National Insurance Health

Success of the Scheme.

There can be no doubt that the British scheme of national health insurance has thoroughly justi fied itself by its results. At the inception of the scheme consid erable hostility and opposition were encountered. It did not meet with a favourable reception from the medical profession and was unpopular with large sections of employers and with some classes of insured workers. This opposition has now almost entirely dis appeared. There can be no question that the benefits provided under the scheme are highly appreciated amongst the insured community and the contributions are paid with almost entire absence of friction. The financial success of the scheme has been demonstrated by the results of successive valuations, and the great majority of insured persons are receiving benefits substan tially greater than the minimum provided under the act. The amount of distress amongst the working-classes occasioned by rea son of sickness of the wage-earners has been materially reduced, with the result that expenditure on poor law relief is substantially less than it would have been in the absence of a scheme of na tional health insurance. As regards the effect of the scheme on the general health of the nation, it is difficult to produce any con vincing statistics but the fact that all insured workers are entitled to free medical attendance immediately they have any need of it must obviously be conducive to prompt treatment of incipient ill ness, with a consequent lessening of more serious results. The general death rate has fallen materially since the scheme was intro duced and it is reasonable to attribute this in some measure to the medical and other benefits provided under the scheme.

Northern Ireland.

The original National Insurance Act of 1911 applied to the whole of Ireland as well as to Great Britain, and as a consequence a scheme of national health insurance almost identical with that of Great Britain is still in operation in Northern Ireland. The most important variation is that medical benefit is not included in the Northern Irish scheme, but a benefit known as sanatorium benefit is provided. This benefit consists of the right of treatment in sanatoria or otherwise of insured persons suffering from tuberculosis. It is administered through the local insurance committees under arrangements made with the councils of the counties and county boroughs. The same benefit was originally provided in Great Britain but was discontinued in 1921 when the duty of making comprehensive arrangements for the treatment of tuberculosis amongst the whole population, insured and uninsured alike, was laid upon the county and county borough councils. Owing to the absence of medical benefit in Northern Ireland the rates of contributions are less than those in Great Britain by 2d. a week.

Aside from the Irish Free State no complete scheme of national health insurance exists in the self-governing dominions of the British Empire. Measures to establish such schemes have been introduced in several Canadian provincial parliaments, and the parliament of British Columbia passed such a law in 1937, but the Ministry suspended its operation because of the objections of the medical profession. Governmental commissions and commit tees of the medical profession in 1939 were studying various pro posals looking to the enactment of legislation. Experiments in providing medical care for the indigent by provincial and local governments in co-operation with the medical profession form the basis of the proposed laws. In 1939 parliaments of Australia

and New Zealand passed acts to establish health insurance, but objections of the medical profession to certain features led to a suspension of the acts. (E. HA. ; X.) An active agitation for health insurance in the United States from 1912-19 led several State legislatures to appoint commis sions to investigate the subject and to the introduction of numer ous proposals but no legislation. Interest revived by the report of the Committee on the Cost of Medical Care in 1932 which recommended health insurance. In 1934 a Committee on Economic Security was appointed to draw up a program of social legislation which originally proposed to include health insurance. Objections by the medical profession led to the omission of health insurance from the Social Security Bill, which became a law Aug. 14, 1935. This law contained extensive medical provisions for maternal and child health, for crippled children and for the ex tension of public health as well as for unemployment and old age insurance. The Interdepartmental Committee, appointed by the President continued the agitation and submitted a report, many of the factual statements of which were challenged, recommend ing a broad "health program" of extension of hospital facilities and public health services. The whole program depended upon heavy Federal subsidies to the States and included a section which was interpreted as offering Federal financial assistance to States establishing health insurance schemes. Although extensive hearings were held before a congressional committee, this law was still pending in Congress in 1939. In the meantime State and county medical societies set up a large number of voluntary pre- , payment or insurance plans to assist the low income class in paying for medical care. (A. M. Si.) Organized provision of some kind for the insurance of workers against sickness has been made in all European countries. Among the countries having compulsory schemes are Bulgaria, Denmark, France, Germany, Hungary, Norway, Rumania, Russia and Yugoslavia and certain cantons of Switzerland. All these schemes are on a contributory basis, the cost being shared between the employers and workers, except in Rumania, where the whole contribution is payable by the worker, and in Russia, where the whole cost falls on the employer. Some part of the cost of the scheme is borne directly by the State or other public funds in Bulgaria, Norway and Switzerland and more or less in directly in other countries. Voluntary schemes, which receive as sistance from public funds, and which cover a large proportion of all the wage-earners, are in operation in Belgium, Sweden and Switzerland. In Holland a compulsory scheme of insurance against permanent invalidity was brought into force in 1919 but up to 1939 sickness insurance was still on a voluntary basis and received no direct assistance from the State. In Italy a scheme of compulsory maternity insurance for employed women was in stituted in 191o, and compulsory insurance against invalidity in 1919. Seamen, civil aviators and some sections of agricultural workers are covered by schemes of partially compulsory sickness insurance, and a special plan for insurance against tuberculosis is in existence. All such plans are a part of the Fascist organiza tion of industry.