On the point of equity, it must be admitted that any system of so-called insurance which, like that of the English Act, excludes a large proportion of the population who, while paying in taxes in aid of the insured, require but do not receive their benefits, is contrary to the principle that any expenditure of Government funds should enure to the whole community in need of the provision in question.
The provision of 10 shillings a week for incapacity lasting 26 weeks (7s. 6d for women), followed by 5s. a week disablement benefit, although inadequate provision for family maintenance during sickness undoubtedly is helpful. It is mischievous when in consequence of this provision, the patient is tempted to remain at home under unsatisfactory domiciliary treatment, instead of receiving the shorter and more successful institutional treatment, which should have been given.
As to economy of administration, I can speak only with reserve; but it requires little imagination to appreciate that the numerous migrations of wage-earners imply great difficulties in book-keeping as well as in securing insurance medical attendance, and that a very high percentage of the total insurance funds is swallowed up in elaborate and meticulous account keeping.
The point as to malingering can best be considered in connection with a discussion of the
Medical Benefit
This consists of such medical treatment, at home or at the office of the panel doctor,[12] as “can consistently with the best interests of the patient be properly undertaken by a practitioner of ordinary professional competence and skill.”
The Act itself promised “adequate medical attendance and treatment,” but under regulations this has been limited, so that in practice it means chiefly the treatment only of minor ailments. Thus (a) there is no provision for hospital treatment of patients needing this, except the Sanatorium provision for tuberculosis; (b) with the same exception, there is no provision for expert services. A patient requiring operative treatment for fractures, for an amputation, or an operation for appendicitis, or needing treatment for some affection of the eyes, or nose, or throat, or ears, or the intravenous treatment of syphilis is excluded from medical benefit. So likewise are dental requirements. (c) There is no provision for pathological diagnosis, except such as is common to the entire population, and no X-ray diagnosis, except possibly for tuberculosis. (d) There is no provision for nursing assistance.
In view of the unequal distribution and insufficient provision of hospitals for the general population, of their inaccessibility to large masses of patients, and of the insufficiency of the present provision for the scientific aid to treatment which modern medicine demands for insured and non-insured alike, it is evident that the provision for medical treatment under the Act is unsatisfactory and inadequate, and that it conduces to prolonged illness, which treatment provided on more satisfactory lines would avoid.
To state adequately the defects of the medical provisions of the Insurance Act a long address would be required. They are, however, generally well known, and their existence and seriousness is admitted by all. (See also page [90].)
It is necessary, however, to say more on the