DEVELOPMENT OF THE HEALTH SERVICES.

(7) That the various Medical Services organised by the State will continue to expand both in their scope and in the range of persons to whom they apply. (paras. 55-56, 115.)

(8) That these services should be maintained in close relationship with each other, both at the centre and in their local administration. (para. 123.)

(9) That in considering any changes or developments in the Insurance Medical Service regard should always be had to the importance of the fullest possible co-ordination with other health services. (paras. 115, 120.)

MEDICAL AND TREATMENT BENEFITS.

(10) That medical benefit has been a valued and successful element in the Scheme of National Health Insurance. (para. 74.)

(11) That while it has been inevitable hitherto that medical benefit should be confined to a general practitioner service, this limitation has detracted from the value of the benefit and its removal is urgently desirable. (para. 261.)

(12) That the additional benefits of a treatment character have been, on the whole, successful and appreciated, though in varying degrees, but that they suffer from the following defects inherent in the conditions under which they are provided :

(a) They are only available for those insured persons who are members of Societies having surpluses at valuation, and only for those members who fulfil certain qualifying conditions, and that consequently large classes of insured persons are debarred from participating in these valuable services.

(b) Even among the Societies giving a particular type of treatment benefit there is no uniformity in the content of the benefit, with the result that there is widespread confusion in the minds of the insured persons as to what precisely their rights are.

(c) The arrangements made between Societies and professional bodies are wanting in authority and uniformity, and in some cases are accompanied by undesirable conditions (para. 81.)

MATERNITY BENEFIT.

(13) That it is desirable that, as soon as funds are available, the scope of maternity benefit should be expanded to cover medical and midwifery services in addition to a cash payment; that the service element should then be administered by the local Health Authorities and be co-ordinated with the other local medical services; and that a cash element should be retained

and be administered in connexion with the other cash benefits. (paras. 114 and 343.)

THE FINANCIAL BURDEN OF THE EXISTING SOCIAL SERVICES.

(14) That the financial burden of the various social services is at the present time so great in proportion to the productive capacity of the country, and so much in advance of what is provided in countries which are our trade competitors, that no extensions of benefit involving substantial additional expenditure should be contemplated now or in the immediate future, but that any immediate changes in the Scheme of National Health Insurance should be limited to such as are possible within its present financial resources. (paras. 151-153.)

(15) That accordingly there should be no increase at the present time in the rates of contribution or in the scale of the Exchequer Grants. (para. 153.)

THE FINANCIAL RESOURCES OF THE NATIONAL HEALTH INSURANCE SCHEME.

(16) That the financial arrangements of the Scheme are well devised, and that the machinery works smoothly and effectively. (para. 155.)

(17) That an analysis of the expenditure of Approved Societies on sickness and disablement benefits reveals the need for more effective supervision of claims for those benefits, and that the attention of the Central Departments should be directed to the matter so that they may consider in co-operation with the Approved Societies more effective methods of supervision. (paras. 176-177.)

(18) That by a modification of the actuarial basis of the Scheme, particularly with regard to expectation of sickness and assumed rate of interest as set out in the First Report of the Actuarial Committee, and by certain financial readjustments described below, a margin can be made available out of the present weekly contribution which, with the related State grant, will provide a sum of about 7s. a year in the case of men and 3s. 9d. a year in the case of women. (para. 179.)

(19) That the first charge on this margin should be the provision of the balance (estimated at 3s. per insured person per annum, both for men and women) of the cost of the present medical benefit for which no statutory provision has been made beyond the end of 1926; further that any deficiency in respect of the cost of medical benefit for the three years 1924-1926 should be met by an increase of the charges imposed by the National Health Insurance (Cost of Medical Benefit) Act, 1924 upon the moneys to which recourse is authorised by that Act. (para. 182.)

(20) That the balance of the margin should not be devoted to decreasing the present weekly contribution, but should be

applied to its full extent towards meeting the cost of extending the statutory benefits. (paras. 183-186.)

(21) That Section 67 of the Act should be amended to provide that the amount of the weekly contribution to be devoted to providing interest on and redemption of reserve values be reduced from 1d. in the case of men and from nine-tenths of 1d. in the case of women to such amounts as may be actuarially shown to be necessary without disturbing the redemption period, after the charges and readjustments have been settled. (para. 194.)

(22) That Section 67 should also be amended to provide that the amount of the weekly contribution to be retained for the purposes of the Contingencies Funds and Central Fund should be reduced from five-ninths of 1d. to one farthing in the case of men, and from two-fifths of 1d. to one farthing in the case of women. (para. 194.)

(23) That the maximum proportion of these reduced sums to be paid to the Central Fund should be increased from one-eighth to one-fourth. (para. 194.)

(24) That Section 76 (5) of the Act should be amended to provide that consequentially on the reduction of the contribution to the Contingencies Funds, the whole (instead of a maximum of one-half) of the balances of the Contingencies Funds of all Societies with less than 1,000 members should be liable to be pooled to make good deficiencies in any such Societies. (para. 194.)

(25) That the balances accruing to the credit of the Reserve Suspense Fund after the 31st December, 1926, should be made available for averting deficencies which would otherwise arise on the valuation of Approved Societies by reason of the imposition on their funds of the proposed new charges. (para. 194.)

(26) That consequent upon the placing of the liability for the whole cost of medical benefit on the funds of Approved Societies, the appropriate changes should be made in the rates of contribution of men serving with the Forces of the Crown, foreign-going seamen of the Mercantile Marine, and voluntary contributors with incomes exceeding £250 a year and that, in the event of the provision of allowances for dependants of insured persons, a further appropriate adjustment should be made in the contribution payable in respect of men serving in the Forces of the Crown. (paras. 191-193.)

THE APPROVED SOCIETY SYSTEM.

(27) That the Approved Society system as a means for the administration of the cash benefits of National Health Insurance should be retained, but that this question might have to be reconsidered in the event of fundamental changes being made in the system of social insurance. (paras. 222-223.)

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(28) That the administration of additional benefits of the nature of treatment should remain in the hands of the Approved Societies in so far as the consideration of claims for benefit is concerned. (para. 228.)

(29) That where a treatment benefit has been so widely adopted as an additional benefit as to be available for a large proportion of the total insured population, the negotiations as to terms and conditions of service with the profession by whom the service is provided should be undertaken by the Central Departments, and that the organisation and supervision of the service should rest with those Departments either directly or through the agency of the local bodies responsible for the administration of medical benefit. (para. 228.)

(30) That Section 22 (1) of the Act should be amended so as to empower the Minister in any case in which the rules of a Society do not in the view of the Department adequately provide for its proper government, or are likely to operate unfairly to the prejudice of members, to give notice to the Society not less than one month before a general meeting, to consider an amendment of any rule to which exception is taken; and if the rule is not so amended, to make an Order directing that the amendment desired shall be deemed to be incorporated in the rules; and that appropriate machinery for dealing with objections should be set up. (para. 240.)

(31) That in the case of centralised Societies there should be only one tribunal for the determination of disputes between Societies and their members, before reference to the Minister, and that in the case of Societies with branches not more than two such tribunals should be allowed, namely the branch. tribunal and a tribunal of the District to which the branch is attached, or of the central body of the Society. (para. 241.)

(32) That provision should be made by an extension of Section 38 of the Act whereby the Department should have power to hold an inquiry into the methods of administration of any Society where the administration of the Society is regarded as unsatisfactory in any respect; and that if the Department is satisfied that it is not in the interest of the insured members that the Society should continue to be approved, the Department should have power to require it to arrange for the transfer of its engagements to some other Society. (para. 242.)

(33) That it is inexpedient to impose any statutory restriction on the size of Societies. (para. 230.).

(34) That in any case in which the Minister is satisfied that the administration of a Society or branch does not conform to a reasonable standard of efficency he should be empowered to order a reduction as he may think fit, of the amount allowed to the Society for administration purposes. (para. 242.)

(35) That the members of an international Society resident in any national areas other than that in which the head office of the Society is situated should be given a further opportunity of electing, subject to the consent of the central body of the Society, to have a combined valuation for the whole Society; but that no new option should be given to international Societies to be valued separately in respect of each part of the United Kingdom in which they operate. (paras. 562-563.)

(36) That Section 30 (2) should be amplified so as to provide that where the number of members of an international Society who are resident in any national area other than that in which the head office of the Society is situated is less than a definite percentage of the total membership and is not more than a certain number, approval may be withdrawn in respect of that area and the members resident therein should be deemed to be resident in the area in which the head office is situated. (para. 606.)

(37) That where at a general meeting of an Approved Society with branches a resolution in favour of the centralisation of the branches either wholly or in districts is passed by such substantial (e.g., four-fifths) majority representative of the insured members as may be prescribed, such resolution should, subject to prescribed conditions, be binding on all branches of the Society. (para. 609.)

(38) That the provisions of Section 76 for the pooling of the Contingencies Funds of small Societies through associations should be repealed, but that existing associations be allowed to continue on a voluntary non-statutory basis for the purposes of consultation and general co-operation. (para. 567.)

(39) That Section 72 should be amplified so as to give to the Auditors powers of disallowance and surcharge in the case of improper expenditure by Approved Societies. (para. 244.)

PARTIAL POOLING OF SURPLUSES.

(40) That while the possibility of the existence of differences in the benefits provided by different Societies may justifiably be continued as a feature of the Scheme of National Health Insurance, the disparities which have emerged are greater than are expedient in the interests of the insured community regarded as a whole; and that, therefore, some mitigation of these inequalities is desirable. (para. 255.)

(41) That to effect this result, a scheme of partial pooling of surpluses on the following lines should be instituted :

(a) No surplus (including Contingencies Fund) which has accrued prior to the change of system should be subject to pooling, and thereafter pooling should apply only to such part of a surplus as has accrued since the date of the last

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