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INFECTIOUS DISEASE
278
NATIONAL HEALTH INSURANCE IN IRELAND
(FROM FOR
some
OUR DUBLIN
time
CORRESPONDENT)
past the demand for development in the national health insurance
improvement system has been becoming more insistent. Medical benefit has never been part of the system in Ireland except during the last few years in Northern Ireland. The only statutory benefits were those for sickness, for disablement, for maternity, and for marriage. Before the unification of the approved societies, which took place some five years ago, a number of the stronger approved societies were able to give some extra benefits, of which dental benefit was the most popular. The present unified society is unable to give any extra benefits, and its inability to continue or
benefits to which some members had become accustomed has given rise to discontent. Taking a wider view, it is recognised that a national health insurance system that does nothing for either prevention or cure of disease beyond making some cash payments is not in reality health insurance. On three occasions since the establishment of the system in 1912 committees of inquiry or other commissions appointed by Government have recommended extensions of the health insurance system to include at least medical treatment. With the increasing developments of various forms of social insurance in recent years many recognise that a mere inclusion of medical treatment would be inadequate and that the various forms of insurancehealth, workmen’s compensation, unemploymentrequire coordination. The whole subject was brought before the public recently by the chairman of the committee of management of the National Health Insurance Society, the Most Rev. Dr. Dignan, Bishop of Clonfert. He cleared away many misunderstandings by a clear statement of the powers of the committee and of the legal limitations which prevent its doing much that it would like to do. He quoted figures showing the changes that have taken place between 1932, the last year when the 65 independent approved societies were working, and 1937. The membership has increased by 114,000. Income has increased by 59,000, and expenditure decreased by JE33.000. Expenditure on sickness benefit has fallen by 43,000 but that on disablement benefit has risen by 33,000. The assets of the society have increased by 699,000. He proceeded to criticise the actuarial basis on which she system is founded, suggesting that it is a matter or consideration whether the actuarial requirements The committee, said. are not unnecessarily exacting. the Bishop, has already represented to the Minister that in its considered opinion a radical and fundamental change is needed in national health insurance and that a comprehensive review of medical and other social services in Ireland is required with a view to their coordination. This task is one for experts, and the Minister had been requested to set up a committee of experts to suggest a scheme or schemes suitable for Ireland. Such a committee should contain experts with knowledge of the schemes in force in other countries, and study should not be confined to the British schemes. Among the points to be considered should be: (1) the financial basis, whether it should be the present actuarial basis or an assessment over a number of years or an income and expenditure basis ; (2) the rates of benefit, whether on the present fixed basis or in some relation
to the contributions paid or both contributions and benefits in some relation to wages ; (3) the income limit, whether it should be extended and a class of voluntary insured added ; (4) statutory benefits, whether the list should be increased ; and (5) the relation of the law of national health insurance to the law of workmen’s compensation. The chairman closed by an appeal to the officers of the society and to the medical certifiers to cooperate in the duty of protecting the funds of the society from misuse. They should remember that the society was not a charitable organisation but a service controlled by law, and that they must harden their hearts against appeals on the grounds of hardship or poverty. There might be people who were very deserving objects of charity, who were not entitled to benefits. It is satisfactory to find that the committee and its chairman are alive to the inadequacy of the present system of national health insurance in Ireland and are pressing the Minister, to take steps toward
devising a
more
efficient and
comprehensive scheme.
INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED JULY 16TH, 1938
Notifications.-The following cases of infectious disease were notified during the week : Small-pox, 0 ; scarlet fever, 1740 ; diphtheria, 1075 ; enteric fever, 26 (54 " expected ") ; pneumonia (primary or influenzal), 528 ; puerperal pyrexia, 201 ; cerebrospinal fever, 20 ; acute poliomyelitis, 8 ; acute polio-encephalitis, 1 ; encephalitis lethargica, 3 ; dysentery, 39 ; ophthalmia neonatorum, 94. No case of cholera, plague, or typhus fever was notified during the week. The number of
cases
in the Infectious
Hospitals of the London
County Council on July 22nd was 33 25, which included : carlet fever, 742 ; diphtheria, 948 (carriers 45); measles, 385; whooping-cough, 264 ; puerperal fever, 8 mothers (plus 5 babies) ; encephalitis lethargica, 279 ; poliomyelitis, 1. At St. Margaret’s Hospital there were 2 7 babies (plus 12 mothers) with ophthalmia neonatorum.
Deaths.-In 126 great towns, including London, there was no death from small-pox, 2 (0) from enteric fever, 5 (1) from measles, 3 (0) from scarlet fever, 6 (2) from whooping-cough, 26 (3) from diphtheria, 61 (17) from diarrhoea and enteritis under two years, and 23 (1) from influenza. The figures in parentheses are those for London itself. Hull and Swindon each reported a death from enteric fever.
Fatal cases of Hull had 2 deaths from whooping-cough. diphtheria were reported from 14 great towns : 5 from Liverpool, 3 from South Shields. Birmingham reported 11 deaths from diarrhoea, Manchester 3, no other great town more than 2. The number of stillbirths notified during the week was 254 (corresponding to a rate of 35 per 1000 total
births), including 32 in London.
THE LANCET 100 YEARS AGO July 28th, 1838, p. 630. From a leading article. IN the medical evidence lately given before the PoorLaw Committee, it was shown that the appointment of a Medical Guardian in every Union, and a Medical Commissioner in London, would be useful to the entire community. The Medical Guardian ... would advise the Guardians in any case requiring medical skill, and, from the reports of the medical officers, draw up an annual sanatory report, to be submitted to the Guardians, and to the Medical Commissioner, who would condense the results deducible from all the Union returns, into one general Report, to be laid every year before Parliament. The influence which the knowledge collected in this manner would have upon the health, and life, and happiness of the working classes, can scarcely be imagined ... ...
NATIONAL HEALTH INSURANCE IN IRELAND
(FROM FOR
some
OUR DUBLIN
time
CORRESPONDENT)
past the demand for development in the national health insurance
improvement system has been becoming more insistent. Medical benefit has never been part of the system in Ireland except during the last few years in Northern Ireland. The only statutory benefits were those for sickness, for disablement, for maternity, and for marriage. Before the unification of the approved societies, which took place some five years ago, a number of the stronger approved societies were able to give some extra benefits, of which dental benefit was the most popular. The present unified society is unable to give any extra benefits, and its inability to continue or
benefits to which some members had become accustomed has given rise to discontent. Taking a wider view, it is recognised that a national health insurance system that does nothing for either prevention or cure of disease beyond making some cash payments is not in reality health insurance. On three occasions since the establishment of the system in 1912 committees of inquiry or other commissions appointed by Government have recommended extensions of the health insurance system to include at least medical treatment. With the increasing developments of various forms of social insurance in recent years many recognise that a mere inclusion of medical treatment would be inadequate and that the various forms of insurancehealth, workmen’s compensation, unemploymentrequire coordination. The whole subject was brought before the public recently by the chairman of the committee of management of the National Health Insurance Society, the Most Rev. Dr. Dignan, Bishop of Clonfert. He cleared away many misunderstandings by a clear statement of the powers of the committee and of the legal limitations which prevent its doing much that it would like to do. He quoted figures showing the changes that have taken place between 1932, the last year when the 65 independent approved societies were working, and 1937. The membership has increased by 114,000. Income has increased by 59,000, and expenditure decreased by JE33.000. Expenditure on sickness benefit has fallen by 43,000 but that on disablement benefit has risen by 33,000. The assets of the society have increased by 699,000. He proceeded to criticise the actuarial basis on which she system is founded, suggesting that it is a matter or consideration whether the actuarial requirements The committee, said. are not unnecessarily exacting. the Bishop, has already represented to the Minister that in its considered opinion a radical and fundamental change is needed in national health insurance and that a comprehensive review of medical and other social services in Ireland is required with a view to their coordination. This task is one for experts, and the Minister had been requested to set up a committee of experts to suggest a scheme or schemes suitable for Ireland. Such a committee should contain experts with knowledge of the schemes in force in other countries, and study should not be confined to the British schemes. Among the points to be considered should be: (1) the financial basis, whether it should be the present actuarial basis or an assessment over a number of years or an income and expenditure basis ; (2) the rates of benefit, whether on the present fixed basis or in some relation
to the contributions paid or both contributions and benefits in some relation to wages ; (3) the income limit, whether it should be extended and a class of voluntary insured added ; (4) statutory benefits, whether the list should be increased ; and (5) the relation of the law of national health insurance to the law of workmen’s compensation. The chairman closed by an appeal to the officers of the society and to the medical certifiers to cooperate in the duty of protecting the funds of the society from misuse. They should remember that the society was not a charitable organisation but a service controlled by law, and that they must harden their hearts against appeals on the grounds of hardship or poverty. There might be people who were very deserving objects of charity, who were not entitled to benefits. It is satisfactory to find that the committee and its chairman are alive to the inadequacy of the present system of national health insurance in Ireland and are pressing the Minister, to take steps toward
devising a
more
efficient and
comprehensive scheme.
INFECTIOUS DISEASE IN ENGLAND AND WALES DURING THE WEEK ENDED JULY 16TH, 1938
Notifications.-The following cases of infectious disease were notified during the week : Small-pox, 0 ; scarlet fever, 1740 ; diphtheria, 1075 ; enteric fever, 26 (54 " expected ") ; pneumonia (primary or influenzal), 528 ; puerperal pyrexia, 201 ; cerebrospinal fever, 20 ; acute poliomyelitis, 8 ; acute polio-encephalitis, 1 ; encephalitis lethargica, 3 ; dysentery, 39 ; ophthalmia neonatorum, 94. No case of cholera, plague, or typhus fever was notified during the week. The number of
cases
in the Infectious
Hospitals of the London
County Council on July 22nd was 33 25, which included : carlet fever, 742 ; diphtheria, 948 (carriers 45); measles, 385; whooping-cough, 264 ; puerperal fever, 8 mothers (plus 5 babies) ; encephalitis lethargica, 279 ; poliomyelitis, 1. At St. Margaret’s Hospital there were 2 7 babies (plus 12 mothers) with ophthalmia neonatorum.
Deaths.-In 126 great towns, including London, there was no death from small-pox, 2 (0) from enteric fever, 5 (1) from measles, 3 (0) from scarlet fever, 6 (2) from whooping-cough, 26 (3) from diphtheria, 61 (17) from diarrhoea and enteritis under two years, and 23 (1) from influenza. The figures in parentheses are those for London itself. Hull and Swindon each reported a death from enteric fever.
Fatal cases of Hull had 2 deaths from whooping-cough. diphtheria were reported from 14 great towns : 5 from Liverpool, 3 from South Shields. Birmingham reported 11 deaths from diarrhoea, Manchester 3, no other great town more than 2. The number of stillbirths notified during the week was 254 (corresponding to a rate of 35 per 1000 total
births), including 32 in London.
THE LANCET 100 YEARS AGO July 28th, 1838, p. 630. From a leading article. IN the medical evidence lately given before the PoorLaw Committee, it was shown that the appointment of a Medical Guardian in every Union, and a Medical Commissioner in London, would be useful to the entire community. The Medical Guardian ... would advise the Guardians in any case requiring medical skill, and, from the reports of the medical officers, draw up an annual sanatory report, to be submitted to the Guardians, and to the Medical Commissioner, who would condense the results deducible from all the Union returns, into one general Report, to be laid every year before Parliament. The influence which the knowledge collected in this manner would have upon the health, and life, and happiness of the working classes, can scarcely be imagined ... ...