National Insurance Health

Cash Benefits.

The cash benefits, i.e., sickness, disablement and maternity benefits, are administered by bodies known as Approved Societies. These bodies are independent self-governing groups of insured persons banded together for the purposes of the national health insurance scheme. They are not ordinarily on a territorial basis but the members generally have some com munity of interest which may be religious, occupational or social, or may arise out of private insurance with the same society. Any body of persons may make application to the Minister of Health for approval, the only statutory conditions attached being that the body should not be carried on for profit and that it should make rules to the satisfaction of the Minister for the administra tion of State insurance under which the affairs of the society must be subject to the absolute control of its members. On approval being granted the society becomes entitled to receive the contributions of all insured persons who become members and it undertakes to pay them the cash benefits to which they may become entitled. An insured person is free to select his own approved society and a society may accept or reject any applicant for membership in accordance with its rules. The number of approved societies in Great Britain is about r,000, and the membership varies from less than ioo to more than 2,000,00o. About thirty approved societies are divided into branches, each of which is a separate and autonomous financial unit. The total number of such branches is about 7,000. Ap proved societies are of many types, of which the principal are Friendly Societies (either with or without branches), Trade Unions, societies associated with industrial assurance companies, and employers, or works, societies. Every approved society has complete control of its own funds and the members stand to gain or lose as the result of their society's experience and standard of administration. The insured members of a society are required to surrender to the society their stamped contribution cards at the end of each contribution period and the society is credited in the National Health Insurance Fund with the total value of health insurance contributions represented by the stamps on the cards surrendered by all the members of the society. Out of its credit in this fund, with the relative State grant, the society obtains the necessary money for paying all benefits to which the members become entitled, as well as the cost of the society's administration. So far as the amount standing to the credit of a society in the National Health Insurance Fund is more than suffi cient to meet the current expenses of the society, the balance becomes available for permanent investment and one-half is paid over to the society itself for investment by the trustees, the other half being transferred to the credit of the society in the invest ment account and invested by the national debt commissioners.

A small deduction is made from every weekly contribution paid in respect of each member of a society and is allocated to a contingencies fund which is available to meet any deficiency which may be disclosed on the valuation of the society. After each valuation the sum standing to the credit of the contingencies fund is transferred to the benefit fund of the society, and in so far as it is not required to make good any deficiency it becomes avail able for the provision of benefits. A further protective fund, similarly derived, but augmented by a contribution from the Exchequer, is the Central Fund, which is a single fund common to all societies and is available to meet the balance of any valu ation deficiency which cannot be met out of a society's own contingencies fund. The granting of assistance from the central fund is conditional on the deficiency not being due to unsatis factory administration on the part of the society.

In order to claim sickness or disablement benefit an insured per son who has become incapable of work through sickness should at once obtain from his insurance doctor a certificate of incapacity and should forward it to his approved society. Further medical

certificates should similarly be obtained and forwarded at inter vals (normally weekly) as required. If the society is satisfied that the member is incapable of work and that the necessary qualifying conditions for benefit are satisfied, payment of benefit is made to the member weekly. Similarly a claim for maternity benefit is made by the insured person sending to the society the necessary certificate of confinement. Any dispute between an in sured person and his society with reference to a claim for benefit has to be referred to arbitration in accordance with the rules of the society, and a final right of appeal lies to the Minister of Health, whose decision is binding on both parties.

A society which is in doubt as to the incapacity for work of a member claiming benefit, can obtain a second medical opinion on the point by referring the member for examination to one of a body of medical referees known as Regional Medical Officers, ap pointed by the Minister of Health.

Every approved society is required to keep accounts of its receipts and expenditure under the act and to submit these ac counts to audit by auditors appointed by the Treasury. The amount which a society may expend on administration is limited to 4s.6d. per member per annum. Every approved society and branch is subject to a valuation of its assets and liabilities at inter vals, usually of five years, by valuers appointed by the Treasury. If on valuation a surplus is disclosed, such part of the surplus as the valuer certifies to be disposable for the purpose is used by the society in providing additional benefits for its members in accordance with a scheme drawn up by the society and sanctioned by the Minister of Health. A scheme of additional benefits ordi narily covers a period of five years. If on valuation a society or branch is found to be in deficiency, recourse must be had first to the society's own contingencies fund, and if that is not sufficient to make good the deficiency application may be made for a grant from the central fund.

The results of the valuations which have been made show that the finance of national health insurance is on a thoroughly sound basis. At the first valuation, which was made as at Dec. 31, 1918, the great majority of all societies and branches were found to have surpluses, the aggregate amount of which was about .L7, 000,000. On the second valuation, which was made as at Dec. 31, 1923 (or a year earlier in the case of certain societies) the mem bership of societies showing surpluses was about 15,000,000, while that of societies with deficiencies was less than 250,00o. The ag gregate amount of the surpluses exceeded £42,000,000, of which about £15,000,000 was kept in reserve, the balance being devoted to the provision of additional benefits. Many of the societies were thus enabled to make substantial additions to the standard rates of sickness, disablement and maternity benefits, and also to pay the whole or part of the cost of various forms of treatment required by their members and not provided as part of medical benefit. The most popular of these treatment benefits is dental benefit, which is provided for about 75 per cent of the whole insured population, and to which a sum of nearly £3,000,000 a year is devoted. The benefit ordinarily takes the form of the pay ment by the society of not less than 75 per cent of the cost of any dental treatment obtained by the member and not less than 5o per cent of the cost of any dentures supplied. A scale of charges has been agreed between the approved societies and the dental profession, and insured persons are given free choice amongst the dentists willing to provide treatment on the agreed scale.