The medical profession, the National Insurance Act, and the state of the Poor Law dispensaries in Ireland : being the first part of the Carmichael prize essay, 1913 / by H. Nelson Hardy.

  • Hardy, Horatio Nelson.
Date:
1913
Catalogue details

Licence: In copyright

Credit: The medical profession, the National Insurance Act, and the state of the Poor Law dispensaries in Ireland : being the first part of the Carmichael prize essay, 1913 / by H. Nelson Hardy. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    remunerated on the same basis as the Insurance Fund was formed on (the capitation plan), yet there were cases under the provident system where the doctors were paid either by fixed salaries or by payment per attendance. The chief example of the latter mode of payment under the provident system was found in 1905 to be the National Deposit Friendly Society the working of which Society in some districts had been found not altogether satisfactory. The Friendly Societies, it was shown, were most unsuitable bodies to have control over the administration of any public medical service, most of them continuing to demand, in spite of repeated protests, that all their members, whatever their income, shall be free to obtain medical attendance upon the same terms, and maintaining that the payments they make (of 4s. a year, for example) are quite adequate. It was foreseen, of course, that if the administration of a Medical Service, such as the British Medical Association was in 1905-6 then designing to establish, were placed in the hands of the Friendly Societies, the better class of medical practitioners would decline to have anything to do with it. Such, then, was broadly the general opinion in the profession on the subject, when the Chancellor of the Exchequer startled and amazed the profession and the public by introducing his National Insurance Bill in the House of Commons. From the Bill itself, and from Mr. Lloyd George's explanations of it in the House and elsewhere, it was found that the Public Medical Service proposed to be established by it was a system of club or contract practice of the lowest type, that it was to be adminis- tered by the very Friendly Societies against whose doings the profession had for years been protesting, and that it contained most of the evils of the old club practice, which were to be extended so as to include about a third of the population of these islands. Mr. Lloyd George had not taken this step of adopting club practice as his model in ignorance of its many faults, for he had been reading, he tells us, the reports in The British Medical Journal on clubs and contract practice, and finding there that the ordinary Friendly Society capitation fee was at the rate of 4s. a year for selected lives, seems to have thought that he was acting quite generously to the profession in proposing that it should be 6s. a year for quite unselected, good, bad, and indifferent lives, with is. 6d. taken off for medicines, leaving it at 4s. 6d. a year. He quite expected, he tells us, to be hailed as a benefactor by the profession, instead of being denounced as a villain. Lie was soon undeceived. All the chief organs of medical opinion, The Lancet, 2hc British