General Practitioner Treatment
provided under the Act. Every insured person is allowed to choose his own doctor within a given distance. In practice very few patients change their doctor at a fixed time each year as they are allowed to do; and a considerable proportion of insured persons do not trouble to choose a doctor at all. The free choice of doctors is rather a sentimental than a real demand. The panel doctor is paid an annual capitation fee, and hitherto no limit has been placed on the number who may place themselves on his roll. The domiciliary treatment given by some doctors is entirely satisfactory within the limits stated above. Commonly, however, it is as unsatisfactory as the “club practice” which preceded it, and against which the British Medical Association inveighed. It involves a continuance of the mischievous ideal of medical practice of the past, a conception still held by a large portion of the public to its own detriment, that a hasty inquiry, a perfunctory examination, and a bottle of medicine, represent the best that scientific medicine can offer a patient. Had there been organized a chain of medical services for all needing it, including consultations and expert assistance when needed, every patient having the right to call for these when dissatisfied with his panel doctor, including also hospital provision and nursing as required, what a different story could now be told!
It is probable that some at least of these additional services will be added gradually; but it must be noted that the present payments of the insured will not suffice to pay for them; and that if they are to be provided,—as they will probably need to be,—out of public funds, the general public are in equity entitled to these services even though they are not insured.
If these complete services were provided, the medical treatment now provided largely at the expense of the community could be made a means for advancing the public health. This it can not at present claim to be. For nothing is more certain than that the prompt and adequate treatment of disease curtails its duration, diminishes its severity, and prevents its spread to others.
But even such a service would not fulfil its complete possibilities for good unless it were joined to a system of hygienic supervision of each insured person and of each insured person’s family, this system being organically linked up with the wider public health work of the larger Public Health Authorities.
The chief justification of a national system of insurance against sickness is that it shall be an active auxiliary in the prevention of disease. At present it is doubtful whether any national system of sickness insurance has been so. It has only been so, to the extent to which the medical treatment of the masses of the population has been improved by it; and no such improvement can be claimed for British insurance. The wider possibilities of prevention of illness and elevation of the general standard of health, by making each medical practitioner a family adviser on health more than a practitioner in medicine, have not been realised or even brought within sight.
Evils of the Present Medical Benefit
The inadequacy and unscientific character of the medical treatment given to insured persons are associated with a large amount of lax certification of illness, which is injurious to the character of doctor and patient, besides being unfair to the insurance funds. Those interested in this point should read paragraphs 118, 119, 120, 121, 123, 125 of the Report of the Departmental Committee on Sickness Benefit Claims (Official Report Cd 7687).
There is almost universal testimony of the belief (of representatives of friendly societies) that medical certificates are granted recklessly (par. 119).
Doctors ... feel a difficulty in refusing certificates owing to the possible effect upon their practice.... If a doctor falls out with his patient he loses the entire family (par. 120).