Abbildungen der Seite
PDF
EPUB

the salaried man of from £250 to £500 a year, thinks he should have some opportunity of becoming a voluntary contributor. The elderly uninsured spinster resents that the childless widow should participate in the benefits while she does not. Among the aggrieved also are the persons entitled to superannuation on retirement who will receive only a modified pension.

66

Short of granting pensions to all, it is difficult to see how these grievances could be met, and on the whole the satisfied greatly outnumber the dissatisfied. The difficulties of drawing the line" at the initial stages of the Act were obviously considerable and inevitable.

Reports of misuse of the pension are uncommon. Here and there an old man was said to have spent the arrears (which there is no authority to pay otherwise than immediately in full) on a drinking bout. This points to the advisability of considering whether the practice of paying arrears, if the amount is large, by instalments, might not profitably be applied to pensions, as it is in certain circumstances to National Health Insurance benefits.

It is only right that a word of thanks should again be given to the many persons in all spheres of official and unofficial life who have helped in the work of completion and investigation of claims. Employers, ministers of religion, doctors, inspectors of poor, teachers, trade union and approved society officials, all rallied to the assistance of the widows, the orphans and the old people. Without such help the investigations would have been much more arduous and in many cases unfruitful. Time and again applicants have expressed their surprise and gratitude that their claims had been substantiated through other sources when they themselves had been unable to supply the necessary information. It has been a pleasure to us to be accorded so unstinted a measure of voluntary co-operation, and we feel that it promises well for the scheme that it has received a welcome so widely and practically expressed.

CHAPTER XV.

NATIONAL HEALTH INSURANCE.

APPROVED SOCIETIES.

1. Consequences of the Industrial Stoppage.-The industrial disturbance during 1926 had a very serious adverse effect on the funds of approved societies. Following on the widespread unemployment there was a considerable decline in societies' income from contributions. It is estimated that after allowing for the changes in the rates of contribution which took place at the beginning of 1926, the contribution income for that year was £226,000 less than for the previous year.

Coupled with the diminution in income, there was a disquieting increase in benefits expenditure. When due allowance has been made for increases in the rates of cash benefit made under schemes of additional benefits, it is estimated that the expenditure on sickness and disablement benefits during 1926 was some £250,000 in excess of that for 1925, representing an increase of sixteen per cent.

From investigations commenced shortly after the stoppage in the coal industry in May, it appeared that the increase in benefit payments was confined practically to the industrial areas. It was appreciated, of course, that the industrial conditions would occasion some legitimate increase in the volume of claims, but the actual increase could only be ascribed partly to this cause, and there was no epidemic or exceptional outbreak of sickness to account for the remainder.

In June a circular was issued to all insurance practitioners in Scotland drawing attention to the sudden rise that had taken place in the demands on societies' benefit funds, and stating that from enquiries it appeared that the increased claims were largely due to practitioners in some quarters granting certificates of incapacity more freely than hitherto and not observing the former standards of incapacity for work. Practitioners were reminded of the conditions for the payment of benefits, and were urged to have proper regard to the requirements of the National Health Insurance Act when issuing certificates of incapacity.

Notwithstanding this circular the expenditure remained at an abnormally high level, and its incidence was unchanged. The effect on some societies and branches was particularly severe, the increases experienced ranging to 500 per cent.

The increase in the number of cases referred by approved societies to the District Medical Officers reflected the disquietude of the societies as to the situation. During the months June to December, 1926, more than four times as many male claimants for benefit were referred by societies to the District

Medical Officers for their opinion regarding incapacity as in the corresponding months of 1925. The large proportion of cases found on examination by the District Medical Officers to be capable of work shewed that the apprehensions of the societies were well founded.

As the high rate of expenditure continued, and as the evidence afforded by the records of the District Medical Officers pointed to relaxation in the criterion of incapacity applied by insurance practitioners, it was felt that further endeavours to cope with the situation by enlisting the co-operation of the medical profession were called for. The question was first discussed with the Consultative Council on National Health Insurance (Approved Societies' Work). Thereafter we consulted the Insurance Acts Sub-Committee (Scotland) of the British Medical Association, who recognised the responsibility of practitioners in the matter, and agreed that the remedy lay in the hands of the profession. It was resolved that meetings of practitioners should be held in the various areas affected, in order to discuss the matter in its general and local aspects, with a view to securing the general observance of a satisfactory standard of certification, and also that those practitioners more deeply concerned should be interviewed personally.

The termination of the industrial stoppage brought a rapid improvement in the rate of benefits expenditure, and, while this occurred shortly after the consultation with the British Medical Association and before the meetings could be inaugurated, it was nevertheless felt that the steps proposed to be taken would serve a valuable purpose in bringing clearly to the notice of insurance practitioners the serious effect lax certification had on the National Health Insurance Scheme, and the need for counteracting any future tendency in that direction.

Action was accordingly taken on the lines recommended and was proceeding at the close of the year.

2. The Royal Commission.-During the year the recommendations of the Royal Commission on National Health Insurance have been under consideration, in consultation with the Consultative Council on National Health Insurance (Approved Societies' Work).

3. The National Health Insurance Act, 1926.-This Act, being Part I of the Economy (Miscellaneous Provisions) Act, 1926, made several changes in the statutory provisions relating to National Health Insurance. The most important of these were (1) the reduction, as from 1st January, 1926, in the State grant from two-ninths of expenditure to one-seventh in the case of men and one-fifth in the case of women, and (2) the increase, from 10s to 13s. per person per annum, as from 1st January, 1927, in the maximum sum which approved societies may be required to contribute in respect of the cost of medical benefit and the administration expenses of Insurance Committees. The latter change, which was recommended by the Royal Com

mission, constitutes a permanent provision for meeting the excess which the actual expenditure on medical benefit and Insurance Committees' administration has always shewn over the existing contributions by societies towards these objects. During recent years, under temporary arrangements made by the National Health Insurance (Cost of Medical Benefit) Act, 1924, the greater part of the excess has been charged on moneys. accumulated in respect of unclaimed stamps, but these arrangements terminated at the end of 1926.

4. Other matters of special interest in 1926 were the completion of the second valuations of approved societies, and the consequent institution of new schemes of additional benefits; the inauguration of improved arrangements for the provision of dental benefit, following on negotiations between accredited representatives of approved societies and of the dental profession; the continuance of the Prolongation of Insurance Act and of the grant of free credits of contributions to genuinely unemployed persons. These various subjects are dealt with in detail below.

5. General Correspondence: enquiries and complaints.-The volume of correspondence dealt with during 1926 exceeded that dealt with in 1925 by some 20 per cent., but it continues to be small in comparison with the number of transactions which occur annually between societies and their members.

Only in a comparatively small proportion of the complaints received from insured persons has the society or its agent been found to be at fault. In the majority of cases it has been found either that the member's claim was invalid by reason of some statutory provision, or that he himself had failed to comply with some prescribed requirement.

The great majority of complaints from insured persons relate to their society's rejection of a claim for sickness, disablement or maternity benefit. Lost contribution cards and, in the case of sickness or disablement benefit, late notification of incapacity are frequent causes of the failure of the claim. It is inevitable that, in so large a scheme as National Health Insurance, there will always be a certain number of claims which will fail for some such reason.

Title to "additional" benefits, and in particular to dental benefit, continues to be imperfectly understood. Many complaints have been received of failure to grant such benefits where the complainer's society or branch has elected not to provide the particular benefit desired, or has been unable to do so owing to lack of funds.

During the first six months of 1926, members of societies which were valued as at 31st December, 1923, and whose resultant schemes of additional benefits only came into operation on 5th July last, found difficulty in appreciating the reason why their claims for dental benefit, for example, were being dealt with on a different basis from those of members of societies whose second schemes of additional benefits came into operation in

1925. In the latter half of the year this class of case disappeared, but a further cause of complaint arose from the fact that " treatment" benefits, such as dental benefit, can be provided during any calendar year or other period of account only to the extent of the sum of money allocated to the period. Unfortunately, certain societies, having exhausted their funds, found it necessary in the latter months of 1926 to suspend the grant of applications for dental benefit until further funds became available on 1st January, 1927.

On the whole, considering the very extensive provision of additional benefits now made by approved societies, the number of complaints of difficulty in obtaining such benefits has not been

serious.

Reference was made in the last Report to complaints lodged by insured persons of stoppage of cash benefit where the stoppage had followed examination by a District Medical Officer. While there are still many insured persons who do not appreciate that the District Medical Officer acts in an advisory capacity only, and that it is the society which determines whether or not benefit is payable, the number of complaints of this class received during the past year has been inconsiderable, despite the very great increase in the number of persons referred to the District Medical Officers. It would, therefore, seem that the functions of the District Medical Officers are becoming more widely understood.

It is clear that the extensions of insurance conferred on unemployed persons by the Prolongation of Insurance Act and Regulations, and the partial excusal of the arrears of such persons, are now very generally known. Many persons have complained that they have not been granted the concessions to which they thought themselves entitled, and in some cases they have been able to substantiate their claims.

The Widows', Orphans' and Old Age Contributory Pensions Act led to many enquiries from elderly persons as to their position in insurance, on which their title to an Old Age Pension will depend. Representations were also received from societies to the effect that the special provisions of the Pensions Act relative to such persons are, by their complexity, productive of considerable difficulty and misunderstanding, a contention with which the Board in the light of their own experience are inclined to agree.

6. Approved Societies: their number, classification, &c.-The number of societies operating in Scotland has been increased by the approval of two unregistered Friendly Societies with Head Office in England. Each of these societies was set up by a special group of employed persons previously completely excepted from insurance, in order to accommodate such of the group as have become or may in the future become Voluntary Contributors with a view to participating in the benefits of the Pensions Act.

A registered Trade Union with Head Office in England decided during the course of the year to separate its trade union

« ZurückWeiter »