Dáil Éireann díospóireacht -
Thursday, 24 May 1928

Vol. 23 No. 17

IN COMMITTEE ON FINANCE. - VOTE 43—NATIONAL HEALTH INSURANCE.

MINISTER for FINANCE (Mr. Blythe)

I move:—

Go ndeontar suim ná raghaidh thar £220,933 chun slánuithe na suime is gá chun íoctha an Mhuirir a thiocfidh chun bheith iníoctha i rith na bliana dar críoch an 31adh lá de Mhárta, 1929, chun Tuarastail agus Costaisí an Choimisiúin Arachais agus chun Ilsíntiúisí agus Ildeontaisí mar gheall ar chostas Sochar agus Costaisí Riaracháin fé sna hAchtanna um Arachas Sláinte Náisiúnta, 1911 go 1927 (maraon le Deontaisí áirithe i gCabhair).

That a sum not exceeding £220,933 be granted to complete the sum necessary to defray the Charge which will come in course of payment during the year ending on the 31st March, 1929, for the Salaries and Expenses of the Insurance Commission and for sundry Contributions and Grants in respect of the cost of Benefits and Expenses of Administration under the National Health Insurance Acts, 1911 to 1927 (including certain Grants-in-Aid).

MINISTER for LOCAL GOVERNMENT and PUBLIC HEALTH (General Mulcahy)

The only matter to which, perhaps, attention should be drawn in connection with this Vote is the decrease of £3,000 under F (2). This must not be read as indicating that less advantage is being taken of the National Health Insurance Act. As a matter of fact, young people are coming in under the Act to a much greater extent than formerly, and the old people who are in are keeping more regularly in contribution. The reduction is the result entirely of the withdrawing of the Prolongation of Insurance Act from December last, under which 60,000 people from whom no contributions had been received for several years were kept in insurance, involving a State grant towards additional administration on the part of societies and grants towards sickness benefit in respect of which no contributions were received.

Sir JAMES CRAIG

I have only a few remarks to offer, and I hope the Minister will take them in good part. What I propose to say I think I said before. Perhaps that was what the Minister objected to in my remarks on the Local Government Estimate. I called attention before to the fact that the cost of administration, so far as this Estimate is concerned, seems to me always to be out of all proportion to the amount of the benefits paid to those who are insured. The sum of £123,800 is paid in administration and in medical certification. The amount of benefits paid under the statutory contributions is £218,720. Of course, this has nothing to do with what the societies' contribution is. But it seems to me that that is a tremendous proportion of the amount paid to the societies for the benefit of the people who are insured, in comparison with the cost of administration. There is no information here as to the cost of administration of the insurance societies themselves or what proportion it bears to the amount of the benefits paid.

I think I spoke before about the additional benefits paid. Amongst the additional benefits, hospital treatment is, in my opinion, extremely important. Out of the 44 approved societies, I understand 19 societies have adopted the additional benefit of hospital treatment for the people insured with them. One of the largest societies—the Ancient Order of Hibernians—has not yet adopted hospital treatment as an additional benefit, with the result that the hospitals have to treat the people who belong to this society for nothing. There are a certain number of societies who are extremely willing to pay this hospital benefit. Among them are the Prudential Insurance Society, the Irish Amalgamated Insurance Society, the Liver National Health Society, the South Dublin Catholic Insurance Society and the Dublin Catholic Young Men's Association. I am told that, so far as the hospitals are concerned, these five societies are particularly good in paying the amount that they decided upon— 25/- a week for treatment of the poor people who are insured with them. I am quite sure that the Commissioners have endeavoured to get this additional benefit of hospital treatment adopted by the various societies. I am told that the larger societies, like the Ancient Order of Hibernians, are giving money in other ways—that they are giving greater benefits than this would provide. Speaking from the point of view of the hospitals, I think it is hardly fair that these hospitals should have to treat for nothing the people who are insured in certain approved societies.

Dr. WARD

I think this is about the most unsatisfactory public service of all the public services we have been dealing with. Some time ago, when a Vote was passing through this House under this heading, I raised the question of the difficulty of securing benefits for people who are ill and entitled to benefit. The Minister for Local Government, on that occasion, gave me to understand that it was merely a matter of bringing the irregularities under the notice of the National Health Insurance Commission and steps would be taken immediately to ensure that benefits would be paid to those people entitled to them. At that time when we were discussing the question I emphasised the necessity for prompt payment of sickness benefits, and I want to touch on that side of the question again. When people are ill and all sources of revenue are cut off it naturally is a tremendous handicap to them if they cannot secure sickness benefit under the National Health Insurance. That is the time when they would require to be removed from mental anxiety concerning the provision of the necessaries of life for themselves and their dependants. It is essential at that time that there should be some source of revenue in order to procure the necessary forms of nourishment to insure a speedy recovery.

Another serious aspect of this difficulty in securing payment of benefit is that people have to return to work before they are physically fit, because the people dependent on them are in want and they cannot secure benefit. The result is that these people become chronic invalids, and are a permanent drain on the societies or other institutions. Since this matter was discussed in the House before I have had complaints from various parts of the country on this question. I do not want to deal with these now, but I wish to mention a few cases in my own experience as a medical certifier. The first case I wish to bring to the notice of the Minister is number 8879, Sláinte Insurance Society. The first certificate was issued on 21st February, 1928. This person was discharged as being fit to resume work on 26th March, 1928. No payment was made until after he had been discharged as being fit to resume work. Number 22116, Sláinte Insurance Society, is another case. The first certificate was issued on 10th January, the first payment was made on 15th March, and there was no communication or acknowledgment whatever from the Society during that period. I may mention that I brought these cases to the notice of the National Health Insurance Commission after a reasonable period had elapsed, and that eventually resulted in payment. I could cite further cases but I do not suppose it is necessary. I could cite half a dozen cases in my own experience since this matter was discussed here before where the very greatest difficulty was experienced in extracting benefits out of insurance societies.

When one comes to consider the cost of administration of this particular service one would expect that it would be administered more efficiently. The total cost of administration in 1926, the latest year for which figures are available, was about £180,000, and yet in spite of that enormous figure for administering the National Health Insurance people are unable to secure benefits when they are ill. I think one of the great difficulties is the multiplicity of societies, and the different societies being in different financial circumstances there is no uniformity of benefit. Another considerable drawback—and it is a very big question that, I presume, we cannot discuss now—is that no treatment is provided, and that all these people are entitled to under the National Health Insurance is a medical certificate that they are unfit to work. Of course, they get certain benefits from their societies. The fact that no treatment is provided means the people have to go to the dispensaries in most cases, and as we know there is a certain taint of pauperism attaching to the dispensary service. To my mind, if this service were entirely taken over and administered by the Public Health Department it would be more efficiently administered than it is at present. I think it ought to be administered as a department of Public Health, and as a part of the State services. It is an extraordinary fact—and the Minister for Local Government is responsible for this particular Department—that its inspectorial staff is costing upwards of £28,000 per annum. I fail to see what return is given for that, and what all these inspectors are doing. I think if the Minister for Local Government had complete control of the administration of this Department he would find that he could put into operation some of the suggestions we made yesterday on the Local Government Vote with regard to the co-ordination of his work, and that some of the inspectors engaged in other sub-departments of the Department of Local Government could carry out inspections under this National Health Insurance.

For instance, the medical inspector goes to a certain district to carry out ordinary inspectorial work under the Department of Local Government. I do not see any reason why he should not be able to examine a patient and decide whether such person was physically fit to resume work or not. Certain classes of people are bound by law to have National Health Insurance cards stamped. It is hard to understand why it is necessary to have what for all practical purposes is a civil police force in the form of inspectors, at enormous cost, going about to see that people comply with those provisions. We have a police force in this part of the country, and I fail to see why they should not be able to secure that people comply with this law as they do in the case of other laws. I do not know that anything very much can be done, but I think the Minister has not been fully aware of the very serious difficulty insured people labour under in securing these benefits. If it is necessary to scrap this Department and take complete control to secure efficiency, then the sooner the Minister for Local Government does it the better.

Mr. FRENCH

I am not going to delay the House by reiterating every word said by my colleague, Deputy Dr. Ward, but I would like to make a few suggestions to the Department of Local Government from what may be interpreted as a novel point of view. National insurance is a system necessary for any country which claims to have any respect for democracy. We have to cater for the sick and the afflicted as best we can, and for those who can subscribe in a small way to insurance we have to insure them not alone against death, but against temporary unemployment and disablement. My interpretation of and objection to the old English Department of Local Government was that it did not govern this country from the Irishman's point of view, but from the Englishman's, and I am suggesting to the Minister that he is simply following on false footsteps when he is not changing it from that of the British regime to the Irish point of view. The whole mistake in the present Irish Government is that we are following the footsteps of the English, and in no place is it more conspicuous than in the Local Government Department. There is no change. I am not going to suggest that there are not things in British administration that we cannot take and use for our own benefit. They have adopted national insurance from another nation and we can interpret the best of that system for ourselves. In Ireland at present in relation to all forms of local government there is a medical service. I have a definition of medical services that applies generally, and no one can argue that there is a difference in medical services as between one system and another, say as between public health and national health insurance.

The appointment of medical officers is a step in the right direction and will lead to a far bigger development than we have any idea of at the moment. I think there should be one medical head for every area for everything that comes within the ordinary layman's interpretation or definition of medical jurisprudence or the particular sphere of a medical officer. Anyone who knows anything about poor law dispensaries knows that there is no more disgraceful way of attempting to do even the ordinary justice that a medical officer at a dispensary intends to do for his patient, than is attempted under the present system. I am not speaking of the urban areas, but of the city dispensaries. I have practical experience of individuals who are supposed to dispense, within a given period of at the most two hours, sometimes 250 prescriptions, if a man could possibly do that. One or two mistakes are bound to happen in the case of the individual who dispenses. He may not dispense the prescription properly. I cannot visualise 250 patients going into a dispensary with ordinary complaints and being prescribed for in the same manner as a private physician dealing with a private patient would prescribe for him. It is a physical impossibility, but that is the system in every city in Ireland at the present.

AN CEANN COMHAIRLE

Has that anything to do with the Vote? I feel it is a little bit remote from it. I thought the Deputy would come to the Vote, and I was waiting for him.

Mr. FRENCH

I am suggesting that national health expenditure could be applied to general health services in Ireland.

AN CEANN COMHAIRLE

This is a vote for the administration of the National Health Insurance Acts, and the point the Deputy raises is relevant to the Department of Local Government proper. This is a question of the National Health Insurance Acts and not national health generally.

Mr. FRENCH

What I am suggesting is that the Minister might extend the system.

General MULCAHY

What the Deputy wants is a new Act.

Mr. FRENCH

At this hour of the day you might have asked us to anticipate and say that in the near future you would apply for an Act which might extend to the dispensing of medicine and bring the full medical benefit to Ireland, as we see elsewhere in Germany or England. I am suggesting that National Health Insurance at present is a certain amount of waste, because you have not extended it sufficiently in other directions which possibly might save money in your Department. What I am really trying to say is National Health Insurance cannot stand on its own footing. It must include all medical services within Ireland. If I am in order by calling it national insurance I will do so.

AN CEANN COMHAIRLE

The Deputy is not in order in referring to these matters by calling them national health insurance. I am giving him as much latitude as I can, but he cannot come into order by simply mentioning national health insurance. This Estimate is entirely for the expenses of administration connected with the National Health Insurance Acts. This is not the time or place to advocate an amendment of these Acts or the repeal of these Acts, which I understand is advocated by some people.

Mr. FRENCH

You will admit that it is the only opportunity we have of hinting at it.

AN CEANN COMHAIRLE

The Deputy has hinted at it for ten minutes. That is a long time for hinting.

Mr. FRENCH

I am only suggesting that, on the next opportunity we have, the Minister will increase his demand on us, and that in the meantime he may possibly produce an Act that will really deal, from the national insurance point of view, with necessitous cases, and will provide for benefit for certain men out of work. I am not going to criticise the Minister for the manner in which the Act is administered at present. I am not an exception to other members who have had many applications in cases of hardship. There is no question that at present there are many cases that, in my personal opinion—and I am trying to judge it as impartially as I possibly can—appear to have a reasonably fair claim for sympathetic consideration, and who have not got that from the Department. I am quite prepared to admit that those who are charged with the administration of that particular branch, and are employed in the Department—I am not talking of the Minister—are not paid by the State for giving sympathetic consideration to such cases, but at the same time I would suggest that we, the Irish people, at any rate, have always boasted that we were prepared to look after our own poor people. If we want to keep our own people within the country, and that we intend to provide for them as best we can, through the National Health Insurance scheme we have a method of dealing with them from a health point of view. That is the essence of the whole Act. At any rate it is the essence of the foundation of the Act. It is not an Act of this House, but I think every member would wish it to be interpreted in the most beneficial manner, and that every member would try to be as charitable as he possibly can. At the present moment this Dáil is not able to give the whole population the necessities of life. This House is responsible for not giving the people even the ordinary necessities to maintain their health, and therefore we must provide for them from the point of view of national health.

I would suggest seriously that it is really the duty of the Minister, if possible, to err even in sympathy and in charity, not alone in the ordinary way of providing grants through the unemployment section of the Act, but also under the sickness part of the Act and, above all, in regard to the section of the Act dealing with blind people. I do not know whether it is connected with the present Vote, but it is a bone of contention everywhere. There are certain people who perhaps according to your medical officers are not totally blind, but is there any individual at present in Ireland who would employ a person wearing black glasses? Would they employ him in any business, no matter what it is? No person who walks into an office wearing black glasses will get employment. Such persons are rejected and anybody else is employed. They are absolutely denied employment because they are, to a percentage, blind. It may be 25 or 20 per cent. They are cast absolutely on the poor law system, and the National Health Insurance Authorities turn them down because they are not totally blind. Until such time as we have sufficient respect not to want to brand Union clothes as Union clothes, there is only one other way of giving an individual who wants to be respectable what he is justly entitled to receive and what he has actually paid for, and that is through a National Health Insurance scheme. If the Local Government Department and the Minister would treat these cases with a little more sympathy than they have been treated, that is all I am asking for. You would not destroy every bit of originality they possess by making them paupers instead of respectable Irishmen?

Mr. CAREY

I wish to say a few words in connection with this Vote. The valuation of an approved society is made every five years. The last valuation was made in 1923, and the next will be carried out in December, 1928. The surplus accruing in each society will be distributed for the following five years amongst contributors, with the result that some wealthy societies are able to afford hospital treatment, dental treatment, and other advantages for their contributors, while other societies cannot afford anything beyond the ordinary benefit. That is very unfair to those societies who cannot afford to give the extra benefit. It is very unfair to societies that they cannot give the same benefits as societies which have a large surplus. In that connection I would suggest to the Minister, if it is possible, that the surplus should be pooled amongst the different societies and an equal proportion given to the contributors of the various societies. Then there is the case of a contributor who has been paying in for years to an insurance society—a married man, for instance. When he dies at sixty or sixty-five years of age his widow gets no benefit, even though he would not receive any benefit from his society during his lifetime. I believe that there should be some clause inserted in the Act whereby the widow of a contributor should get either a gratuity or some burial benefit. Certainly some benefit should be given in cases of that kind.

Under present circumstances there is no clause in the Act that would allow that to be done. Then you have cases where employers are more or less careless in sending in cards, or where perhaps, the fault is the agents' in not collecting and forwarding cards to the society. If the cards are late in being handed in benefit is not payable for four weeks later. I think there should be some clause put into the Act, so that in cases where it was not the fault of the individual who was claiming benefit, he would be paid by his society. The Act allows an individual to claim from an employer, but we all know that the employer will not pay benefit. He stamps the cards and he gives it to the insured person. If a person was working for a firm in a town one could understand that the cards would be handed in when the half year was up. In the rural districts you have cases where cards are not stamped until it is thought that the employees are going to claim benefits under the Act. I think it is unfair that a contributor or an employee should be deprived of benefit in this way.

I have been connected with one society since the inauguration of the Act, and I believe if a little more was contributed, both by employer and employee, the latter, on attaining the age of 65 years, could be given a pension. The awkward thing about the matter is that under the rules of the House Deputies are not allowed to make suggestions when dealing with the general Estimate. It is very hard on contributors, whose cards are not handed in to the societies in time, that they should be deprived of benefit for four weeks. I think that is a great hardship. For instance, if a person were insured since 1912, if all his insurance cards were handed in up to last January, and if the last card was then late that person would be deprived of benefit, even though he never drew benefit before. I could speak for a long time on this subject and make suggestions, but that would not be in order at this stage. I appeal to the Minister to take this matter into consideration.

Mr. O'KELLY

I have been looking over the Estimates and, to my mind, the cost of administration seems to be out of all proportion to the benefit that the Act gives the country. The cost at headquarters is, I think, a matter that would bear considerable pruning and, I think, could bear it without any disadvantage to the working of the National Health Insurance Commission. No doubt when the Act was first brought into operation three Commissioners may have been necessary. It was new, difficult and intricate work, and perhaps required a great deal of attention from expert people to deal with it. Nowdays it is routine work, work that anybody going into that office, with ordinary intelligence, would be able to perform, I imagine, after a few weeks. I think that some effort ought to be made by the Department to cut down the heavy cost at headquarters. There is one chairman at £1,500 yearly and bonus, I presume, and two other Commissioners with, I think, £1,200 each, with bonus. There is also a chief clerk at £1,000 with bonus, I presume. The Minister may have looked into the matter and found that all these officials are absolutely required, and that the Department could not be conducted efficiently without them. I do not think that is so. I would be glad if the Minister would look into the matter, and if he would tell us whether it would be possible, in his opinion, to run the Department cheaper. Of course I know that there would be difficulties. The officials were there and were taken over and cannot be got rid of, perhaps, in a hurry, but work, where their abilities might be equally usefully employed with advantage to the Saorstát, might be found for them as vacancies arise in other Departments. I think, and others have mentioned it in previous years, that the Department seems overstaffed, and that the weight of expenditure at headquarters is out of proportion to the amount of benefit that the country derives from it.

There is just one point which, perhaps, the Minister will be able to tell us about. There are large surpluses in a number of these societies. How are these surpluses from years of working disposed of? We know that in some cases extra benefits, medical and otherwise, are given to members, but if the Minister can give a rough sketch of how the surpluses are disposed of I think it would be of interest. Then there is the question of the number of societies. There is nothing new in that point; it was discussed before. If efforts have been made recently in connection with the unification of societies in Ireland we would like to hear of them. There are too many societies, and the redundancy means that the cost of officialdom is too great. A number of the smaller societies have been amalgamated. Others might be amalgamated with advantage to the country and to the insured persons.

Mr. KENNEDY

Much that I would like to say on this Vote has been said by other Deputies. My principal point is in connection with the delay in the administration of insurance benefits. Weeks often elapse before a working man gets benefit that is due to him. One of the evils that I see is the number of societies. I would not amalgamate societies at all; I would abolish them and work the Insurance Act under the Insurance Commissioners. There is duplication everywhere. Perhaps the staff and the cost of it is necessary. Our contention is that the amount paid in benefit is out of all proportion to the salaries paid to the staffs. The staffs of the societies have to be paid out of the contributions, and if you do away with the societies I contend that there would be more money available from that saving for sickness benefit. I will give a case in point which shows one of the evils that arise. An individual paid up his insurance contributions from May, 1923, to December, 1927, and then fell sick. He got certificates for ten weeks, but got no benefit on the grounds that he was not registered, as he thought he was, with the Irish National Foresters, nor with any other society. He went to the inspector, and, weeks having passed, he was finally told to apply for arbitration. He applied for arbitration, but a month has passed since then. That person is now four months out of work and has got no benefit. If the societies were not there, and if this Act was administered nationally— and it is one of the services which calls for nationalisation—that man would have got benefit. Delay in giving benefit often results in bringing families to the point of starvation, and consequently, as I pointed out, this service calls for nationalisation.

Sir JAMES CRAIG

Will you allow me to correct my figures? I find that the benefits paid are £197,000, roughly. The cost of the office is £86,700, and what is paid in the administration of the societies is £21,700, making a total of £108,541, and when to that is added nearly £37,000 that is paid for medical certification, the total expenses are £145,500, as against benefits of £197,000 paid.

Mr. DERRIG

To the amount that Sir James Craig has mentioned could also be added the sum of £5,400 for audit. Before the discussion on this Vote closes I hope that the House will have some assurance from the Minister that this whole question of national health insurance will be looked into. A commission, or committee, sat on this question three years ago and made certain recommendations. I do not know whether these recommendations have been turned down by the Department, but I am sure that some of them would bear further consideration, and that some of them might even be adopted. As Deputy French said, we have in this country a system of insurance which is based on the industrial requirements of a large country like England, and which is not suitable for us. In this respect it was mentioned that a good deal of the time of the national health insurance officials was taken up with unemployment insurance work. The expenses in connection with the Department also are very heavy in proportion to the benefits which the country receives. I think that the overhead expenses under unemployment insurance come to about £114,000, so that it ought to be possible, if the question were gone into in a national manner and in the way that Deputy French has suggested in connection with the whole revision of national health insurance, to bring these services together or, if not to amalgamate them, at least to effect considerable economies.

We have not the same amount of benefit as they have in Great Britain and Northern Ireland; we have no contributory pensions for insured persons at 65 or for their wives. I understand that there are certain benefits for married women in Great Britain and in Northern Ireland which we have not here; but in spite of the fact that we have not these benefits, and that we have not medical benefits, we have a state of affairs that the central administration, leaving out the approved societies' expenses, cost in 1925 3s. 8¼d. for insured persons, whereas in England it cost only 1s. 4d. I know that in England there is a much larger number of persons, and that under a system such as this, where you have so many red-tape regulations, your overhead expenses are bound to be proportionately higher in this country. Nevertheless, it ought to have been possible, since the present Government came into office, to reduce expenditure somewhat more than has been done.

While it might not be possible to give the benefits that have been given in Great Britain and Northern Ireland, there are certain benefits which could be given, especially in the poorer districts throughout the country. I am sure that a great many Deputies are aware that the Dudley nursing scheme in the congested districts depended to a great extent for support on the amounts which were available from National Health Insurance Society sources. I understand that they have dispensary nursing services in most of these areas where you have migration to England for seasonal work, and that a great many of these dispensaries have been closed down. I know that the Minister is particularly interested in the Gaeltacht, and is anxious to do what he can for it. I hope he will be able to resume these services, and even extend them, as soon as possible.

Then there is the question of tuberculosis. The local authorities at present have to bear a larger burden than they should be expected to in connection with the treatment of that disease, and the Central Government ought to endeavour to give more financial assistance for the treatment of tuberculosis. There is also the question of the provision of school meals for children in rural districts. In a large number of urban districts meals are being provided through the urban district councils.

General MULCAHY

We have passed away from the Local Government Estimate, and we are now on National Health Insurance.

Mr. DERRIG

This is one of the recommendations made by this Commission which sat three years ago. I think if other Deputies were in order in suggesting various benefits which could be given, that there is no reason why I should not be allowed to do so.

AN LEAS-CHEANN COMHAIRLE

Except that it would mean legislation.

General MULCAHY

So would all the other things.

Mr. DERRIG

In any case there are constant complaints from the other side that they never get suggestions. It has been pointed out also that approved societies have large surpluses and that these surpluses could be made available for giving additional benefits. It has been mentioned to me, in connection with future policy, that the Minister may be likely to depend largely on the 1918 to 1923 figures. During that period, of course, National Health Insurance was probably in a more flourishing condition from the point of view of contributions than it will be at any time in the future. If charges are contemplated the period from 1923 to 1928 must, of course, be regarded as a lean period. I suggest that the Minister should hold out some hope for an extension of benefit, and at the same time some economies in administration, which would reduce this enormous cost per insured person. The approved societies are supposed to carry on their work at a cost of 4/5d. per person, and when the Central Commission in Dublin takes over the work of a society which, for some reason or other, is not able to carry on, I believe that they are not able to do the work at anything like the rate that is statutorily laid down. There ought to be an endeavour to standardise expenditure and to standardise benefits, so that all societies would pay the same benefits and incur the same expenditure.

General MULCAHY

The total amount of benefit distributed for the year 1927 was £666,800. While, no doubt, the costs of administration do appear large, they ought to be taken into consideration in relation to that figure, and not in relation to the amount of the State grant. I do consider that three Commissioners are not necessary to run the National Health Insurance Commission at present. I have given some consideration to that, and no doubt it will be possible in due course to make some economy in that direction. But whether any greater economising in the general machinery, without changing the whole system, could be brought about is a thing that I question.

Criticism has been directed to the fact that there has been delay in the making of payments from the societies. Considering that the number of persons normally in receipt of benefit per week is about 21,500, or, say 22,000, the number of complaints that reach the Commission is very small. There are many reasons causing delay in the cases where delay does occur. I think we might take it that if 22,000 people are being dealt with weekly that the number of complaints is comparatively small. Deputy Ward mentioned two cases—one on the 21st February, 1928. When that case was brought before the Commissioners, the result was that the claim was paid in full by the 21st March, that is, inside a month, and the cause of the delay was stated by the society to be that the wrong membership number was furnished, and that, therefore, correspondence arose. The second case mentioned by Deputy Ward arose on the 10th January, 1926, and he said that the first payment was made on the 15th March. My information is that the first payment was made on the 3rd March, and the cause of the delay was stated to be the failure of the member and the local agent to furnish a medical certificate. There are points in such cases which Deputy Kennedy brought up of persons who do not take the trouble to see how they stand with their societies until sickness or accident strikes them. The Commission will do all they can to bring defaulting societies to book where the society appears to be seriously in fault. With regard to delay the Commissioners have power to wind up that society and transfer its business to a better-run society.

Mr. BRISCOE

Might I ask the Minister, as a result of his explanation of these examples given by Deputy Ward, if these are exceptions rather than the rule, and that it is the desire of the Department where sick people would go into hospital or undergo any treatment that the benefits should be immediately paid?

General MULCAHY

As far as the benefits to people in hospitals are concerned, there are regulations with regard to them, and if there is any delay the Commissioners will deal with it in the same way. But I say that the volume of complaint is comparatively small. The question has been raised about some societies paying more benefits than other societies. It is impossible to avoid that. If you have well-run societies with a very large number of members, it is possible for them to pay benefits that a small society cannot pay. No society accumulates a surplus above the statutory quantity or the quantity allowed by the regulations of the Commissioners, and when there are surpluses these surpluses are expended in additional benefits of various kinds. The benefits are very many. In actual practice, there are eighty societies, and of these additional benefits are given as follows:—Dental benefit is given by 56 societies and 19 branches; hospital benefit by 45 societies and 14 branches; optical benefits by 34 societies and 19 branches, and the provision of medical and surgical appliances by 8 societies and 17 branches.

So far as the Commissioners are concerned, they have a scheme of adding various useful additional benefits, and the societies put these schemes into force when they have a fund, and according to their own option. It would be impossible without changing the law to alter the system of securing a flat condition in the different societies. While the Deputies who spoke about a national scheme of national health insurance were a bit outside the scope of the discussion, nevertheless I welcome their contribution to the discussion dealing with our general national health insurance problem. It is inevitable that in a wide-flung and intricate piece of insurance organisation, when it is developed in the country and left to grow for a number of years, a particular kind of organisation and vested interests growing around it, that it is very difficult to deal in a revolutionary way with it, except a way is seen very clearly and the results are very clear. Whether we can improve the present system by developing it in a more or less organic way, or whether it is to be radically changed, is a question that we can hardly take a decision on at this particular moment. We would require time for further investigation of the matter, and we would require time for a further sensing of the national pulse by way of what it would desire in the way of a national health insurance scheme, or what it would desire by way of a particular scheme.

Vote put and agreed to.