National health insurance : explanatory statement as to medical benefit as affecting medical practitioners / presented to Parliament by command of His Majesty.

Date:
1912
Catalogue details

Licence: In copyright

Credit: National health insurance : explanatory statement as to medical benefit as affecting medical practitioners / presented to Parliament by command of His Majesty. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    11/18 (page 9)
    System E: Simple Payment per Attendance. 28. Lastly, System E enables simple payment per attendance to be adopted, both as regards ordinary, and as regards special services. 29. Most of tbe systems above described bave been adopted in different places in Germany, and tbe profession there bave not finally decided, after many years’ experience, upon any one system as in tbe long run more equitable than any otber. 30. In every case in wbicb payment per attendance is desired, whether simply, as in system E, or in combination with capita- tion payment, as in systems B, C, and D, it will be for tbe profes- sion to work out tbe appropriate fee to be assigned to each service as tbe basis of calculation of tbe remuneration. From what has already been explained it will be appreciated that, in settling the scale of fees, tbe aggregate remuneration of all tbe practitioners will not be affected by assigning a high or low figure to any particular service. If for example, high fees are fixed for any particular operations, it will only mean that a greater amount of tbe money to be distributed will go to those individual practi- tioners who bave in any given period performed a greater propor- tion than others of operations of those kinds, and that less, therefore, will be paid, proportionately, in respect of otber services. 31. In conclusion of this part of tbe subject, it is perhaps well to add an observation on a question on wbicb much misappre- hension appears to bave arisen, namely, the question whether tbe practitioners bave any guarantee ” that they will receive 65. 6^^. per bead per annum of tbe insured persons on their list in respect of a twelve months’ liability for medical attendance. It will be clear from what has been said that under a simple capitation system, in an urban area in wbicb no mileage ” is paid, every practitioner is secure of payment after tbe rate of at least 65. 6^^. per bead per annum in respect of bis liability to attend any gh^en insured person. If, however, the profession in any district prefer to adopt to any extent tbe payment per attendance system, it is clear that such an assurance cannot be given, since tbe remuneration of each must in that case be determined by tbe amount of work which be is in fact called upon to do, and this cannot be foretold. Tbe essence of tbe system of payment per attendance (or as it is sometimes called ‘^payment for work done”) is that an individual practitioner is secure, not of a definite income in propor- tion to the number of persons whom be is under contract to attend, but of a definite income in relation to tbe amount of work that he is called upon to do. This, indeed, is the reason assigned by many practitioners for preferring this system. y.—Provision of Drugs and Appliances. 32. Under the Act tbe provision of drugs and appliances must ordinarily be carried out by chemists and other persons, firms and bodies corporate, who undertake tbe provision on tbe terms offered by tbe Insurance Committee. Arrangements cannot be