MEDICAL BENEFITS UNDER THE INSURANCE ACT.
[To THE EDITOR or THE "SPECTATOZ:] SIB,—Probably most people, if they think about it at all, believe that the struggle which is now taking place between the medical profession and the Government is entirely on the subject of an extra is. or la. 6d. per head of insured people. But that this is only one part, though of course a very important part, of the controversy will be obvious to anyone who cares to read the following extracts from a paper which is now under the consideration of the profession. I will give a few points that may be of interest to those of your readers who believe that individualism is better than collectivism, and which show that the so-called "free choice of doctor by insured patient" has only a limited application. Clause (2) seems "very unnecessarily to tie a patient to one doctor for the year, . . . From this Regulation (20) it appears—and it should be noted not only by the profession, but by the whole country—that an insured person who desires to make his own arrange- ments for obtaining treatment, or through an institution, must make application 'on the appropriate form' and send it to the Committee, which shall notify to him their consent or refusal as the case may be. What is to happen in the case of a refusal is not stated." In the case of a patient who has changed his address, his motive for so doing must be investi- gated by the Committee, and he is allotted to a doctor, without apparently being consulted in the matter. This also applies, it seems, to the "bad lives" who have been refused by the doctors of their choice. Now, as to consultations, which people of the class of the insured have hitherto obtained at hospitals. "Even if a general understanding with the Government should be reached, insured persons, as the staff of St. Bartholomew's Hospital has pointed out, are no longer necessitous persons, as the Government has undertaken to be responsible for their treatment. . . . There is no provision for laboratory assistance in diagnosis, none for X-ray work, none for orthopedic, ophthalmic, dermatological, gynmcological, and other expert advice and assistance. The whole of the Act and the regulations appear to assume that the unpaid work of hospitals will continue in full swing as hitherto. Indeed in his speech on October 23rd Mr. Lloyd George states that the Act does not provide for operations and services of a specialist character." From the doctor's point of view, I will only make one quotatio I, as I know that this is not a subject of general interest. "The doctor's 'round' would cover an area of about thirty miles. No provision for vehicular conveyance for such a 'round' is deemed necessary. Yet the Admiralty, for the Coastguards, and the Ordnance Survey department, for their employees, pay is. 6d. for each complete mile after the first." (And these, like the Post Office lives, are picked lives.) The maternity fee is, apparently, only payable by the honesty of the patient, as the thirty shillings is given directly to her. Why should cases of miscarriage and abortion be included in the capitation fee when confinements are not ? I cannot here enter into the difficult subject of illnesses due to misconduct, and will merely point out that there is no close definition of them, even though the sickness benefit but not the medical benefit is suspended in these cases.
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