(2) the examination of the quality, workmanship or fittings of dentures or other work or material involved in carrying out such estimates; and

(3) making enquiries at the direction of the Board into matters relating to dental treatment under the scheme.

The cost of the Regional Dental Service, like the expenses of the Dental Benefit Joint Committee and ancillary charges, will be treated as part of the expenditure, by societies taking part in the scheme, on the provision of dental benefit.

At the close of the year all the societies concerned were invited to notify formally their acceptance of the new scale and conditions attaching thereto. It appears that a few societies and branches are reluctant to adopt the new arrangements because the new scale may entail heavier calls upon their funds. It is anticipated, however, that the great bulk of societies will operate the new arrangements, and that eventually these will be generally taken advantage of. An important factor in the situation is that the dental profession is understood to have accepted the new scheme almost unanimously, so that the new scale of charges is the only generally recognised scale now available to approved societies under their schemes of dental benefit.

It is intended that the Dental Benefit Joint Committee will remain in existence for the purpose of exercising a general supervision over the arrangements between societies and dentists and of dealing with other matters, such as the determination of any disputes which may arise following on examination by a Regional Dental Officer, and the formulation of procedure for disciplinary action.

Apart from the important developments referred to above, the administration of dental benefit during 1926 calls for little comment. Most societies appear to have found their funds sufficient to meet all claims for the benefit. In a few cases, however, including at least one large society, we were asked to approve amendments of schemes making further funds available for dental benefit at the expense of some other benefit less in demand, while, in certain other cases where funds proved inadequate, we allowed the societies to utilise, during the first eighteen months of operation of their schemes, a proportion of the funds reserved for subsequent periods. We felt justified in so doing in view of the tendency of claims to be most numerous during the early period of operation of a scheme. A few societies were compelled to suspend dental benefit entirely towards the close of the year through lack of funds, but most of them will be able to meet the postponed applications out of fresh funds which will become available on 1st January 1927. Two units, one being an important society operating throughout Scotland, improperly granted benefit during 1926 on such a large scale as to make serious inroads on the money reserved for later periods. These cases are at present receiving attention.

A few units were found to be fixing the amounts of the grants to be made by them in a manner contrary to the conditions

laid down in their dental benefit schemes. One such case was that of a branch which, fearing the exhaustion of its funds, had imposed an arbitrarily fixed limit to the amount of grant allow. able in any one case.

In general, however, it may be said that despite the problems and difficulties which inevitably arise in administering so large a sum as nearly £250,000 per annum in the provision of a novel benefit to some 1,330,000 potential claimants throughout the country, the manner in which the work has been carried out reflects creditably on the societies and branches concerned.

23. Ophthalmic Benefit.-Approximately £45,000 per annum is now available in Scotland for the provision of ophthalmic benefit, the membership concerned being, approximately, 1,240,000.

The main features of the arrangements for the administration of the benefit were indicated in the last Report.

While the provision of ophthalmic benefit on its present lines is proving of great value to the insured population, the operation of the benefit has raised certain problems which have not yet been completely solved. Perhaps the most important of these is the delimitation of the respective spheres of the general practitioner, the ophthalmic specialist, and the optician. This subject has been dealt with in the report of the Royal Commission, and it is presently receiving consideration. Meantime we record the view that while we have no desire to see approved societies saddled with any unnecessarily expensive arrangements, we attach the greatest importance to the skilled diagnosis and treatment of eye defects, and consider that ophthalmic benefit should make skilled advice available to insured persons in cases where such service is essential in the patient's interest.

Societies appear to have experienced difficulty in arranging a scale of charges for optical appliances on which their grant to the insured person is to be calculated, as in the parallel case of dental benefit. In consequence, there seems reason to apprehend that the intention that insured persons should receive grants proportionate to their varying needs is not in many cases being realised.

י.

While the number of complaints received regarding the administration of ophthalmic benefit is inconsiderable, we are not satisfied that the existing arrangements are wholly satisfactory. It is accordingly proposed to review the whole position when sufficient experience is available, and when opportune occasion arises.

24. Other additional benefits.-Hospital benefit has been adopted by five societies in the 1923 group, and is now applicable to over half a million members. One large society proposes to distribute the funds available for the benefit in proportion to the duration of the treatment afforded to its members by the various voluntary hospitals. As stated in the last Report, the funds allocated to the provision of hospital benefit do not represent

the full extent of the assistance given by societies to the voluntary hospitals. Many societies and branches are making grants to these institutions under Section 26 of the National Health Insurance Act. There is no exact information as to the extent of these grants, but there is reason to believe that they are considerable.

The provision of medical and surgical appliances, while not an expensive benefit, has without doubt been of great advantage to many insured persons. Enquiries have been received from several societies which provide the benefit on the point whether or not they are entitled to assist a member in obtaining some particular appliance, and the scope of the benefit is so wide that it has usually been possible to express a favourable opinion in reply.

There is an increasing demand for the provision of ultra-violet ray treatment and massage treatment as additional benefits. Unfortunately such forms of treatment cannot be directly given under any existing additional benefit.

Additional Benefit No. 19, which allows societies to remit in part arrears which have accrued in respect of a period of genuine unemployment, has been adopted by 23 societies and 205 branches, with a total membership of 730,000 insured persons. Having regard to the continuing widespread unemployment, this benefit has doubtless proved of great value. Some units received such heavy calls on the benefits, by reason of the industrial situation arising out of the coal stoppage, that it was necessary to revise their schemes to meet the situation.

Following on the amendment of the Arrears Regulations to permit the grant of free credit of contributions to members whose arrears were due to the industrial troubles of 1926, in the same way as if they had been due to genuine unemployment, intimation was made to societies that we were prepared to approve a corresponding amendment in the provision defining title to Additional Benefit No. 19. One society and four branches have taken advantage of the offer.

25. Appeals and Disputes under Section 90 of the National Health Insurance Act, 1924.-The total number of appeals submitted during the year was 33. All related to disputes between societies and their members. In 31 cases questions of the members' incapacity for work and the liability of the society for benefits were involved. In one case the question raised was whether in the circumstances the society were entitled to treat the member as being in arrears. In the remaining case it was found that the question submitted did not arise, and the appeal was consequently dismissed. Nineteen of the appeals were decided in favour of the member and thirteen in favour of the society. Three of these disputes came up for determination under the procedure provided for in Article 183 of the Approved Societies Regulations, 1924, whereby, if a society delays for a specified period to decide a dispute in accordance with its rules,

the member may apply direct to the Board by Petition. One case was outstanding at the end of the year.

26. Grant towards the cost of Medical Treatment of Aged and Disabled members of Societies.-The total amount paid to the private funds of societies from the Special Exchequer grant towards the cost of medical attendance of aged and disabled members up to 31st December, 1926, was £1,581, 11s.

27. Investments of Approved Societies.-The total amount declared available for permanent investment, in terms of Section 70 (1) of the National Health Insurance Act, to 31st December, 1926, was £11,590,682. In addition to this amount, a profit of £11,999, Os. 4d., which was made by the realisation of certain investments, has also become available.

The total sum of £11,602,681, Os. 4d. has been disposed of as follows:

(1) Advanced to Societies for investment (including cost price of investments transferred to Societies)

...

...

£4,465,012 12 4

1,344,056 10 9

The nominal value of investments held by us on behalf of

Approved Societies is £1,507,475, 8s. 7d.

CHAPTER XVI.

NATIONAL HEALTH INSURANCE (continued).

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INSURANCE COMMITTEES AND MISCELLANEOUS INSURANCE QUESTIONS.

1. Insurance Committees.-During the year in eight Insurance Committees vacancies have arisen in the quota of members that, under the Statute, we are entitled to appoint. In each case, after suitable local enquiry, a member has been appointed to fill the vacancy, nine new appointments in all having been necessary.

2. Administration Expenditure.-The scale allowance to Insurance Committees formulated in 1924 with respect to their administration expenditure has continued in force. The payments at scale rates made to the individual Committees are shewn in Appendix XIV. There was little change in the estimates of expenditure of the different Committees. In eleven instances approval was given to the small increases entered in the estimates in respect of remuneration of staff and office and meeting accommodation. In other six cases there was a slight reduction in the estimates for these items, and in the remaining 37 cases there was no change.

At the close of the year it was found that the total expenditure of all 54 Insurance Committees had been roughly £47,000, including approximately £4,000 in respect of the cost of the upkeep of the Central Checking Bureau for the pricing of prescriptions for medicines, &c.

3. Glasgow Boundaries Extension. - Consequent on the extension of the boundaries of the City of Glasgow and the resulting transfer of 6,000 insured persons or thereby from neighbouring areas to the area of the City Insurance Committee, an Order was made providing for an adjustment as at 1st July of the shares of the medical benefit monies credited to the Insurance Committees of Glasgow and of the Counties of Renfrew, Lanark, and Dumbarton respectively.

4. Index Clearance Committee.-In order to give effect to the decision mentioned in the last Report, we established, by regulations, a combination of Insurance Committees for the purpose of constituting the Committee on which would be laid the duty of rectifying the existing Index Register and maintaining, throughout the period of their term of office, a proper record of the persons entitled to medical benefit. Under the regulations there was constituted an Index Clearance Committee, comprising three members appointed by us, three nominated by