Survey

The broad principle of guarding against loss of income from sickness, and of spreading the cost of medical attendance by levying regular, small contributions upon groups of people lias been in use for centuries on a voluntary basis. As a law-enforced system in which the State is directly interested, it owes its institution to Bismarck, who introduced it in Germany in 1883. Since that time similar systems, with many variations in-de-tail, have been put into operation in the majority of European countries in whose economic systems industrialism is a prominent factor, in Japan, and in one or two New "World States. In Britain the principle was adopted in 1911 in the form which is popularly known as Ihe "panel system. In the overseas Umpire, the first and so far the only State which has undertaken it is British Columbia, where an act for its establishment was passed only nine months ago. There is thus a considerable body of experience over a reasonable period of time to-be drawn upon. Should New Zealand in the near future establish a kindred system, she will not be leading the world in social legislation, but will have the opportunity, which accrues to every succeeding generation more often than it is grasped, of profiting by the experience of seniors. Explanation of System

In general terms, the section of the population which is included under compulsory. insurance consists of wage-earners and salaried people below a certain incor-je limit, that is to say, persons who are under contract of service in some employment—not persons who are working for their own hand independently although of no greater income. Those included under a given system are under legal compulsion to pay contributions, usually deducted from the weekly wage. This contribution is subsidised in nearly all cases by the employer and the State. An "insurance fund is thus established from which the cost of the benefits to be secured is defrayed. It is to be clearly borne in mind that those .benefits are of two kinds:— . . Cash benefits, which are payments made during incapacity to offset to a certain extent the loss of earning power. ' . . , - i_.i.Benefits in kind, chief of which is medical attendance. Variations in Different Systems In the schemes of different countries there is a great variety in the methods ot- working out these general principles. The administration may be wholly governmental, or it may be partly delegated to committees and •'approved societies," the latter being bodies previously engaged in the same kind of work on a voluntary basis. Those may add to the statutory benefits others provided by their own organisations. The contributions may be at a flat rate for all, or scaled as a percentage of wages. The compulsory insured population may be limited to very special groups, or may include many occupations embracing a large section of the population. There is sometimes provision for others outside the compulsion limit to be voluntarily included, and it is somewhat significant that this opportunity is little availed of. The income limit varies from as low as about £l2O per annum (France), to as high as about £320 (Norway), and, in one or two instances, is scaled according to dependents. The cash benefits may be on a flat rate or,a percentage of wages and varies from halfpay to as high as 80 per cent. The scope of medical benefit varies from restriction to domiciliary and consult-ing-room service by general practitioners to the inclusion of specialist, hospital, dental, and other services, and may apply to the insured worker only, or include, more or less, dependents as well. Medical men are remunerated sometimes by a capitation on the number of patients held, sometimes by salary, and in other instances, for each attendance. Medical benefit is in some systems entirely free; in others the insured have to bear a proportion of the cost individually. In all systems the period during which the insurance fund is liable to furnish benefits is limited. Cash and Medical Benefits Originally the cash benefit to pijovide subsistence while incapacitated was the primary object of insurance. As experience has been gained, more and more importance has become attached to medical benefits, and it is probably true to say that these now occupy the foremost place in people's thoughts when they speak of health insurance. The trend of opinion amopg those best versed in the subject is now, that while the association of the two classes of benefit is unavoidable for poor people, it is desirable to extend as far as possible to those who cannot command them the medical benefits, and to restrict as far as possible the cash benefits. For there is a tendency, as will be shown later, for indemnification for sickness to frustrate the prevention and shortening of diseases, which is true health insurance. (To be continued.)