The amount and kind of medical aid re quired by the act varies, but in actual practice most of the older systems go beyond the re quirements of the law in this respect, fairly furnishing hospital aid. Drugs, supplies, etc., must be furnished to the sick according to all the acts except that of Holland. There are two additional benefits which are almost as universal as the two essential ones. Under all the 10 acts, maternity benefits of some kind or other are given to the insured working women who - become mothers, and they usually con sist of a special- allowance for medical aid, etc. (or such medical and nursing aid in kind) and the regular money benefit for a specified num ber of weeks (from 4 to 12 weeks) provided the mother abstains from work.
Finally all the acts, with the exception of British, give a modest funeral benefit. Health insurance cannot undertake to solve the finan cial problems arising out of the death of the family's breadwinner, but all the systems recog nize the necessity of meeting the unexpected funeral expenses at the time when the family is most helpless. In Great Britain this benefit was kept out of the National Insurance Act by the influence of the large industrial life insur ance companies, whose policies are held in such large numbers :by the wage-workers mainly for the purpose of meeting funeral expenses.
There is a general tendency to extend the benefits of health insurance to the dependents of the insured wage-workers especially as far as medical and funeral and the maternity benefits are concerned. That is already required by the acts of Hungary, Norway and Rumania, and is practised by a good many large German funds. This is based upon the recognition that the efficiency of the health insurance System in improving the general health conditions of the community would be seriously limited by ex clusion of the wives and children from the benefits of the improved medical service.
Since the- entire method of health insurance has originated in workingmen's mutual benefit societies this has considerably influenced the organization of social health insurance. In most acts a certain variety of organization is permitted. The basic or ideal organization is a' °local" sick insurance fund, limited to a definite locality ; many such funds may, however, exist in the same locality, embracing various industries, or special funds may be organized for employees of individual establishments. These funds are administered according to the requirements of most acts, by joint boards representing employers and employees, accord ing to their respective contributions to the cost.
The British system is, however, organized on a very much different basis. The friendly so cieties had been so strong at the time the act was passed, that to them, under a new designa tion, °approved was left the practical administration of the health insurance system. The essential difference is that these °approved are administered exclusively by their insured without participation of the employers, that these societies are bound by no geographi cal or occupational limits, that the choice be tween any of them is unrestricted. Because of these conditions, it was found impracticable to entrust these societies with the administration of medical aid, which is managed by independ ent local committees. It is generally admitted that the British plan, from an administrative point of view, is not very efficient. • While these 10 acts are compulsory as to their application and as to certain specified benefits, they usually provide for voluntary ex tension. .Voluntary members within certain economic groups may be admitted and the numerous autonomous funds may extend the various benefits required by the law, either in time, amount or quality, or may add certain other benefits permitted. by the act. This is possible because of the financial autonomy, since under most acts the numerous funds are permitted to charge their insured and the em ployers as much (within prescribed limits) as is necessary to pay the benefits agreed upon by the representatives of ' employers and em ployees. Again the British act is an exception to this rule, since the law determines the weekly contributions which cannot be increased by the individual societies, in which the wage-workers are insured.
Growth.— Health insurance is the most de veloped branch of social insurance next to compensation for industrial accidents, and is probably the largest in actual extent of work done and funds collected and distributed. Probably from 40,030,030 to 50,000,000 wage workers with their families in Europe enjoyed the protection of compulsory health insurance before the war. In 1912 the German system alone had 21,659 funds with 13,217,705 mem bers, an income of 417,600,000 marks ($99,400, 000) and an expenditure of 395,000,000 marks ($94,000,000). Of this amount $39,400,000 was paid in money benefits of various kinds, $20, 400,000 for physicians' services, $13,000,000 for drugs, $12,800,000 for hospital treatment and only $5,140,000, or less than 5% per cent, for administrative expenses.