The purpose of this Bill is to relieve the Exchequer of the major portion of the charge for medical certification under the National Health Insurance Act. Heretofore the whole charge has been met out of the Exchequer. That was not the case during the past couple of years in Northern Ireland, nor was it the case in Great Britain, although arrangements for National Health Insurance differs somewhat in Great Britain. The cost of the medical certification in 1923-4 was £51,200. The money for medical certification is distributed each year amongst medical practitioners who enter into agreements with the Commissioners to furnish medical certificates in accordance with the scheme agreed to by the medical profession, and approved by the Minister for Finance. There is also a small provision for second medical opinions in doubtful cases. The average sum per member paid to the medical practitioners for certification was approximately two shillings and three pence.
It is proposed to meet that service and to defray the charge this year out of the various sources indicated in the Bill. However, it will not be necessary to find two shillings and three pence per member. The Insurance Commission have been in negotiation with the medical profession, and they have agreed to accept a reduction in remuneration until the 31st August next, which would give an average of two shillings per member as against two shillings and three pence. It is hoped that it will be possible to have that arrangement extended to the end of the year. Meantime steps are being taken to see if it will be possible for the Government to put forward any proposals in regard to reform and improvement, in whatever way it is found best, of the system of National Health Insurance.
Now, the Bill provides that 10d. per member shall be found out of the Benefit Fund of every approved Society in respect of each member. That is really the effect of Section 2 of the Bill. The financial basis of the Health Insurance Acts makes provision for six shillings and seven pence per insured member for charges other than sickness, disablement and maternity benefit. The charges hitherto against the Societies' fund were four shillings and ten pence for their own administration, one shilling and threepence for sanitorium benefit, four pence for administration of Insurance Committees—a total of six shillings, and five pence, leaving a margin of two pence. That margin arose out of the fact that only four pence per member is allowed for the administration of Insurance Committees, whereas there was actual provision for six pence. It is proposed to take that margin of two pence for purposes of medical certification. The societies have been allowed four shillings and ten pence per member for administration. The Insurance Commissioners have, by regulation, reduced the charge for the Societies' administration to four shillings and five pence from the 1st January last. That four shillings and five pence is the amount allowed for administration in Great Britain and Northern Ireland, and it is felt that the amount is sufficient for the cost of administration in the Saorstát.
The present weekly rates of contribution are 8d. and 7d. That is sufficient to meet the obligations of the societies under the Act, and leaves a margin of 3d. per member per annum. It would not be possible to reduce the contribution by even one farthing, shall we say, without reducing it below what is necessary. On the other hand, the existing contribution does leave this small margin of 3d. per member per annum. So that the 10d. is made up of the 2d. which already exists as a margin and is available for the benefit fund of the society; of 5d. by which it is proposed to reduce the amount allowed—by which, in fact, the Commissioners have already reduced the amount allowed to the societies for administration—and the extra 3d., which is the actuarial margin. That gives 10d. The remainder of the sum required—1s. 2d.—it is proposed to find by diverting money that arises from unclaimed contributions from the National Health Insurance Central Fund. The unclaimed balance in the Stamps Sales Account at the end of 1921, was £196,000 for all Ireland. The Free State share has not been apportioned yet, but it may be taken at £113,000. This is not, of course, entirely surplus, because it includes the value of stamps in the hands of the public and not affixed to contribution cards, and stamps on cards in the hands of societies or insured persons for which credit will ultimately be claimed. But something like, shall we say, £80,000 or £100,000 is definitely surplus. Certain people who have to be insured and who do not wish to apply for benefit, occasionally throw their cards into the fire. In such ways as that the surplus arises. At present it goes to the National Health Insurance Central Fund, which is a second line of defence for the societies. It can be called upon if a deficiency arises in the Contingencies Fund of a society, if the society can show that the deficiency was due to some special cause beyond their control, such as an epidemic of disease.
Under Section 27 of the National Health Insurance Act of last year a small proportion of this money was diverted from the Central Fund to recoup societies for keeping members in benefit who would otherwise have been suspended on account of arrears, but the amount so diverted will be comparatively small. This proposal to take the major part of the amount required for medical certification away from the Central Fund, can only be continued for a short period. It is as tually only for this year, or perhaps for another year, but it could not be continued indefinitely. It is really a temporary provision to meet the need for providing for medical certification until we have been able to look further into the whole question of the administration of National Health Insurance. It would be unwise and unsafe to continue to divert this particular revenue, as it were, from the Central Fund.
The effect of the proposal, taking a membership of 440,000, at 10d. per member, is that from the societies we get £18,340, and from the Stamp Sales Account, or from the portion of it attributable to unclaimed stamps, we get £25,670. In addition, there is the cost of second medical opinions, about £1,600, making a total of £45,610. As the money will in future be taken out of contributions and applied in defraying the expenses of administration, and not, as heretofore, provided by the Exchequer, it will attract the two-ninths State contribution provided for in Section 3 of the 1911 Act. Consequently the total of £45,610 required for medical certification will be distributed in the proportion of seven-ninths from Insurance Funds and two-ninths from the Exchequer. That is, the Insurance Funds will bear £35,480 and the Exchequer £10,130. The net saving to the Exchequer will be £35,480. The two-ninths of these various sums which will be taken from the societies and from the Central Fund will be recouped to the societies and to that Fund. That is, the societies will not really lose the 10d.; they will lose seven-ninths of the 10d. They will be responsible for paying the 10d., but the two-ninths of that amount will be recouped to them under the provisions of Section 3 of the 1911 Act. That is the principal provision in the Bill.
Section 5 of the Bill provides that the limitation in regard to soldiers, which prescribed that they should have been enlisted for a period not exceeding twelve months in order to get the benefit of the Act, is removed. We are now enlisting soldiers for longer periods. The provision which enables people to be kept on the books and not to be suspended because of arrears, which terminated on the 31st December last, is revived, and will continue till the end of 1925. As I have already said, there is a somewhat similar provision in Northern Ireland. The money is found in a rather different way from Insurance Funds, but it comes to the same thing in the long run. That is, that seven-ninths of the cost of medical certification is found from Insurance Funds, and during the past two years the societies had to find the greater part of the cost of medical certification, while in the Saorstát the entire expenses were borne by the Exchequer.
