The question of the delay in making payments has been raised here on this Estimate, and it has been raised annually. Deputy Ward gave cases, and suggested that in his experience the first payment was never made earlier than, say, three weeks. I consider that delay to the extent of three weeks in the first payment is too long. It is inexcusable as a general thing, and I would be very glad if any Deputy who has that experience would discuss the matter with the Commissioners. Very many Deputies complain from time to time that they are not allowed to see the deciding officer in connection with some old age pensioner. But here is a case where there is apparently a general claim that there is a delay in making these payments. Yet from one end of the year to the other I never hear a claim made along these lines, and I know of no cases in which systematic representations have been made by any Deputy in the nature of Deputy Ward's experience. No such case has been made to the Commissioners.
The Commissioners go very systematically into any individual complaints they get in the matter of delay. Their experience is that in a large number of cases the complaint is not justified. There have been either non-surrender of cards, arrears of payment, or non-notification of the illness inside the required period, and a number of other causes. The first payment ought to be made within about ten days or so. The first three days' sickness do not count. Where everything is right, and where the certification of the case is not challenged by the society, there ought to be a payment within ten or eleven days. I think the complaint as to the delay refers to the first payment. Once the validity of a claim has been established there is no delay in any subsequent payments. Systematically we get after all complaints of delay and we are prepared to continue to do so.
In the chronic cases societies insist on getting weekly certificates, but they also agree to accept monthly certificates. The general experience of societies is that where the case is really a chronic case they do agree with the suggestion of the Department to accept a monthly certificate. In the chronic cases, such as Deputy O'Dowd mentioned, of people being forced to go to the medical referee, I would say that the chronic cases are only forced to go to the medical referee when the society to which they belong require that they should do so. That, therefore, is not a matter for the Commissioners at all, but for the society. I take it the cases are very exceptional, and no ordinary society in anything like ordinary cases will insist upon chronic cases going to the medical referee weekly.
Deputy Allen had some difficulty about deposit contributors. He mentioned, I think, that deposit contributors were allowed to join societies of their own choosing inside a certain period after the passing of the 1929 National Health Act. Where they did not join such a society they were allocated to a society. That was done after the passing of the 1929 Act. On a payment of a fee of 2/- they could transfer from the society to which they have been allotted and join any society of their own choosing. The depositor contributor has been abolished as a class because of the reasons given when the 1929 Act was passed.
Deputy Sir James Craig raised the question as to why in certain cases hospital benefits were given by certain societies, but that hospital benefit has now been stopped. I said in my introductory remarks that a third valuation was now nearing completion, and, in fact, the report has been received in the majority of cases, but it has not been finally concluded. Where the report has been received the societies have been notified, and, according to the condition of their surplus, they have had to reduce their benefits. Deputy Morrissey spoke of a case of which he had experience in which there was increased cash benefits to the extent of 3/-, which, as the result of the condition of affairs disclosed in that society by the third valuation had to be reduced by 2/-. In the same way there are no doubt other societies which, as a result of the disclosure of the position of their surplus on the third valuation, have had to reduce their benefits. They have had to reduce their hospital benefits, because these were the only benefits available. It arises not on account of any change in policy on the part of the Commissioners or on the part of the societies, but it is simply due to the fact that the societies have to cut their cloth according to the measure to which they are forced to cut it.
So far as the general question of hospital benefits is concerned the Commission recommend non-cash benefits such as hospital benefits rather than increase the cash benefits above 15s. Deputy O'Kelly referred again to the position with regard to the Commissioners, and a number of Deputies touched on the question of unification or amalgamation. Arising out of the discussion on the 1929 Act, I was agreeable to do it within the limits of the Act as then framed to take statutory powers to enable amalgamation to be brought about in a voluntary way so as to reduce the number of societies in the country. I think the figure of twelve and the figure of five were mentioned. That is an indication of our desire to reduce the number of societies that there are at present. In the meantime no mushroom societies as Deputy Kennedy suggested have been allowed to grow up. No additional societies have been sanctioned since the original societies were brought into being under the 1911 and 1912 Acts. A considerable amount of reduction has taken place. No society has been dissolved within the last two years, but the position with regard to two societies is such that we are contemplating their dissolution.
Following the discussion that took place on the 1929 Act, a certain number of conversations took place between the Commission and representatives of approved societies. A certain number of alternative lines of action were brought to light. The Government, in the conflicting opinions and general circumstances that exist, have not been able to come to a conclusion to proceed with amalgamation, any more than we are at present able to proceed on the voluntary matter. If we see no prospect of bringing about amalgamation or unification in the near future we will have to codify our present National Health Insurance law and our regulations for the convenience of societies.
I have hesitated to dissolve the National Health Insurance itself when it would mean getting rid of the Commissioners while we were in a position of indecision with regard to what might be required to be done in the future. There is a statutory requirement that at least some of the Commissioners will remain as they are until we change the law. I do not see what kind of action we can take in the matter. The whole thing is involved in the changes that are likely to be brought about in the organisation of National Health Insurance in the near future. That is all we can say about it at the moment.
On the question of medical certification, I think a lot of what has been said has arisen out of a rather loose discussion of the position and of expressions of opinion from some of the doctor-Deputies as to their attitude with regard to certification. The difficulty, as far as we can estimate it, in the matter of certification is the hesitancy of doctors to put a person who has been in receipt of national health insurance benefit on the working list again by their certificates. An extra two or three days in the matter of the extension of a certificate materially affects the amount of benefits required to be paid. The weakness in medical certification is probably in that end of the position rather than in any other. Deputy Tubridy asked on what basis medical certification is paid. I think he knows how the amount available for certification is distributed. It is on the basis of dispensary districts. The amount of money available in any dispensary district is divided amongst the doctors in that dispensary district on the number of certificates that they have issued. If there is only one doctor in a dispensary district, then, of course, there is no question of the amount of money being based on the number of certificates issued by that doctor.
