939

THE PRINCIPLE OF THE THING.

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- , -1 1 13-4, LANCET.

ZCNDON: SATURDAY, OCTOBER 27, 1923.

" While willing to serve the community to thebest of its ability, and to make any satisfactoryarrangement to this end with the representativesof the community, the meclical profession is notprepared to accept the position of being underthe dominance or control of a particular section."

THE Panel Conference has met and has amplyendorsed the statement of the issue in the presentcrisis contained in the above words. The words are

those of the Insurance Acts Committee in the latest

stage of the negotiations between the Minister of

Health and practitioners working under the NationalHealth Insurance Acts. The representatives of panelcommittees were unanimously willing, as the reportof the Conference on p. 947 shows, to commit theirconstituents to a refusal of further service under theActs rather than continue to serve under the con-ditions offered. The Minister, it appears, admits hisreponsibility for the financial burden which is to beput on the community, but it seems to us that hehardly grasps the full responsibility placed upon himby Parliament for the nature of the services given inreturn. The medical profession looks, and rightlylooks, to the Minister for protection against the

unsympathetic attitude of approved society officials,who are clearly fighting for something more than theirown autonomy. They desire, overtly or implicitly,control of the national insurance system as a whole,and of the medical benefit in particular, from controlof which they were expressly excluded by the Actof 1911. Clause 14 (1) of this Act is so precise andcategorical that it is hard to see how any doubt uponthis point can have arisen. There is, we are confident,no inherent dislike on the part of doctors for approvedsocieties or their officials, no desire to give them lessthan their due in administering sickness and additionalbenefits ; there is, in fact, a cordial cooperationsteadily growing up in the local working of the Acts.Our special commissioner (p. 951) bears testimony tothis in the Manchester and Salford area. But the

unreasoning rancour shown by some of these officialstowards insurance practitioners as a group affords

ground for suspicion and hesitation on the part ofthe medical profession. Dr. H. B. BRACKENBURY

himself, who presided over a series of round-table

conferences of all interests, and seemed at one timehopeful of an arrangement by consent, is now sadlyconvinced of the futility of such conference inasmuchas the public statements of some of these officialsdo not agree with their private undertakings.

It is this question of the outside control of insurancemedical service which must now be decided once

and for all. It is the real crux of the controversyand the reason and justification for the unanimousrefusal by the Panel Conference of the terms offered

by the Minister of Health. The tone of the con-

ference was firm and restrained, and little doubtexists that its representatives can make good theirundertaking to call in the resignations of the necessaryproportion of the doctors on the panel. Faced withthis evidence of solidarity the medical profession canawait the outlook with confidence. The national

insurance committees have never yet, as Sir WILLIAMGLYN-JONES points out (p. 961), risen to their fullstature, but they are not going to stultify them-selves by attempting to administer medical benefitwith the scanty help of those who stand aside.Action has not been hasty on the part of the doctors.Prolonged efforts have been made on the professionalside to rectify as far as possible the conditions com-plained of by approved society officials. The new

regulations when (perhaps we should write " if ")they are issued, will show how far the insurancemedical service has been willing to go. Nevertheless,the societies insist upon a cheap service, and havetaken upon themselves to discuss what the actualremuneration for this service shall be. Now itcannot be reiterated too often that the societies donot pay the doctors; they are the recipients, as

trustees, of that portion of insurance funds allottedfor sickness benefit and administrative expenses ; theyhave nothing whatever to do with the medical benefitfunds, and it may be feared that, should they attainthe position to which they aspire, of administratorsof the whole fund, they would gladly cut out theMinistry of Health whose regulations they have

always found irksome.This is the danger which the medical profession

clearly envisages in 1923, as it did in 1911-12, andonce again a firm stand is to be made. On matters

medical the profession should and must be given afree hand. There is in existence adequate machineryto deal with delinquents in its own fold, and the newpowers given to panel committees will enable themto exert a much tighter control on any who are slackor devoid of principle. Approved society officialshave attacked the insurance medical service as a wholebecause of their local knowledge of the " black

sheep," whose numbers must be small indeed, judgingby the complaints which are substantiated. The

present action of these officials would drive out ofthe service precisely the type of practitioner whosecooperation is necessary to maintain its standard.We believe that the approved societies will find ithard to convince the insured public that the com-munity will gain by usurpation of the control whichwas refused to them in 1911. It is a misfortunewhich was foreseen and which yet could hardly havebeen avoided, that the Insurance Acts should createvested interests with great political power. The

spirited action of the Panel Conference is likely toprevent this power from becoming a danger to thecommunity. Unless doctors serving voluntarilyunder the Insurance Acts are allowed to give theirservice in accordance with the best traditions of their

profession, they prefer to wash their hands com-

pletely of a system which is in peril of becomingderogatory to their calling. In any case they willfind a way of serving the community. ,