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THE LANCET.

LONDON: SATURDAY, FEBRUARY 18, 1922.

The Cost of Health.

THE COST OF HEALTH.-MEDICAL MEN IN PARLIAMENT.

THE report of the Geddes Committee, as far as itdeals with the Ministry of Health and the medicalactivities in the country, will be read by all medicalmen with gratification. The Committee has singledout the Ministry of Health for commendation, definitelystating that both in policy and; where possible, inadministration, successful efforts to economise havebeen made. One such effort has been, of course, thereduction in the capitation fee for panel practice from11s. to 9s. 6d., and we may lay stress fairly here uponthe fact that the credit won for the Ministry of Healthhas been derived from a lowering of the remunerationof the mass of men who are responsible for the majorpart in maintaining the health of the country. Thismust not be lost sight of. No grounds, it may be, formassive economy in the expenditure of the Ministryof Health have been found to exist-and this fact

emerges from the actual figures-but what savingscan yet be made ought to be made in any directionother than at the cost of the general mass of medicalpractitioners. They should not be called upon, directlyor indirectly, to play any part in the future economyof expenditure until all other expedients have beentried. The last recommendation of the Geddes Com-mittee runs as follows :-" That in view of the whole circumstances, the

Estimates of the Ministrv of Health and NationalHealth Insurance Joint Committee for the year 1922--23should be reduced from £24,269,500 and £350,500respectively to .622,100,000 in all, and that anynecessary legislation be promoted to take effect notlater than the lst July, 1922. This reduction is apartfrom any savings which may accrue from the sale ofhouses."The fact that on an expenditure of nearly £25,000,000the sum of a little over £2,500,000 is estimated as theonly amount that can be saved by drastic reductionis a detailed proof of economic administration ; whilethe fact that the rank and file of the medical professionhave already come under the scale of reduction thoughtnecessary would suggest that further economies, whichmay have to be made, will leave the panel practitionerat least in his present financial situation.The Committee points to the extraordinary position

of financial prosperity revealed by the recent quin-quennial valuation of the approved societies, whosedisposable surplus will in due course be swelled byproportionately large grants from the State. Thereasons for the financial prosperity of these societies are i

analysed in the report, and the fact is set out that thesurpluses are largely due to the war. In illustrationthereof it is shown that, owing to the inclusion inthe health insurance scheme of members of all ages,a reserve value for each original member had to becreated, while war casualties removed the necessityfor much of this reserve, leaving the dependents andsurvivors of men, whose death actually improved thesocieties’ financial position, as a burden on the taxpayerin respect of pensions. Much of this has already beenpointed out in our columns from time to time, especiallyin connexion with the relations which should prevailbetween voluntary hospitals and the approved societies,whose debt to those institutions is incalculable. We

feel strongly, that a large part of any surplus in thehands of approved societies should ho used for themaintenance of voluntary hospitals, and in this wayeconomy would best be served ; but wo do not knowwhether ingenuity can suggest a method by which anorderly subsidy for the voluntary hospitals from theapproved societies will relieve the estimates for theMinistry of Health. Apparently the Governmentactuary has reported against any pooling of societies’surpluses. The small economy which is recommendedin connexion with panel practice is a reduction from£100,000 to £85,000 in respect of the payment ofwhole-time and part-time medical referee consult-a,nts. The report characterises these as to some extenta luxury and suggests a reversion to the plan bywhich societies employed their own referees. Thereare no part-time consultants, and the whole-timeofficers act not only as referees for the societies, butas the only intermediaries between the Ministry andits General Practitioner Service. The creation of theseposts was subjected at the time to criticism much ofwhich was based on misapprehension. The properand prompt dealing with appeals by approvedsocieties against recommendations by panel doctorsis very necessary, and we doubt whether the GeddesCommittee was really cognisant of the large range ofdelicate duties which these officers, if they recognisetheir own position and if it is recognised by theauthorities concerned, are able to perform. If theirservices cannot be saved otherwise, more of the costmight be borne by the societies who stand to gainthereby.A careful study of the report must lead the unpre-

judiced observer to the conclusion that the main reasonfor much of the criticism that has been levelled at theMinistry of Health since its formation in 1919 has beendue to the fact that upon the first Minister was imposedthe unwieldy burden of carrying out a system of Statehousing. Housing is the largest item in the Ministryof Health vote, and is estimated to entail a cost tothe taxpayer of £10,000,000 a year for the next 60years. Any criticisms of the Ministry in the futureshould be based on the understanding that £10,000,000a year of the health vote will be spent on fulfillingexisting commitments for housing. Only £3,000,000represents the actual cost at the present time to thetaxpayer of the public health services, apart frominsurance practice and administration. And even acommittee of railroad and steamship managers hasdeclined to reduce the pace of the public health engineby supplying it with less fuel than this.

" We havehad submitted to us," says the report of the GeddesCommittee, " a very complete account of the adminis-trative system of the Ministry, and are satisfied thatvigorous steps have been taken to reduce expenditureon staff." The sentence is an apt answer to criticswho have reproached the Ministry for expenditureactually necessitated by that truest economy, theprevention of disease.

Medical Men in Parliament.THE opening of what is generally believed to be the

final session of the present Parliament suggests a

consideration of the nature and function of medicalrepresentation in the legislature, and an inquiry howfar this representation has met the needs of medicineand the public health of which medicine is the chiefcustodian. Since its foundation the Federation ofMedical and Allied Societies has taken a specialinterest in the relations of Parliament and medicine ; "in a recent issue of Health, the official organ of theFederation, and now a substantial monthly magazine.