NATIONAL INSURANCE: HEALTH. Any satisfactory scheme of national health insurance should have two main objects, (I) to secure for the insured any medical attendance that he may require at any time, and (2) to compensate him by money pay ments for the loss of wages when compelled to cease work through sickness. Until late in the 19th century there was little or no recognition in any country of any duty of the State to concern itself with the making of provision against sickness amongst its workers. In many countries some provision was made independ ently of the State by the workers themselves through mutual provident associations, but only part of the field was covered by this means, and the less thrifty section of the community, who were most in need of protection, were rarely included. The posi tion in many working-class households was, therefore, that when sickness fell upon the breadwinner, involving ordinarily not only cessation of his wages, but also the extra cost of doctor's bills, as soon as any small savings had been exhausted there was no alterna tive but recourse to the poor law. In 1883 a compulsory scheme of insurance was introduced in Germany and this was extended in 1889 to cover permanent incapacity. The example of Germany was followed by Austria in 1888 and by Hungary in 1891. About the beginning of the 2oth century public opinion in most European countries began to crystallize in favour of some organized pro vision to meet the contingency of sickness amongst the workers, and in one country after another schemes based on the German model of compulsory insurance were brought into operation.
The scheme of national health insurance in Great Britain was founded on the National Insurance Act, 1911, which was brought into operation on July 15, 1912. The scheme is on a compulsory and contributory basis, the cost being shared between the workers, the employers and the State. Since 1938, when employees under 16 were included, roughly all wage-earners with the exception of non-manual workers receiving more than £250 a year have been included under the insurance plan. There are, however, a few exceptions, of _which the most important are persons employed under the Crown, a local authority or a statutory company who, by the terms of their employment, are entitled to provision during sickness at least equivalent to that provided under the act. In
addition to these excepted persons who are completely outside the national scheme of health insurance, persons who would normally be compulsorily insured may claim exemption if they can prove that they have a pension or unearned income of at least £26 a year, or that they are mainly dependent for their livelihood on someone else or on some non-insurable occupation. The employers of these exempt persons are, however, required to pay the em ployer's share of the contribution. Persons who are compulsorily insured by virtue of their employment are known as employed contributors. The scheme also allows any person (other than a married woman) who has been insured for at least two years as an employed contributor and has paid at least 104 weekly contri butions to continue in insurance as a voluntary contributor, if he so elects, on ceasing to be employed. A married woman may not herself be insured as a voluntary contributor but where an uninsured man marries an insured woman who has paid at least 104 contributions he is allowed to become a voluntary contributor. The total number of insured persons at the end of 1927 was about I 6,000,000.