Volume 1

National Health Insurance. : Report [and Appendices Vols 1-4] of the Departmental Committee on Sickness Benefit Claims under the National Insurance Act.

  • Great Britain. National Health Insurance Joint Committee.
Date:
1914
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: National Health Insurance. : Report [and Appendices Vols 1-4] of the Departmental Committee on Sickness Benefit Claims under the National Insurance Act. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

    18/570 (page 2)
    In this matter the Committee desire to acknowledge the assistance which they received from the British Medical Association, the Association of Regis- tered Medical Women, and from Sir Thomas Barlow, President of the Royal College of Physicians. These two associations and Sir Thomas Barlow kindly consented to nominate, for the purpose of giving evidence before the Committee, representative men or women whom they regarded as pre-eminently qualified to state the views of the profession from different standpoints. (c) Representatives from Insurance Committees, nine in number, who again were selected in such a manner as to place before the Committee evidence with regard to typical areas presenting varying characteristics. (d) Witnesses who, while not engaged in connection with any of the agencies on which the administration of the Act devolves, have made a special study of the principles of sickness insurance or of the effect of the National Insurance Act as in operation among the industrial classes, or who have had an opportunity of observing the working of the machine from a standpoint other than that of any of the chief agents engaged in administering the Act. NATURE OF THE PROBLEM TO BE INVESTIGATED. 3. The Committee, by the terms of reference quoted above, was not required to conduct an actuarial investigation into the affairs of societies generally, or of those particular societies which were represented in evidence before them. The question to which the Committee has primarily devoted its attention has been whether the claims made upon the funds either of societies in general, or of particular societies or of societies of particular types were in excess of the claims, which under a proper system of administration should have been made upon, and allowed by, them. In order to ascertain in the case of any particular society whether the actuaries' estimate has been exceeded, it is necessary to enter into elaborate calculations in which the age and sex of each member and in the case of women, her status, whether married or single, have to appear as factors. This work will necessarily be undertaken in connexion with the valuation of each society directed by the Act, and the Commis- sioners may find it necessary at any time to examine the affairs of any given society with the assistance of such a calculation, with a view to ascertaining whether its expenditure is dangerously excessive in amount. These are, however, essentially actuarial questions, and it is evident that such calculations are matters for an actuary and his staff, and not for a Committee which seeks and receives the views of those engaged in the work of administering the Act, and forms opinions upon that work as they see it in operation. While, therefore, in considering the question of how far claims which have been admitted are in excess of what is proper, the original estimates made by the actuaries or the rough rule adopted by the Commission for regulating the amount to be drawn by societies from their accounts in the National Health Iusurance Fund may be taken as a convenient general measure it is clear that such figures cannot be employed as the only or indeed the main criterion in the considera- tion of the question to which we have been asked to direct ourselves. 4. In the investigation of the question how far the claims allowed by a particular society are in excess of what is proper, regard must be had to considerations other than those which can form an element in the actuarial calculations applicable to a general scheme of insurance based upon a flat rate of premium. The estimates of the actuaries were based on figures which had regard to the whole industrial population, and are a forecast of what might be anticipated if that population were insured together as a whole, and not divided into separate societies. This was in accordance with the principle of the Act, which, with immaterial exceptions, requires for each sex one flat rate of premium and one flat rate of benefit, restricted only as to age and marriage by the credit of a reserve value. It may well be, however, that where a society has exceeded the actuaries' estimates this result is due to the membership containing an abnormal proportion of lives of a particular type exposed to a sickness risk in excess of the general sickness risk of the whole population. It may also happen that a society whose expenditure is apparently well within that allowed by the actuarial estimate is notwithstanding spending money lavishly, although some fortunate accident of age distribution, a favourable occupational segregation, or other circumstance may conceal the fact from a casual observer. 5. Our task, therefore, was to examine the actual working of the machine as exem- plified in the action of its several parts, rather than to investigate the financial results