with the object of effecting certain improvements in the method of administration of the benefits concerned. In general, however, societies have been content to leave their schemes unchanged. During the year we have approved proposals from three societies and one branch whereby the rate of additional cash benefits was slightly reduced, and non-cash benefits, such as dental and optical benefits, substituted. One society which had previously decided to carry forward its disposable surplus to the second valuation submitted to us a scheme, which we have approved, applying the surplus to the provision of dental and optical benefits. A markedly increased interest in dental benefit has, however, been manifested during the latter half of the year, and a number of societies and branches intimated to us their desire to provide this benefit in view of the demands of their members. In the great majority of these cases dental benefit could be provided only as a result of a reduction in the additional cash benefits already payable, and, as a result, in four cases only was the requisite amendment. carried through. From our experience, however, it would appear not unlikely that societies will provide dental benefit to a greatly increased extent when schemes arising out of the second valuation fall to be prepared. All indications go to prove that of all the additional benefits in kind dental benefit is the most popular amongst insured persons. The total number of additional benefit schemes approved by us and still in operation is 486, of which 87 relate to centralised societies and 399 to branches of societies. In the case of 2 societies and 17 branches where transfers of engagements have taken place, the schemes are being administered by the transferee societies and branches, the additional benefits to which the transferred members were formerly entitled remaining unchanged. The following table shows the amounts available per annum under existing schemes for the purposes of additional benefits other than increases in cash benefits: Nature of benefit. Hospitals and convalescent homes : No. of central- No. of 12 Dental ... 16 Optical 12 Medical and surgical appliances... Other additional benefits 264262 5 Total amount available per annum. £14,255 782081 3,830 9 3,173 4,200 Benefits provided under Section 21 of the National Insurance Act, 1911. We have stated above that a number of societies and branches expressed the desire to provide dental benefit for their members, but were unwilling to do so at the expense of additional benefits already being provided. Several societies have had recourse in the circumstances to Section 21 of the National Insurance Act, 1911, which empowers societies to make donations out of their benefit funds to "charitable institutions." They have accordingly made donations to certain organisations, which in return have undertaken to provide dental benefit for members of the societies concerned. We are not in a position to state accurately the extent of such arrangements, which are not subject to our control or approval, but it has come to our notice that 14 societies, having a Scottish membership of, roughly, 180,000, are providing dental benefit in this manner. In addition some 40 societies have during the year made donations to voluntary hospitals and nursing associations in terms of the section. In all a sum, probably not less than £16,000, has been expended by societies in Scotland during the year under the provisions of Section 21. In practically every case the societies concerned have, in making these donations, expended amounts in excess of the sums declared disposable for the purpose of providing additional benefits by the valuer in his reports on the first valuation. We have not failed to point out to societies that they have incurred such expenditure entirely on their own responsibility, and that the financial position emerging at the next valuation will necessarily be affected to some degree by this additional call upon their benefit funds. Title to Additional Benefits arising out of Second Valuation. In our last Report we alluded to the difficulties which had to be faced in determining the title of insured persons to additional benefits arising out of the second valuation of societies, since for that purpose societies were being divided into two groups, which were to be valued as at 31st December, 1922, and 31st December, 1923 respectively. As a result of the consideration which, in conjunction with the other Departments concerned, has been given to this question it has been decided that title to additional benefits arising out of the second valuation will in general mature at the beginning of January of the calendar year in which the member will have completed a period of 5 years' membership in the society or branch. To meet any difficulty, however, in the transition to the new system from the old (under which membership as at a specific date was the universal criterion) persons who joined a society or branch in 1922 or 1923 will be treated as becoming entitled to the benefits somewhat earlier. The effect of the new qualification as compared with that of the old is as follows: It will be seen that under the new arrangement title to additional benefits will mature at the same date, irrespective of whether the member's society has been valued in the 1922 or in 1923 group. APPEALS AND DISPUTES UNDER SECTION 67 OF THE NATIONAL INSURANCE ACT, 1911. The total number of appeals brought before us during the year was 14. These related to disputes between societies and their members, and all involved questions of incapacity for work and liability of the societies for sickness or disablement benefit. One was decided in favour of the member; seven in favour of the society; in two cases success was divided and four are still pending. WORKMEN'S COMPENSATION. Section 11 of the National Insurance Act, 1911, provides that, where an insured person is in receipt of compensation or damages under the Workmen's Compensation Acts or the Employers' Liability Act or at common law, no sickness or disablement benefit shall be payable where the weekly compensation or the weekly value of any lump sum payable by way of compensation is equal to or exceeds the rate of national health insurance benefit otherwise payable. The Workmen's Compensation Act, 1923, contains provisions which affect the administration of Section 11 in various ways. Societies. have always experienced difficulty in cases where a lump sum payment has been made in compromise of a claim where the employer has not admitted his statutory liability to pay compensation or damages. In future all such settlements must be registered in the Sheriff Court in the same manner as settlements where liability is admitted. A circular will be sent to societies regarding the effect upon national health insurance of the passing of the new Act. 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, 1923, was £1492, 11s. 7d. INVESTMENTS. The total amount declared available for permanent investment in terms of Section 54 (3) of the 1911 Act to 31st December, 1923, was £9,182,899. In addition to this amount, a profit of £10,752, 13s. 4d., which has been made by the realisation of certain securities, has also become available. The total sum of £9,193,651, 13s. 4d. has been disposed of as follows: (1) Advanced to societies for investment (in- ferred to societies) £3,458,780 19 0 Brought forward ... £3,458,780 19 0 (2) Invested by us on behalf of societies ... ... (3) Credited to societies in National Health (4) Balance still to be disposed of ... ... 1,148,766 8 3 4,564,678 11 8 21,425 14 5 £9,193,651 13 4 The nominal value of securities held by us on behalf of approved societies is £1,283,860, 5s. 8d. SUMMARY. 1. Societies have again successfully surmounted the difficulties presented by continuance throughout the year of abnormal industrial conditions and remain in relatively the same satisfactory administrative and financial position. 2. The permanently invested funds of Scottish societies and branches at the end of the year amounted to over £9,100,000. 3. Improvement in book and record-keeping has been less marked than in the years immediately succeeding the war, but as time goes on this slowing down of progress is only what is to be expected. 4. The total net surplus on the administration accounts of Scottish societies and branches remains in the neighbourhood of £50,000. 5. As before, defalcations have been trifling in number and amount having regard to the great sums handled. 6. In complement of what is said in the Report as to complaints and enquiries, the fact should never be lost sight of that claims made and paid without question or complaint on either side represent the overwhelming majority. The complaints received are numerous, but when it is recollected that millions of transactions occur between societies and their members, the difficulties and misunderstandings are seen to be only what may be regarded as the normal, inevitable and proportionately unimportant incidents of administering so huge. a machine. 7. Dental benefit seems to be the additional benefit of the future. Propaganda work in general has doubtless been a factor in arousing the widespread interest of the insured in this subject. At any rate it is evident from the correspondence we receive that the pressure of members will lead to a considerable increase in the number of dental benefit schemes in the near future. 8. The district medical officers continue to do work which is appreciated by all the interests concerned. The number of cases submitted to them is steadily increasing. 9. From the indications we have observed, we believe that when the figures relating to sickness benefit in 1923 are available they will register a slight decrease, although the disablement benefit expenditure, especially in respect of women, may prove to have increased. This general position is satisfactory having regard to the continued prevalence of unemployment, with its inevitable unfavourable sequelæ. Insurance Committees. ADMINISTRATIVE EXPENDITURE OF INSURANCE COMMITTEES. Consideration was given at the beginning of the year to the question of further reducing the scale of administrative income of insurance committees, but it was felt that the circumstances did not justify any reduction for 1923. We decided, however, to afford some relief to approved societies by reducing the amount of the per capita rate which they contribute for the purpose of defraying the cost of insurance committee administration. This diminution in the total fund available for administration coupled with the maintenance of the 1922 scale of income involved the retention by us of a smaller sum as a margin for contingencies, but the fact that the majority of insurance committees had a fair credit balance on their administration account appeared to us to render this consideration of less practical importance. As a matter of fact only one committee received a special grant for 1923, the amount required being £50. AUDIT OF INSURANCE COMMITTEE ACCOUNTS. Four interim audit reports were submitted to us during 1923. Two of the reports dealt merely with overpayments by committees to doctors or chemists. In one case the payment challenged was a bonus paid to chemists for 1919, but we held that the payment in question was legal and allowed it in the committee's accounts. In another case an overpayment was made to doctors owing to an error on the part of the Clerk and this was adjusted later in the accounts. One report related to an excess payment of staff which was regularised by our subsequent approval. The remaining report referred to a loss of approximately £70 in the committee's funds through the defalcations of one of their staff, and in this case, though we intimated to the committee that the incident might have been obviated had a closer supervision of the committee's finances been in force, we decided in the circumstances to impose no surcharge and to allow the deficit to rank against the committee's general purposes fund. INDEX REGISTER. A statement of the quarterly counts of the index registers of insurance committees is shown in Appendix VI. While in the aggregate the register is considerably in excess of the number of insured persons estimated by the Government Actuary to be entitled to medical benefit and shows an increase of approximately 5000 on the total of the previous year, it will be noted that the number of index slips held by the burgh insurance committees is roughly 4000 less than the number for the previous year, the fall being perhaps attributable to unemployment in industrial areas. Particulars have been inserted in the statement showing the percentage to the total register of the index slips held by each |