Deputies have the interim report of the Committee of Inquiry into Health Insurance and Medical Service. That places them practically on a par with me as regards information for formulating any general policy regarding the question of National Health Insurance. Until the full report is published, and until I have an opportunity of getting the views of all parties concerned, I will not be able to formulate any definite conclusive policy in regard to National Health Insurance as a whole. Accordingly, I will just go through the sub-heads and make a few comments upon them.
With regard to sub-head (a), salaries, wages and allowances, the increase in this sub-head is due to the ordinary normal incremental increases and an increased rate of bonus. The figures are reduced to those required for normal work in the Free State in all branches, except certain sections of the accounts branch, in which a full staff is required until the division between Northern Ireland and the Free State, and also the separation from Great Britain, is finally effected. A portion of the amount provided under this sub-head, estimated at £3,800, is chargeable to the Government of Northern Ireland for work being done by this Department preliminary to the apportionment of the funds of Approved Societies. A sum estimated at £2,000 is recoverable from the British Government for work done by this Department on behalf of the British Ministry of Pensions. There is also a sum which is chargeable to the Ministry of Industry and Commerce, amounting to £11,200, in respect of work performed in securing compliance with the Unemployment Insurance Acts, while a sum of £2,300 is paid to officers on loan to other Departments.
Sub-head (b) deals with travelling expenses. A sum of £9,200 is required for travelling expenses, etc., of the outdoor staff, which includes 63 officers. A portion of this sum, estimated at £4,820 represents travelling expenses incurred by officers of the Department in securing compliance with the Unemployment Insurance Acts on behalf of the Ministry of Industry and Commerce. The cost of travelling expenses is swollen by the cost of car hire, which has increased very considerably since 1914. A sum of £360 is provided for the travelling expenses of the Commissioners and staff attending conferences and attending Approved Societies and Insurance Committees. £90 is also provided for expenses of members of the Advisory Committee when attending conferences.
Sub-head (c) touches special inquiries and services. This is an amount of £10 only, and it is provided merely as a token-sum to keep the sub-head open. Sub-head (d) deals with insurance stamps. The Revenue Department has been approached on the question of reducing the estimate for the manufacture of stamps for the year 1925-26 from £550 to £500. They state that the expenditure for the past year will not approach the estimated figure, because the printing of new stamps has not yet begun, and the only cost will be for the overprinting of old stamps. As soon as the work in connection with the manufacture of the new stamp begins, they consider that the figure of cost given is a correct one. As regards sub-head (e), the item of £80 under it is made up of £20 for washing towels for central office and £60 for the purchase by the outdoor staff of necessary articles of stationery not supplied from headquarters. These are railway guides, ink, gum and local newspapers, and matters of that kind.
The next important sub-head is (g) (1). Prior to the establishment of the Free State there was a small item for administration under (g) (1), which represented the State grant of medical benefit received in Great Britain by stray members of Irish societies. This has now disappeared, and the words "including expenses for administration" are no longer required in the note. Under (g) (2) I may say that the estimate for this sub-head was, up to the year 1923-24, always prepared by the Government Actuary in London. His figures, which were presumably based on the expectation of sickness and on the estimated number of insured persons, were usually much in excess of the expenditure. For the past two years the Commission have endeavoured to bring the estimated figure as low as possible, having regard to the actual sickness experience, but in view of the uncertain factors governing expenditure under this head, a reasonable margin has to be allowed. An increase in employment and greater compliance with the Insurance Acts are likely to increase the expenditure under this sub-head during the coming year, while provision has also to be made for the possible occurrence of an epidemic. A margin of £10,500 to meet these increases does not seem excessive, and it would not be safe to take a lower figure.
The only other point that may arise is that Deputies might be anxious for some information as to how the Medical Referee scheme set up last February is working. I introduced a Bill to-day which is intended to give legal sanction to the setting-up of this scheme. The new Medical Referee scheme for the provision to Approved Societies of second medical opinions in respect of members claiming or receiving sickness and disablement benefits was put into operation by the Commission as from the 1st February, and is authorised to be continued up to the end of this year. Three temporary District Medical Referees were appointed for the making of examinations under the scheme, their headquarters having been fixed at Dublin, Cork and Oranmore, Co. Galway. The examinations of insured persons are made by the Referees at various centres throughout the Saorstát and in the overwhelming majority of cases in premises—for example, dispensaries and hospitals—under the control of local authorities who, in most instances, have given the use of their premises free of charge. Forty-two such centres were set up during the period under review and negotiations are in progress for the setting-up of additional centres in counties including Tirconaill.
The number of applications for reference received from approved societies, from the 1st February to the 30th April, 1925, was 1,733, twenty-eight societies having availed of the scheme. Medical certifiers under the National Health Insurance Acts are also entitled to apply for second opinions in respect of cases in which they are issuing certificates for incapacity for work; but during the period mentioned only twenty-one such applications were received. Of the total number of applications—1,754—451 were considered to be unsuitable for examination on medical grounds, and the remainder were promptly forwarded by the Commission to the respective referees for the necessary action at centres where the arrangement for the making of examinations had already been completed.
The total number of applications sent to the referees during the period in question was 1,049, and I will give you some particulars relating to those. The number of applications for reference received by the Medical Referees amounted to 1,049. The number of cases actually examined by the Medical Referees was 628. The number of cases reported by the referees to be incapable of work was 218. The number of cases reported to be capable of work was 410. The number of cases in which the insured persons did not present themselves for examination, including persons who declared off benefit before the date fixed for examination, and the persons who were certified as unfit to attend was 421, or 40.1 per cent. of the number of cases summoned to attend for examination. I do not think there is anything else I can say now.
Deputies may desire to ask questions under the various sub-heads.
