MEDICAL PRACTICE UNDER THE INSURANCE ACT.

1640

MEDICAL PRACTICE UNDER THE INSURANCE ACT. (BY

SPECIAL COMMISSIONER.) (Continued from p. 1492.)

OUR

XLVII.—UNANIMITY

IN THE

BURY ST. EDMUNDS

AREA. FROM Colchester I went to

had

private

lost some practice among domestic servants and small tradesmen. But instead of 200 club members at 5s. each he had 600 insured persons at 7s. each, and this more than covered his loss in private practice. The longest panel list in the area numbers, I ascertained, about 2000 ; there is a firm with 3000, but it is composed of three

partners. Here, as

at Colchester, the members of the old Bury St. Edmunds, clubs have remained faithful to their original club taking that city as a typical agricultural centre. doctors. But it was pointed out to me that the The impossibility of staying at more than a certain abuses for which club practice has become notorious number of places during such an investigation as did not prevail at Bury St. Edmunds. This bears out that which I was engaged upon forced me to omit, at a remark of mine, which I understand has beenany rate for the moment, the larger and more com- criticised, that now and again the old medical aid associations worked without injustice. There were’ mercially important town of Ipswich. St. the ancient of no bad clubs in this district paying 2s. 6d. or 3s.. Suffolk Edmunds, Bury capital

and the seat of the new East Anglian bishopric of St. Edmundsbury and Ipswich, is the centre of a division of the British Medical Association which is almost identical with the newly formed Bury St. Edmunds insurance area. Newmarket, on the Cambridgeshire border, is also included in the Bury St. Edmunds insurance area, but the interesting and ancient little town on the Norfolk border, Thetford, has been handed over to the Norfolk insurance area. The West Suffolk insurance area is about the same as the county council area, and much of the insurance work is done in its centre, Bury St. Edmunds. The city of Bury St. Edmunds has a population of 16,785; but the surrounding purely agricultural country is fairly well populated, and there are about 35,000 insured persons in this area, with a panel of 59 doctors. But some of these doctors do not actually reside in the West Suffolk area ; they live on the outskirts. Indeed, for eight of them most of their work is not within the area. Such overlapping renders the gathering of statistics very difficult. Every available practitioner went on the panel except one doctor, who could not overcome his antipathy to the new legislation. How the Act Works in the Bury St. Edmunds District. At Bury St. Edmunds, as at Colchester, the members of the medical profession were in the negotiation stages of the Act unanimously in opposition. When ultimately they yielded, they attributed the fault to their geographical neighbours rather than to themselves. It was the overlapping of medical practice from other districts that made the Bury St. Edmunds district fear the danger that doctors who had given way elsewhere would overrun the places where the doctors still held out. West Suffolk doctors were afraid of the men of Essex, Cambridge, and Norfolk, just as I had found the doctors at Colchester complaining that they could not rely on the medical profession around them if any continued stand were made. The Insurance Committee are still accused of subtlety in their way of conducting negotiations and of intimidating the local practitioners. A circular was sent round saying the panel would be closed on the ensuing Monday. Then came another circular that it would be closed without fail at 10 in the evening of the following Thursday, but after all the

annum for all sorts of medical attention and drugs. On the contrary, instead of such monstrous capitation fees or even the usual 4s. the sum generally subscribed was 5s. a year, and the members of the clubs did not complain of carelessOn the ness on the part of their medical offiéers. other hand, I could find no evidence that the Act had done anything that enabled insured persons to obtain better treatment than they were in the habit. of receiving as members of clubs and Friendly Societies. That being the case, there are a certain number of small tradesmen and others who would much prefer paying fees than to be treated as :contract patients under the Act. But if they are willing to pay medical fees they are not willing to pay income-tax, and therefore they have enrolled themselves under the Insurance Act, as a proof that they are below the attention of the Incometax Commissioners. As an instance in point, I was told of a youth of the neighbourhood who, accompanied by members of his family, called on his panel doctor, when a long examination and con. sultation ensued in regard to a nasal polypus.. After much discussion it was decided that the youth should go to London to have the polypus removed The panel doctor naturally felt it rather hard that this 7s. a year patient, after giving him so much trouble, should pay a fee to some London surgeon which would amount to at least 5 guineas; the inevitable question was whether a patient who could on occasion find such sums of money was fairly within the contemplation of the scheme of the Act. The incident is related not as an individual case, but as one of many showing that insured persons are often well able to pay the usual medical fees. In the Bury St. Edmunds district the calling on insured servants was brought to my attention as being often a troublesome duty for panel practitioners ; such visiting entails a greater sacrifice of time than should be expected for contract work. As a rule, not only has the servant to be seen, but the servant’s mistress then wants to know all about the She asks whether she ought to keep the case. servant in the house, how long the illness is likely to last, and is it necessary to get another servant. To discuss all these points may take up a long time, while irksome questions of duty in the matter of The was members of panel kept open indefinitely. the profession, however, did end by being panic- professional confidence may always arise. But the stricken and then they all went on the panel. panel practitioner cannot cut such interviews short losing as private patients the family Apparently they have been quite satisfied ever for fear ofthe servant. since. In any case there is no bickering andemploying Avoid Election of Panel Committee. Attempt to friendly relations are well maintained. In regard to the Medical Committee and the Panel Speaking to one of the leading local practitioners, he explained to me that as a result of the Act heCommittee I found the position at Bury St,

per head per

1641 Edmunds somewhat similar to -what I had seen at minutes, and a good deal of work which generally Colchester. The action of the medical profession has to be done by one or two devoted members. in regard to these bodies has been .:firm and very Such work ought not to be gratuitous, and the unanimous. Indeed here, as elsewhere, the agita- Panel Committee have powers to make a levy. From all this there arose the present very tion in regard to the Act has done much to weld the Throughout the country profession together. At the outset hostility to the interesting situation. Act was such that when the Insurance Com- there are many insurance areas where practically all mittee first appointed its Medical Benefit Sub- the medical men in active practice are on the panel. committee there was not a single medical man This is notably the case at Southend, Colchester, it. After a on while, however, not only and Bury St. Edmunds, the last three places I have a medical man secured for this com-- visited. It does not mean that the Insurance Act was mittee, but eventually a practitioner of Bury was readily accepted ; on the contrary, a very stout ’St. Edmunds who had taken a very prominent and unanimous resistance was made. The fact that part in the organisation of the profession was all the doctors are on the panel only means that, selected. Fortunately, the shortage of medical men as the Act could not be prevented, it was best on the subcommittee led to no trouble. Though to control its operations as far as possible. Now the Act has been in force for more than a year, no that official Panel Committees have been created complaint whatsoever has been made against any this is much more easy than formerly. Formerly doctor in the area. the great difficulty was the want of money to pay The Local Medical Committee was constituted on secretaries and working expenses generally. But March 13th, 1913. Twelve members were elected. to-day the Panel Committees have powers to make ’The one doctor who, though in active prac- compulsory levies-that is, to deduct a halfpenny or tice, refused to go on the panel, was unani- more from the floating sixpence: money thus mously elected on the Medical Committee. obtained only to be spent for administrative purposes Another doctor who is also not on the panel, and in a manner approved by the Commissioners. but who is not in active practice, was likewise The latter, however, cannot exercise any control elected to the Medical Committee. The remaining whatsoever over a voluntary levy. On the other ten members of the Medical Committee are all hand, a good many practitioners might object to pay panel doctors. It will be seen, therefore, that the levy. But the position is quite changed. The efforts were made to secure the representation of practitioner can hardly avoid a levy now ; he can every possible interest on the Medical Committee. only decide which sort of levy he prefers-a comBut the new regulation insisting on the elec- pulsory levy imposed by the Panel Committee with tion by panel doctors only of a Panel Committee the money so raised controlled by the Insurance Comproduced difficulty. At Bury St. Edmunds no one missioners, or a voluntary levy of about the same wanted this committee, as, with but the two excep- ’, amount, but which the subscribers would themselves tions mentioned above, it would be a mere duplica- control and spend in the way they thought best. tion of the Medical Committee. However, there is (To be continued.) a clause which says that where no Panel Committee is formed the Commissioners might recognise any ’existing committee. Therefore nothing was done, and after waiting till the last day for electing a Panel Committee had passed the Commissioners (FROM OUR OWN CORRESPONDENTS.) were written to and invited to recognise the Local Medical Committee as the best existing committee. The Commissioners, however, refused to see the LIVERPOOL. matter in the same light. Though the date for electing a Panel Committee was passed they insisted .Liverpool Hospital for Consumption and Diseases of the Chest. that such a committee should be -elected. An THE fiftieth annual report in connexion with the inspector even was sent down by the Commissioners a little before Christmas (1913). Then 20 nominaHospital for Consumption and Diseases tion forms for the Panel Committee were sent to of the Chest, which was presented at the annual the secretary of the Medical Committee. Thereupon meeting held recently, showed that the hospital in a general meeting of the profession was convoked, Mount Pleasant and the sanatorium at Delamere and they proceeded to elect a Panel Committee on Forest are fulfilling an important and beneficial their own lines. work for the community. The Lord Mayor, who Funds for Medical Organisation Secured by Law. presided, moved the adoption of the report. It was The problem has arisen in many places whether to be regretted, he said, that the resources of the the profession shall go through the form of keep- laboratory attached to the hospital could not be fullest extent owing to financial ing both the Medical and the Panel Committees in utilised to their The Government had appointed a existence. In this matter the financial aspect ’of difficulties. the question has also to be eonsidered. The medical research committee to direct research Medical Committee has no -other resources save into the problems connected with tuberculosis. that of voluntary levies paid by its members. The There were funds available for the purpose, but Commissioners seem desirous ofdoing away with up to the present no grants had been made. State the Medical Committees, so as to give all the power aid was not forthcoming, and the scientific study to the men who are working the Act, but at Bury of tuberculosis, which was a national question, St. Edmunds it is the same men who are on both was left to private endeavour and philanthropic committees, a position that has arisen elsewhere effort. School After-care. and is bound to continue to arise. The ComThe chief subject of discussion at the last meetmissioners will not effect any real change if the Medical Committee does cease to exist. The ing of the Liverpool education committee was a Medical Committee met 24 times last year. This suggested change in the method of ensuring the means sendingout -notices, keeping a-.book. -of after care of children.It was proposedthatthe_

Home and Foreign Notes.

Liverpool

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