MEDICAL REMUNERATION.

[To THE EDITOR OP THE "SPECTATOR."] SIR,—Seldom, if ever, has an important statistical document been the subject of such hasty and false deductions as has fallen to the lot of Sir William Plender's Report upon Medical Remuneration, and the result has been that an impression has been circulated throughout the country which is grossly unfair to the medical profession, and is falsified by the very Report which it claims as its basis.

There is but little question that the general public have been led to believe that Sir W. Plender's statistics prove that the terms offered by Mr•. Lloyd George in the Insurance Act bear a very fair relationship to those at present in vogue under the private fee system. And yet nothing could be farther from the truth. The whole position has been grossly misrepresented by the simple expedient of tearing the money figures from the Report without any reference to the amount of work which they represent.

What are the actual facts ?

1. Mr. Lloyd George has pointed out most emphatically that for the kind of work which will be done under the Insur. ance Act the doctors in the five towns are at present only receiving 4e. 2d; per head of population, including drugs in four of the towns. What he absolutely omitted to mention was the most pregnant fact of all—namely, that this figure is based upon an average of 1.5 to 1.8 medical visits per year, whereas the British Medical Association statistics of medical contract practice, of which he had a copy (and which have been calculated from a total of nearly two million visits), work

out at an average of 5.5 per annum.

What does this signify ? It means that once you institute a gigantic medical contract scheme, such as this Insurance Act, the medical profession must be prepared for nearly three times the amount of work (so far as their insured patients are concerned), owing to the enormous number of people who will now have the right to demand the doctor's services at all times, and who hitherto have been in the habit of seeking their ordinary medical help by haphazard visits to a chemist's shop, unless seriously ill.

Express the Plender Report in terms of fees per visit, instead of a capitation fee, and the false deductions which have been made from it are at once apparent. The very figure upon which the estimate of 4s. 2d. per head is based gives an average of 3s. ld. per visit for visits inside the town,

and 9s. 4d. for those outside the district. Take away the proportionate allowance for cost o drugs and bad debts, and we are left with 2s. 7d. and 8s. 10d. respectively. Now what is Mr. Lloyd George actually offering ? On the British Medical Association's calculation of five yearly visits per

insured man, he is offering 11d. per visit, which he claims as being well justified by the Plender Report; whilst he asserts that the British Medical Association's claim of ls. 8d. per visit, with extras for mileage and special expenses is quite excessive.

Mr. Lloyd George may, of course, refuse to accept this estimate of five visits per annum, and may still believe that his terms are as good as the Plender Report. There is a simple way of proving it. Let him abolish the capitation fee, and make an offer on the Plender basis of 2s. 6d. per visit, and I guarantee to say the profession will come to terms without the slightest difficulty.

2. Another gross misrepresentation of the doctors' case arises from the statement, freely circulated, that Sir William Plender proves them to be receiving an average income of £720 per annum, " good, bad, or indifferent," and that their present claim is an attempt, as Mr. Lloyd George put it, to

"more than double their income." That this is an absolute perversion of the facts is proved by the following points:—

(a) From this average income of £720 for the five towns there must first be deducted the heavy professional expenses of rent, taxes, and motors, to which Sir William Plender draws special attention.

(b) The income in the five towns is calculated upon a medical clientMe of 2,400, whilst the average clientele for Great Britain is only 1,600 or 1,800.

(c) It is true that the doctors are claiming bettor remuneration for the insured portion of their patients (approximately £261 per annum, instead of £123, or an average of 550 insured, and allowing ls. a head for extras), but their fees from the non-insured, who constitute two-thirds of their practice, will not be affected in the slightest.

(d) Owing to the vast increase in work already referred to, paid assistants will be an absolute necessity, and many more men will need to enter the profession.

I trust that you may find space in your valuable paper for some reference to these facts. The Insurance Act does not affect me personally, as my medical practice lies in another country; but the whole profession is suffering under this cloud of misrepresentation, and one cannot but raise a protest 75 Ilighbury Hill, N.