HEALTH INSURANCE

New Zealand Herald, Volume LXXIII, Issue 22389, 8 April 1936, Page 10

HEALTH INSURANCE

THE BRITISH SYSTEM SICKNESS BENEFITS MEDICAL TREATMENT BY OR. G. F. M'CLEARY (Formerly Principal Medical Officer of th* English National Health Insurance Commission.) The British national health insurance system was established by the National Insurance Act of 1911, and since 1912 health insurance has been .obligatory over the whole country. All persons, male and female, aged 16 and upwards, are required to be insured under the health insurance system if employed under a contract of service in manual labour, irrespective of the remuneration received, or in non-manual labour if the rate of remuneration does not exceed £230 a year. Such persons are termed "employed contributors." The total number of insured persons in England and Wales is about 16,500,000, forming rather more than 40 per cent of the whole population. There is also provision for voluntary .contributors, who number about 500,000. The cost of the system is met by contributions from the insured persons, their employers and the National Exchequer. An insured man pays and an insured woman 4d, a week; in either case the employer pays 4Jd a week. The employer is responsible for the payment of his employees' contributions, as well as his own. No contribution from either employer or employee is required for any week in which the employee is incapable of work by reason of physical or mental disablement. The National Exchequer pays (1) the cost of the central administration, and (2) one-seventh in the case of men. and one-fifth in the case of women, of the cost of the benefits and their, local administration. The Exchequer's payments are equivalent to about 17 per cent of the total cost of the system. In 1934 the contributions of' insured persons and employers amounted to £23,824.800, the Exchequer contribution to £5,562.900, and the sum of £5,590,500 was derived from interest on accumulated funds. The total cost was £32.698,400, the administration expenses amounting to about 15 per cent of the total cost. Administration The system is administered centrally by the Ministry of Health, and locally by the Approved Societies and the Insurance Committees. The Approved Societies, which" are not organised on a territorial basis, are self-governing associations of insured persons (employers are not included) approved by the Ministry of Health for health insurance purposes, one condition of approval being that the society must not be carried on for profit. The function of the Approved Societies is to enroll the insured persons into administrative groups, and to provide the statutory cash benefits and such additional benefits as they may be able to give as bonuses. Many of the societies were formed by tha Friendly Societies, but all are independent organisations. The total number is about 6000. The Insurance Committees, of which there are 146 in England and Wales, one for each county and county borough, administer the mescal and pharmaceutical services. They are not directly elected, the members being nominated by (1) Approved Societies having members in the area, (2) the local Health Authority, "(3) the local Medical Committee (4) the Ministry of Health. On each Insurance Committee there are representatives of the lord doctors and chemists, and with eaci committee there is associated a loorl Medical Committee and a local Pharmaceutical Committee, each of which is charged with important administrative and disciplinary duties in relation to the medical and pharmaceutical services respectively. ,

Benefits The system provides cash benefits and medical treatment, including the supply of medicines and approved appliances. The cash benefits are of two kinds: (1) Statutory benefits, which must be given to all insured persons who fulfil the conditions, entitling them to benefit; (2) additional benefits, which may be given as bonuses by approved societies .found by the Government actuary on periodical valuation to have a sufficient surplus for the purpose. . The statutory cash benefits are as follows: —Sickness benefit, i.e., a weekly payment to an insured person rendered incapable of work by bodily or mental disablement. For men the weekly rate is los, for unmarried women, 12s; and for married women, 10s. Sickness benefit is payable from the fourth day of incapacity and continues for 26 weeks. If incapacity continues beyond 26 weeks the insured person receives disablement benefit, which is a weekly payment at half the rate of sickness benefit, and continues until the patient recovers working capacity, or diesj or reaches the age of 65, when he, or she. begins to draw a contributory old age pension of 10s a week, and ceases to pay insurance contributions. The third statutory cash benefit is maternity benefit, which is a lump sunt payment of 40s on the confinement of the wife of an insured man. If the wife is herself insured she receives a second maternity benefit of 40s. Maternity benefit; whether accruing from the husband's or the wife's insurance, is paid direct to the wife. s The additional benefits may take the form of increases in the rates of sickness, disablement or maternity benefits, or of contributions, in no case less than one-half, toward the cost of dental or ophthalmic treatment obtained by an insured person, with the consent of his approved society. About £1,175,000 is expended annually on dental benefit.

Medical Benefit All insured persons are entitled to medical treatment, excluding specialist, hospital or obstetric treatment, and such medicines and appliances as may be ordered by their doctors. Every registered medical practitioner has the right to undertake the treatment of insured persons if he wishes to do so,, and the insured persons have free choice of doctor. There are about 16.500 insurance doctors in England and AValcs, and the average number of insured per* sons per doctor is about 1000. The method of medical remuneration in anv area is that chosen by the doc-tors of the area, and in all the 146 areas the doctors have chosen to be paid on the capitation method —in proportion to the number of persons sick or well, for whom they assume responsibility. The amount of medical remuneration was fixed by an independent Court of Arbitration at 9s per head per year, and in addition there is a sum of £250,000 set aside annually for mileage grants. There are about 11,120 insurance pharmacists, all of whom carry on a private business in addition to insurance dispensing, and the annual number of insurance prescriptions-dispensed is about 60,000,000. In 1934 the sum of £'2,176,750 was expended in the provision of medicines and appliances. The system was subjected some years ago to a prolonged and critical examination by a Royal Commission, whose gen - eral conclusions were that it had ru . justified itself, that workers had obtained under it substantial advantaj. ajid that the commissioners were c l ' vinced that National Health J nslir ' 0 f has now become a permanent feat'i , the social system of this country, should be continued on its presen pulsory and contributory basis.