ENGLAND’S EXPERIENCE WITH HEALTH INSURANCE.

Star (Christchurch), Volume LXVI, Issue 20482, 7 December 1934, Page 6

ENGLAND’S EXPERIENCE WITH HEALTH INSURANCE.

To-day’s Special Article

System is Justified by the Results in Spite of Hostility at Inception.

By

I Louis M. Lyons

When the last word is to be said on any subject in England

they say it with a Royal Commission. After fifteen years of health insurance, a Royal Commission reported that “ national health insurance has established its position as a permanent feature of the social system in this country and should be continued on its present compulsory and contributory basis.” Thq British Medical Association, which strongly opposed the English health insurance law when it went into effect twentyfive years ago, now endorses it. American medical groups, however, stand against suggestions for health insurance, on the ground of their general objection to the socialisation of medicine.

BRITISH health insurance law must have gone a long way toward the “ socalisation ” of medicine, for it fixes the rates at which medical treatment is to be given those insured under the British Act. And doctors cannot well turn their backs on this kind of practice for the Act embraces 17,500,000 potential patients who are able to pay. It covers all persons between 16 and 65 in the employments which come under the Act and that means nearly all except farming and housework and certain services, such as Government workers, that are separately covered. It includes sickness benefits, disablement benefits and maternity benefits, and under its wing also come the contributory old age pensions to which the insured workers are eligible at 65. The British system of health insurance does not include funeral expenses, and an explanation goes with that—the story that Lloyd George, who was responsible for the health insurance measure, reached an agreement with the insurance companies selling 44 industrial ” insurance to exclude funeral benefits in return for their promise not to oppose the Bill. England has its separate Workmen’s Compensation Act. The National Health Insurance is for the more ordinary disabilities of life, aside from industrial accidents. The weekly contribution comes to one shilling and sixpence for a man, thirteen pence for a woman, of which the employer in all cases pays half. The Government pays one-third. All payments are at a flat rate regardless of the age at which the worker becomes insured. The rates are figured to cover actuarial costs of benefits in the case of persons entering the scheme at the age of 16, as all workers now do. The State's contribution takes care of the deficit in the payments of those who entered at older ages. Sickness Benefits. Sickness benefits are paid after four days’ absence from work, and can continue for half a year, with a further extension of time at half the sickness rate for a second half-year if disability continues. The sickness payments are 15s a week to men and 12s to women Maternity benefits, payable either to an insured woman or the wife of an insured man, come to 40s. Certain additional benefits when required bv special treatment, and such needs as glasses, are also covered by the sickness insurance Medical attendance and also the doctor’s prescription at the drug store are provided in addition to the cash payments. Doctors register for this patronage, with a district committee, and the insured patient has free choice from among the

doctors registered in his district. The doctor is paid at the rate of 9s for every insured person on his list of patients. Rural doctors are also allowed a certain additional mileage charge. Most of the insured workers receive their sickness benefits through co-operative societies administered under the supervision of the Government. There are about 1000 of these “ approved societies ” in England operating health insurance under Government regulation. The cost of administration has been about 13* per cent of the total revenues. By economical management of the funds, many of the societies have been able to increase the benefits to their members. Through these societies the National Health Insurance Fund pays out £32,000.000 a year in sickness payments and £5,000,000 more for operating expenses. The Government, which theoretically contributes one-third, actually has to find only about one-sixth of the total. The invested funds of the 17,500.000 contributors now come to more than £120,000,000, and the interest on these funds exceed £6,000.000 a year, reducing to £7,000,000 what the British taxpayer has to meet. Justified by Results. After sixteen years’ operation of the health insurance scheme, the Encyclopaedia Britannica reported on it: “ There, is no doubt that it is entirely justfied by its results. At the inception considerable hostility was encountered. It did not meet with a favourable reception from the medical profession and was unpopular with large sections of employers and with some classes of insured workers. The opposition has now almost entirely disappeared. There can be no question that the benefits provided are highly appreciated amongst the insured community and the contributions are paid with almost entire absence of friction. The financial success of the scheme has been demonstrated and the great majority of the insured are receiving benefits substantially greater than the minimum provided under the Act. The amount of distress amongst the working classes occasioned by sickness of the wage-earners has been materially reduced, with the result that expenditure on poor law relief is substantially less than it would be without this scheme. The general death rate has fallen materially since the scheme was introduced and it is reasonable to attribute this in some measure to the fact that all insured workers are entitled to free medical attendance immediately they have any need of it.” (N.A.N.A. Copyright.) This is (he third of six articles outlining England’s efforts to reform her economic system.