NATIONAL INSURANCE

Stratford Evening Post, Volume XXIX, Issue 120, 13 July 1911, Page 6

NATIONAL INSURANCE

IJOY THE J?O£T.ORS IN REVOLT. (“Public Opinion.”) The doctors, those good friends or the family, are in revolt. They do not like the terms which the State Insurance Bill offers them *n return for their skilled assistance, which has taken so much time and money to acquire. The case for tiie doctors is well stated by “Stephen Andrew” hi the “Daily Despatch.” He is the author of tin excellent medical' novel. “The State Insurance Bill, if it goes through in its present form, will bring about a complete revolution in the medical world,” says “Stephen Andrew.” “Every doctor in the land will be affected profoundly by it; nearly every patient, or prospective patient, will find the relations between himself and his doctor altered. Private practice, as wo know it to-day, will be abolished—gradually, perhaps; but none the loss completely. For it is clear that the framers of the Bill look to a time when everybody—except, perhaps, the really .. well-to-do—-shall get his doctoring done by contract. “Now, contract practice—or club practice, as it is commonly called—has been a cause of friction between doctors and working-class public for many years past. The doctors have complained that the pay given for club work has been insufficient, and the conditions of employment unsatisfactory; the club official}* have retorted by saying that they have not seen the necessity of paying more.

‘iney ha ye gone on tiie commercial p: meiulc of buying as c'aapU as pospossibfo, and, in practice, they have been able to buy medical attendance for their club members very cheaply ’indeed. There are plenty of clubs ■which pay their, doctor no more than Ms per annum for each adult member, and 2s for children. In return for these payments the doctors undertake to supply all the medical attendance, drugs, and dressings which, the members may require. In other clubs the payment is slightly higher —3s Gd being the usual.rate for adults in the M idlands; w bile in other districts Is, or occasionally 5s is paid. ■

“On tliQ whole this club system is had. The doctor finds that lie can make his club work remunerative only if he has a very large number of club members. A thousand club members at 3s 6d per head will bring him in only £175 pci’ annum; and, if he is to make anything like a living out of his clubs, ho must multiply the £175 several times. “In other words, he must, in selfdefence, undertake the medical care of several thousands of people. A doctor with a large club connection may have 5000 or 6000 members on his books; and in times of stress—that is, in most winters—ho is certain to be faced with a visiting list with which it is impossible for him to cope properly. A busy club doctor may have GO or V 0 visits to pay day after

day, and anything from GO to 100

patients to see in t ic surgery. “Doctors are asking whether this dangerous cheap club system is to be extended. That the club system is to bo oxl.aided is clear: the question is, will it be cheap ? The :State Insurance Bill aims at converting the milk of private practice into contract practice. Nearly every doctor in fcjio' country is to be a club doctor on a big scale. “In the future anyone who chooses will be able to get all the doctoring he needs for a few shillings a year. Will these shillings be very few? If so, the result will be disastrous; and the sooner the, people of the country realise this the better it will be for them. At 4s per head a doctor will have to undertake to look after 3000 people if he is to receive £6OO a year, it is not easy to run a doctor’s practice on less, for a doctor’s’.expenses are heavy.” The main point, of the whole issue is put thus by “Stephen Andrew” : “That tire son’ices of a doctor ought to 1)0 assured to everyone who is sick needs no demonstration: a sick man’s need is a pressing need; but if those services are to be of any use they must be paid for adequately. To force a cheap contract rate upon the medical profession will bo disastrous.” The “Lancet” says that “Mr Lloyd- • George has declared himself to be ready to meet the medical profession in a generous manner, and that the onus is now upon the medical profession to demonstrate not so .much that hitherto it lias been very badlyi treated, as that it now knows its own mind, and will only co-operate in a scheme where just professional claims are admitted to proper rank. “The dislocation in private pracU tico will necessarily he enormous. Patients whoso wages range frrtni 30s to £3 arc at present a substantial -.support of many private practices; all those are to be lost to the general practitioner. “His work under contract terms will be lightened by the removal from bis care of the tuberculous, but some other patients will bo added to ins list, which will also contain many below the av.-rage in physique.” “Tim Chancellor lias read with a great' deal of interest the suggestion in the “British Medical Journal” that doctors should receive something extra for excessive sickness, payment for which, if caused by the default of a, nornploycr or a local authority can be obtained by the friendly societies under this Bill from the employer or the authority. He thinks that point well worth consideration, for as the Bill stands the doctor gets nothing extra for the extra work ho may he called upon to do in time of excessive sickness. “On another important point, the choice of doctors for persons insured, ire are able to state that the Chancellor will give : the Insurance Commission power to see that satisfactory arrangements are entered into with tiie doctors ,and on this point the doctors will have the right of appeal through their advisory committees. “Mr Lloyd-G serge thinks that the danger of the loss of private practice under the Bill has been greatly exag- - gerated. He points out that private attendance on the family bf the in-, cured person is not interfered with, and that the doctors will secure payment from all persons insured, whether attendance is required or not.” The editor of the “Lancet” says in the “Mail” : “The chief points the medical profession want satisfying on are, first, that, if they must work on any per capita scheme, the fees per patient must, lie adequate to the work done. The 4s per patient per annum rate of most friendly societies medical men rightly consider grossly inadequate. The second point the profession are insisting on is that they shall not ire placed in a subservient position to the officers of friendly societies. Thirdly, there is a universal demand that the insured patients must be allowed upon reasonable terms a choice of medical attendant. “The capitation fee estimated by Mr Lloyd-G eorge at six shillings per head for each person insured does not soern to bo enough. In practice it may mean little more than the old terms of the friendly societies. “The chief fault remaining in the Bill is the matter • of payment. - If the scheme can be financed in such ; a way as to ensure the general practitioner who is now earning a living wage from a middle class, and lower middle class practice the ‘same income . whbu G;>;ss same patmnis insure under the ins, I!ill Jr will lie found that much oi 1 he nuje.-l'in)) urged by the profession against the Chancellor’s Hill will disappear.” “A meeting of 80 per cent of the medical practitioners of Rending protested.,” says “The Times,” “against the voluntary clauses in the Insurance Bill which provide for medical attendance irrespective of a wage limit, and pledged the practitioners to refuse all service under the Act if those clauses are retained.” In speaking in the House of Commons on the' debate on the second reading (which was carried) of the National. Insurance .Bill, Mr LloydGoorge said, witli regard to the agitation as to doctors’ fees, that the proposed 6s payment, per patient is not fixed • or final. “We are raising twenty-five millions of money. There is nothing fo prevent doctors walking off with every penny of it—except their own consciences and the common sense of the comunity.” The Chancellor said that he questioned whether the working classes yet appreciated fully the magnitude of the boon that, they were receiving. Sixteen millions were to be raised for their benefit, partly by the employers and partly by the State. Insurance was to be brought within tlio reach of everybody at the age of 10. As to flic' quest,ion of married women, Mr Lloyd-G eorge remarked: “It is no use disguising the fact. The mo-

meat you put married women on to club practice it acids enormously to the burdens of tiie doctor, and 1 am perfectly certain that doctors would not look at 6s a head if matried women wore included in it. Every actuary warned me that they would break down any scheme. The difficulty has got to be faced sooner or lave! ; Init wo cannot start with it.”