1'''i -'?'%■ inftARY copy / '; RATIONAL JFtEAX^THL-TArguRANCE. Cornell University Library HD7102.G72A5 1915 National health insurance. Handbook fo^ 3 1924 002 405 466 HAFDBOOK FOR THE USE OF INSURANCE COMMITTEES IN SCOTLAND. (l.s( Octuher 1915.) Zi) t'j2H HP 1315 EDINBURGH: PRINTED UNDER THE AUTHORITY OF HIS MAJESTY'S STATIONERY OFFICE By MORRISON & GIBB, LIMITED, Tanfmlb. To be purchased, either directly or through any Bookseller, from H.M. STATIONERY OFFICE (Scottish Branch), 23 Forth Street, Edinbuegh ; or WYMAN & SONS, LIMITED, 29 Bbeam.s Buildings, Fetter Lane, London, E.G., and 54 St. Mary Street, Cardiff; E. PONSONBY, LIMITED, 116 Grafton Street, Ddblin ; or from the Agencies in the British Colonies and Dependencies, the United States of America, and other Foreign Countries, of T. FISHER UNWIN, London, W.C. 1915. Price One Shilling. THE LIBRARY OF THE NEW YORK STATE SCHOOL OF INDUSTRIAL AND LABOR RELATIONS AT CORNELL UNIVERSITY NATIONAL HEALTH INSURANCE. HAJrDBOOK FOR THE USE OF INSURANCE COMMITTEES IN SCOTLAND. (Is;; October 1915.) EDINBURGH: PRINTED UNDER THE AUTHORITY OF HIS MAJESTY'S STATIONERY OFFICE By MORRISON & GIBB, LIMITED, Tanfibld. To be purchased, either directly or through any Bookseller, from H.M. STATIONERY OFFICE (Scottish Branch), 23 FoKTH Steeet, Edinbtjkgh ; or "WYMAN & SONS, LIMITED, 29 Bekams Buildings, Fettbb Lane, London, E.G., and 54 St. Makt Street, Cardiff ; or E. PONSONBY, LIMITED, 116 Grafton Street, Dublin; or from the Agencies in the British Colonies and Dependencies, the United States of America, and other Foreign Countries, of T. FISHER UN WIN, London, W.C. 1915. Price One SMllingt CONTEI^TS. Introdtjction — Genekal Scheme op Administration of THE National Insurance Acts . . . v Central Authorities. Local Administration. Special Committees. Chapter I. — Constitdtion, Procedure, Powers and Duties OF Insurance Committees . , . . ' . 1 Constitution :^ Introductory ; Insurance Committee Areas ; Composi- tion of Insurance Committees ; Representatives of In- sured Persons, County and Town Councils, Medical Practitioners, and the Commissioners ; Combination of Committees. Procedure : — Standing Orders ; Offices. Powers and Duties : — Administration of Benefits ; Miscellaneous, Chapter II.— -Constitution, Procedure, Powers and Duties OP Sub-Committees op Insurance Committees . . 25 Sub-Committees : — Medical Service Sub-Committee ; Pharmaceutical Service Sub-Committee ; Joint Services Sub-Committee ; General. District Insurance Committees. Chapter III. — ^Looal Medical Committees, Panel Com- mittees, -A^ND Pharmaceutical Committees 35 Chapter IV. — ^Medical Benefit . . . 45 General ; Arrangements with Practitioners and Institu- tions ; Arrangements with Chemists and Pharmacists ; Register ; Arrangements in reference to Insured Persons ; Complaints. Chapter V. — Sanatorium Benefit . . . .83 Arrangements with persons and Local Authorities, including arrangements with Medical Practitioners : — General ; Institutional Treatment ; Dispensary Treat- ment ; Domiciliary Treatment. Expenses of Sanatorium Benefit and miscellaneous adminis- trative questions : — Financial basis ; Recommendation for Sanatorium Benefit ; Expenses of Conveyance. Extension of Sanatorium Benefit to Dependants. vi.aTS •Chapter VI. — ^Deposit Contributors . . . . 102 Contributions ; Kefunds ; Rules ; Medical and Sana- torium Benefits ; Sickness and Disablement Benefits ; Maternity Benefit ; Administrative Procedure. ■Chapter VII. — Finance and AocountinS of Insdhakce Com- mittees ........ 128 Medical Benefit Income ; — General Medical Benefit Fund ; Medical Benefit Fund Account ; Central Medical Benefit Fund ; Special Income. Sanatorium Benefit Income : — General Sanatorium Benefit Fund ; Central Sanatorium Benefit Fund. Administration Income. General Purposes Income. Transfer between Funds. Expenditure and Accounting : — General ; General Cash Book ; Ledger Accounts ; Cur- rent Account with the Commissioners ; Medical Benefit Fund ; Panel Service Fund ; Practitioners Fund ; Drug Fund ; Institutions Fund ; Special Arrange- ments Fund ; Temporary Residents Fund ; Special Transactions ; Sanatorium Benefit Fund ; Admini- stration Fund ; Deposit Contributors Benefits Ac- count ; General Purposes Fund ; Alternative Forms of Accounts ; Bank Account. •Chapter VIII.— General . . . . . 156 Administration. Contracts. Appendix I. . . List of Acts and Principal Regula- tions AND Orders . . . 157 Appendix II. (A.) . Constitution of Insurance Committees . 159 (B.) . Electoral Divisions and Votes for Ap- pointment of Drug Accounts Com- mittee ..... 160 Appendix III. . Model Rules for Administration of Medical Benefit . . . 161 Appendix IV. , List of Local Medical Committees Re- cognised BY the Commissioners . 165 Appendix V. . . List of Panel Committees with Member- ship, Quorum, and tJECRjiTARiES ; . 165 Appendix VI. . List op Pharmaceutical Committees WITH Membership, Quorum, and Secre- taries . . . . . 167 Appendix VII. . Agreement between Medical Practi- tioner AND Insurancf Committee . . 169 Appendix VIII. . Procedure in Inqijiries as to Range of Medical Service ' . . . . 173 Appendix IX. . Medical Record Card . ', . . 175 M & G Ltd Wt 4B05/358 10-15 4000 G. 3 Appendix X. . Appendix XI. Appendix XII. Appendix XIII. Appendix XIV. Appendix XV. Appendix XVI. Appendix XVII. Appendix XVIII. Appendix XIX. Appendix XX. Appendix XXI. Appendix XXII. Appendix XXIII, Appendix XXIV. Appendix XXV. Index , Memoeandom dealing with New System OF Medical Certification of In- capacity OF Insured Persons for Work (Memorandum 211 I.C.) . InsuiSIncb Committee Areas foe which THE Post Office '.Medical System has BBE-N Approved under Section 15 (4) OF THE 1911 Act .... Agreement between Person undertak- ing TO Supply Deugs and Appliances AND Insurance Committee Medical Card .... , List op Sanatoria in Scotland ap- proved BY THE Local Government Board for Scotland for the Institu- tional Treatment of Tuberculosis under the national insurance acts Model Scheme op Arrangements for THE Domiciliary Treatment op Tubee- cuLosis, WITH Relative Circular Letter of the Chancellor op the Exchequer to Mr. Henry Hobhouse regarding financial arrangements for defraying the cost op schemes FOE TeEATMBNT of TUBERCULOSIS Model Rules for Deposit Contribu- tors ..... Diagram illusteating the System op Medical Benefit Finance . opposite Scheme for the Distribution of the Parliamentary Grant in Aid of Mileage in sparsely populated Dis- tricts in Scotland, exclusive of the Highlands and Islands, for the Year 1914 .... Commissioners and Officials (A) Insurance Committees in Scotland, WITH Names and Addresses of Clerks AND ' Telephone Numbers ; (B) Ad- dresses op Insurance Committees in England, Ireland, and Wales Reference Ciphfrs op Insurance Com- mittees (United Kingdom) Fair Wages Clause in Contracts Insurance Committees Contracting with Members (Circular No. 427) Admission op Press to Meetings op Insurance Committees (Circular No. 382) . . . . 177 195 195 200 204 209 216 217 220 221 224 231 233 235 236 237 mTROD.UCTIOl^. This Handbook is intended primarily for the assistance of members of Insurance Committees, and does not profess to be an exhaustive or technical exposition of the powers and duties of the Committee. Detailed information and authority for administrative purposes should be obtained from the National Insurance Acts, 1911-1915, and the Regulations and Orders made in pursuance thereof. A list of the Acts and the principal Regulations and Orders forms Appendix I. hereto. The general scheme of administration of the National Insurance Acts in Scotland in so far as relating to National Health Insur- ance is briefly summarised in this introduction in order thai; the position of Insurance Committees which is dealt with in detail in the subsequent chapters of the Handbook may be seen in true perspective. Unemployment insurance which is administered through the Board of Trade and the Labour Exchanges controlled by that Department is not dealt ^vith. The following is the general scheme of administration of National Health Insurance ; — I. Central Authorities. 1. The Treasury — (a) Appointment of Commissioners and Joint Committee. (6) Appointment and direction of Auditors of Insurance Com- mittee and Approved Society transactions. (c) Appointment of Valuers of Approved Societies. {d) Approval of Stafi of Commissioners. (e) Control of Payment of State contributions to cost of benefits and administration thereof and control of Special State grants in aid of benefits and administra- tion thereof. (/) Consent to Orders under Sec. 78 of 1911 Act to remove difficulties, and Special Orders to bring classes of persons within scope of the Act (Sec. 1 (2) of 1911 Act). {g) Making of Regulations — (1) defining duties of Joint Committee (Sec. 83). (2) prescribing conditions for investment by the National Debt Commissioners of sums in the several funds available for investment (Sec. 54 (3) of 1911 Act). VI {h) Consent to Regulations under Sec. 56 (1) of 1911 Act as to transactions between Commissioners and Approved Societies. 2. Joint Committee — (a) Financial, adjustments between funds of the several; countries. (b) Preparation of schemes for the administration of Govern- ment Grants and their apportionment between the several countries. (c) Making of Regulations common to the several countries. (d) Making of Special Orders. (e) .Approval of International Approved Societies. The Chairman of the Joint Committee is the Minister re- sponsible to Parliament in matters relating to National Health Insurance. 3. Commissioners— (a) Carrying the Act into efEect in Scotland (Sec. 80 (1)). (6) Making of Regulations, Orders, and Special Orders. (c) Management of the Scottish National Health Insurance- Fund. , (d) Supervision of payment of contributions. (e) Approval of rules of Approved Societies and powers of control of mismanagement. (/) Co-ordination of financial relations between Approved Societies and Insurance Committees, and distribution of Special State Grants. {g} Approval of office arrangements and staffing of Insurance Committees. (h) Determination of questions of Kabihty to insurance- or right to become a voluntary contributor subject to appeal to the Sherifi and Court of Session. (i) Determination without right of appeal of questions of rate of contribution. (j) Determination of disputes between an insured person and an Approved Society or Insurance Committee, or between two Societies or two Committees, or a Society and a Committee, or a Committee and a panel practi- tioner or chemist. (h) Determination of questions arising in regard to transfer from one Approved Society to another. 4. Local Government Board for Scotland — (a) Administration of capital grant for Sanatoria (Sec. 64 (1) of 1911 Act). (6) Assisting the co-operation of local authorities for the- provision of Sanatoria, etc. (Sec. 64 (3) of 1911 Act), (c) Approval of sanatoria and institutions for treatment under Sanatorium Benefit. vn {d) Approval of manner of treatment under Sanatorium Benefit otlierwise than in an approved institution, (e) Determination of what diseases are to be treated under Sanatorium Benefit (with approval of Treasury) (Sec. 8 (1) (6) of 1911 Act). (/) Consultation with Commissioners as to form of reports by Insurance Committees on the health of insured persons. The Board also administer the Special Maintenance Grant voted in terms of the Hobhouse * letter for the rehef of Local Authorities who are treating tuberculosis under a general scheme approved by the Board. 5. Other Authorities to whom certain duties are entrusted are — (1) Secretary for Scotland (Sees. 63 (6), 80 (3), and 80 (4) of 1911 Act). (2) Registrar of Friendly Societies (Sees. 72 and 75 of 1911 Acb). ■ (3) Comptroller and Auditor-General — audit under direction of Treasury of Scottish National Health Insurance Fund. (4) Board of Trade — ^formation of Seamen's National Insurance Society (Sec. 48 of 1911 Act). (5) Commissioners of Inland Revenue — ^preparation and issue of stamps and regulations appljdng provisions of Stamp Duties Management Acts. (6) Post Ofiice — sale of stamps and issue of forms. (7) Admiralty and Army Council — administration by arrangement with Approved Society of Maternity Benefit of sailors and soldiers and of Navy and Army Fund benefits (Sec. 46 (2) (iii.) and (3) (/) of 1911 Act). (8) The Highlands and Islands (Medical Service) Board — improvement of medical service, including nursing in Highlands and Islands (Highlands and Islands (Medical Service) Grant Act, 1913). II. Local Administration. 1. Approved Societies — , (a) Maternity Benefit for all members. (6) Sickness and Disablement and additional benefits (except those of nature of Medical Benefit), for all members who are not members of the MiKtary or Naval Forces of the Crown. 2. Insurance Committees — (a) Sickness, Disablement, and Maternity Benefit for all Deposit Contributors. * See paragraphs 345 and 347. VUl (b) Medical and Sanatorium Benefit for all insured persons resident in the area of the Committee except — (1) Members of Military and Naval Forces of the Crown. (2) Members of the Seamen's National Insurance Society. 3. Seamen's National Insurance Society— All benefits of members, but may arrange for Medical or Sanatorium Benefit through Insurance Committees. 4. Navy and Army Insurance Fund — (a) Maternity Benefit of all soldiers and sailors who are not members of an Approved Society, administered by the Admiralty and Army Council either directly or through Insurance Committees. (6) All benefits of discharged sailors and soldiers whose state of health precludes admission to an Approved Society. All persons entitled to benefits out of the fund are deemed to reside in England, and the fund is managed by the National Health Insurance Commission (England). III. Special Committees. 1 . Advisory and Joint Advisory Committees — Consulted by the Commissioners and Joint Committee in con- nection with the making and altering of Regulations (Sec. 58 of 1911 Act). H. Local Medical Committee — Consulted by Insuraiice Committee on all general questions afiecting the administration of Medical Benefit (Sec. 62 of 1911 Act). 3. Pand Committee — Medium of conveyance to the Insurance Committee of the opinions and wishes of panel practitioners in its area (Sec. 32 of 1913 Act). 4. Pharmaceutical Committee — Consulted by Insurance Committee on all general questions affecting the supply of drugs, medicines, and ap- pliances to insured persons in the area (Sec. 33 (1) of 1913 Act). 3. Association of Insurance Committees in Scotland — (Sec. 31 (3) of 1913 Act.) CHAPTER I. CONSTITUTION, PROCEDURE, POWERS AND DUTIES OF INSURANCE COMMITTEES. SECTION (I.)— CONSTITUTION. (i.) Introductory. (1) The local administration of the National Insurance Acts is entrusted, witt certain exceptions, to bodies called " Insurance Committees," whicli are established for the purpose under Section 59 of the National Insurance Act, 1911, and to the Societies approved under the Acts, subject in both cases to the central -control in matters so provided in the Acts of the National Health Insurance Commission (Scotland) and the National Health Insurance Joint Committee. (2) Insurance Committees are bodies corporate with perpetual succession and a common seal. They have power to sue and be sued and to acquire and hold land for the purposes of the Act (subject in every case to the consent of the Commissioners) (Sec. SOjoi the 1913 Act). (ii.) Insurance Committee Areas. (3) Section 59 of the Act of 1911 as applied to Scotland by Section 80, requires that an Insurance Committee shall be set up for — (1) every county, excepting (a) Clackmannan and Kinross, and (b) Elgin and Nairn, in which two instances the counties are to be regarded as a single county ; and (2) every burgh containing a population of 20,000 or upwards, according to the census of 1911, including the burghs of Dumfries and MaxweUtown, which are to be regarded as a single burgh. All burghs other than those falling under (6) are included in the appropriate counties, and in those cases where they were not represented on the County Councils they have been given such representation for the purposes of the Act, under an order issued bv the Secretary for Scotland on 25th May 1912 (Sec. 80 <4) of 19"ll Act). (iii.) Number or Members of Insurance Committees. (4) The number of members of each of the 56 Insurance- Committees in Scotland has been determined by the Scottish Insurance Commissioners, subject to the following limits laid down by the Act of 1911, viz. the minimum is 25 where the population within the area of the Committee is less than 40,000 and 40 where the population is 40,000 and upwards, and the maximum is 80. Where a Committee contains less than forty members, its composition may be varied by the Commissioners, but no alteration may be made in the proportion of the members appointed by insured persons and by a County or Town Council, or in the number of members possessing a medical quaHfication (Sections 59 (2) and 80 (6) of 1911 Act). The membership of no Committee was fixed as low as 25, owing to the fact that with a Committee of that size it would not be possible for the Commissioners to include among the persons appointed by them two women as required by the Statute. (5) In determining the number of members of the respective Committees, the Commissioners in general adopted population as the basis ; but in the case of counties other circumstances were given weight, such as the density of the population, the means of communication, and the geographical con- ditions of the county generally. A proportionately higher membership was therefore allowed in counties containing a widely scattered population than in counties where the area is smaller, the population more compact, and the difficulty of securing attendance at meetings less. (6) The number of members determined for each Committee is given in Appendix II. (A). (iv.) Composition of Insurance Committees. (7) The coriiposition of Insurance Committees consisting of forty members or more, is as follows : — (a) Three-fifths of the members represent insured persons resident in the county or burgh who are members of Approved Societies and who are Deposit Contributors, in proportion as nearly as may be to their respective numbers. (b) One-fifth are appointed by the Council of the county or burgh. (c) Two members are elected, either by an Association of duly qualified medical practitioners resident in the county or burgh which has been formed for that purpose, or, if no such Association has been formed^ by such practitioners. (d) One, two, or three (according to the size of the Com- mittee) medical practitioners are appointed by the Council of the county or burgh. (e) The remaining members are appointed by the Commis- sioners. (Sec. 59 (2), Act of 1911.) (8) The exact composition of each Insurance Committee in Scotland can be seen from the Table in Appendix II. (A). (v.) Ebpeesentativbs of Insured Peesons. (9) The representatives of insured persons on Insurance Committees are appointed or elected under regulations made in pursuance of Section 59 (2) (a) and proviso (i.) of the Act of 1911 (Appointment of Representatives of Insured Persons on Insurance Committees Regulations (Scotland), 1913, and Amendment Regulations, 1914 and 1914 (No. 2)). The representation is apportioned between Deposit Contributors and Approved Society members in proportion to their respective numbers resident in the area. The basis of the scheme of apportionment between Approved Societies is to give each Society a right — itself to appoint or to vote with other Societies-;— measured by its membership in the area. The carrying out of the election is entrusted by the regulations to the Clerk to the Committee. (10) The Clerk to the Committee must appoint in writing some fit person to be his deputy The deputy so appointed may exercise any powers and do anything which the Clerk is authorised or required to exercise or to do under the Regulations. If the Clerk is unable to act and no deputy appointed by him is available the Commissioners may appoint one (No. 32 of 1913 Regulations). Count of Insured Persons. (11) Triennially, in 1916, 1919, and so on, on a date in February specified in the Regulations, the Clerk ascertains by counting the index sUps in his index register — (a) The number of Deposit Contributors resident in the area ; (6) The number of members resident in the area of each Approved Society which has members so resident ; and (c) The total number of insured persons resident in the area, i.e. (a) plus the total of (6). (Nos. 5, 7, and 9 of 1913 Regulations.) Electoral Unit. (12) Having ascertained the number of insured persons within the area of the Committee, the Clerk proceeds to determine an electoral unit figure. This is arrived at by dividing the total number of insured persons resident in the Committee's area by the total number (three-fifths of the Committee's total member- ship) of representatives of insured persons on the Committee. Any fraction is disregarded (No. 6 of 1913 Regulations). Deposit Contributors' Representatives. (13) The number of representatives to be allocated to Deposit Contributors is the figure ascertained by dividing the total number of Deposit Contributors resident in the area of the Committee by the unit figure. A fraction of one-half or more than one-half of the unit figure is regarded as equivalent to the unit figure. A fraction of less than one-half is disregarded. Where the total number of Deposit Contributors is less than the unit figure one representative is allowed (No. 7 of 1913 Regulations). Approved Societies'' Representatives. (14) The number of representatives allocated to Approved Societies is the total number of representatives of insured persons less the number allocated to Deposit Contributors. The repre- sentatives of members of Societies are divided into two classes, viz. : — (a) Representatives to be appointed direct by individual Societies whose membership within the area equals or exceeds the unit figure — called for convenience " A " Societies ; and (b) Representatives to be elected jointly by Societies whose membership in the area is less than the unit figure —called " B " Societies. (Nos. 8 and 9 of 1913 Regulations.) (15) The number of representatives allocated to "B " Societies is the figure ascertained by dividing the total number of members, resident in the Committee's area, of all " B " Societies having members resident in such area, by the unit figure. A fraction of less than one-half of the unit figure is disregarded, and a fraction of one-half or more than one-half is regarded as equivalent to the unit figure. If in any case the total number of members of " B " Societies resident in the Committee's area is less than the unit figure, one representative is allowed (No. 10 of 1913 Regulations). (16) The number of representatives of " A " Societies is the difference between the total number of representatives allotted to Approved Societies and the number allotted to " B " So- cieties. (17) The number of representatives allocated to each " A " Society is the figure ascertained by dividing the number of members of the Society resident in the Committee's area by the unit figure, any fraction being disregarded. (18) The allocation is commenced with the "A" Society which has the largest number of members resident in the Com- mittee's area. The Clerk then proceeds to allocate the appropriate number of representatives to the Society having the next largest number of members resident in the Committee's area, and so on. (19) If, as may happen owing to the ignoring of fractions, any representatives remain unallocated, one of these is assigned to the Society in the case of which the largest fraction was dis- regarded, the next to the Society in the case of which the nelct largest fraction was disregarded, and so on until the allocatiori is completed. (20) It may happen, as a consequence of Deposit Contributors and "B" Societies ■ being each entitled as a minimum to one representative, that the quota of representatives allotted to " A " Societies is not sufficient to complete the allocation among the. Societies in the manner above described. In such circum- stances, if the preliminary allocation has resulted in an " A " Society having more than one representative, a readjustment will require to be made, and one of its representatives will be given to * the " A " Society which the preliminary allocation may have left unprovided for. If there are more " A " Societies than one having two or more representatives, the necessary readjustment is made by taking one representative from that Society in the case of which the smallest fraction was disregarded (paragraph (17)). If there is no " A " Society having more than one repre- sentative, the matter requires to be reported to the Commis- sioners, who have power to direct that a representative shall be taken from the " B " Societies, or that the allocation shall be completed in such other manner as they may think right (Nos. II and 12 of 1913 Regulations). Return of Allocation of Representatives of Insured Persons. (21) The Clerk must, before a date in April specified in the Regulations, complete the allocation of the representatives of insured persons in the manner described above, and furnish the Commissioners with a copy of a return in a form prescribed in the First Schedule to the Regulations, showing how the repre- sentatives have been allocated. (22) The Commissioners have power to direct the Clerk to make alterations on the return. This power enables the Commis- sioners to verify the return in matters as to which a Society may not have the necessary information. (23) On receiving the copy of the return back from the Com- missioners, the Clerk must forthwith pubhsh an intimation of it in a newspaper or newspapers circulating in the Committee's area, and must send a copy of the return to each Society whose: name appears therein, and to the Association of Deposit Contri- butors, or where there is no such Association, to each repre- sentative of Deposit Contributors on the existing Committee. He must also display a copy of the return at his office for seven days for inspection by all persons concerned. (24) If within seven days from the date or last date of the newspaper advertisement, the accuracy of the return is not challenged in writing by any authorised person or body, the ret am is to be treated as final and conclusive. Provision is made for th^ 6 determination of objections by the Committee within seven days, subject to appeal to the Commissioners, and for the return becoming final and conclusive ten days after the Committee's decision, or, if any appeal has been lodged with the Commissioners, when the objection is finally disposed of and the decision intimated (Nob. 14-17 of 1913 Eegulations). Notices. (25) Within three days from the date on which the return becomes final and conclusive, the Clerk must — (1) Send by registered letter a notice (a) to the Association of Deposit Contributors (if any), and (6) to each " A " Society, stating, inter alia, the number of representatives to be appointed by them, and calling upon them to make the appointments and intimate the names of the persons appointed within twenty- eight days from the date on which the return became final and conclusive ; (2) Send by registered letter in a prescribed form a notice to each " B " Society stating, inter alia, the number of representatives to be appointed by the group of " B " Societies, and calling upon the Committee of Manage- ment of each Society to appoint a delegate to attend a joint meeting at which the election of the representa- tives of the " B " Societies is to be carried through (Nos. 18, 20, and 22 of 1913 Regulations). Appointment of Deposit Contributors^ Representatives. (26) If a recognised Association of Deposit Contributors «xists, the representatives of Deposit Contributors are to be «lected by vote of the members taken in accordance with the Association's Rules, and the names must be intimated to the €lerk by registered post within the 28 days referred to in the preceding paragraph. Regulations under which Associations of Deposit Contributors may be established were made on 11th April 1913 (Associations of Deposit Contributors Regulations ^Scotland), 1913), but no Association has been formed there- under. Where no such Association exists, the representatives of Deposit Contributors are to be appointed by vote of the Insurance Committee within the time mentioned (No. 19 of 1913 Regulations). Appointment of " A " Societies' Representatives. (27) The representatives of " A " Societies are appointed by the Committees of Management of the Societies concerned, and it is contemplated that those Committees in making the appoint- TOcnts will wherever possible be guided with regard to the persons to be appointed by the advice of the branches operating in tlie area. The names of the representatives so appointed must be intimated to the Clerk by registered post within the 28 . days already referred to in paragraph (25) (No. 23 of 1913 Regu- lations). Apfointment of " B" Societies' Re-presentatives. ' (28) Within 14 days from the date on which the return be- •comes final and conclusive, the Committee of Management of •each " B " Society is required to appoint a delegate, and intimate his name and address to the Clerk by registered post. The names and addresses of two other persons should also be inti- mated in order that one or other of therd may take the place of the appointed delegate at the joint meeting in the event of the 'latter's being unable to attend. Notice of the date and place of the meeting is sent by the Clerk to the appointed delegate only. If unable to attend, he should hand the notice to one of the persons nominated as substitutes. (29) Within 17 days from the date on which the return be- comes final and conclusive, the Clark must fix a date and place ior the joint meeting, and intimate the same to the appointed delegates by registered post, giving them not less than 7 days' notice of the meeting. Unless with the consent of the Commis- sioners the place of mj^ting must not be outside the area of the Oomnaittee. (30) The Clerk acts as Returning Officer at the meeting. He must call to the chair the delegate in attendance from that " B " Society which has the largest number of members resident in the Committee's area, and in the event of such delegate refusing to act or leaving the meeting prior to the business being com- pleted, the delegate of the next largest Society, and so on in succession. If two or more Societies have an equal number of ' members so resident, the order in which the delegates shall have the right to be called to the chair is determined by lot by the Clerk. The Chairman so appointed must thereupon ask the delegates to nominate and elect the required number of repre- sentatives on the Committee. Power is given him to decide finally all points of order. (31) The election is made by vote of the delegates in attendance. Each delegate has a number of votes equal to the required number of representatives of the " B " Societies on the Coin- mittee. (32) If more persons are proposed and seconded for member- ship than the required number of representatives, the Clerk must call the roll of delegates. Each delegate in attendance as shown by the roll-call (including the Chairman), must then write down the names of the persons so proposed and seconded for whom he votes. He must use all his votes, and give not more than one vote to each person, otherwise his voting paper will be regarded as spoiled. (33) The Clerk counts the votes so recorded, and declares to 8 be elected the required number of representatives having the largest number of votes. (34) If the voting is inconclusive, owing to equality of votes, the meeting decides bv show of hands which of the persons having an equality of votes are to be regarded as elected. The . Chairman determines the order in which the persons having an equality of votes are to be set against each other. He has both a casting and a deliberative vote. In accordance with the result of the voting so taken, the Clerk declares the required number of representatives to have been elected. (35) In the event of any delegate being dissatisfied with the elections made as above provided, he may move that they be set aside, and that a " card " vote be taken. If at least one- third of the delegates in attendance support the motion, the elections are set aside, and the votes of each delegate as previ- ously recorded are, subject to the provision set forth in the next paragraph, thereupon multiplied in each case by the number of members, resident in the Committee's area, of the Society he represents. The Clerk counts the votes resulting from the multipHcation, and declares to be elected the required number of representatives having majorities. If the voting is incon- clusive, as a result of equahty of votes, the procedure detailed in the preceding paragraph is carried out, and the Clerk declares the required number of representatives elected accordingly. (36) If the number of delegates present and voting exceeds twenty, and the multiplication of the votes would involve an unduly long sitting, the Clerk need not proceed with it at the meeting. He must, however, complete it as soon as possible. If an equality of votes renderiug the election inconclusive is disclosed, he must call upon the Chairman of the meeting (or, if there were successive Chairmen, the Chairman who presided last) to exercise a casting vote or votes. As soon as the result ' of the voting is ascertained, the Clerk must intimate it by post to each delegate, stating the names of all persons proposed and seconded, the number of votes recorded for each, and the names of the persons declared by him to have been duly elected (No. 21 of 1913 Eegulations). Intimation to Commission of Names, etc., of Representatives. (37) Within seven days after the expiry of the time within which the representatives of insured persons are required to be appointed or elected, the Clerk must send to the Commissioners a list containing the names and addresses of all such repre- sentatives, and he is also required to display a copy of the list at his office for a period of seven days for inspection hf all concerned (No. 24 of 1913 Regulations). Double Membership. (38) Membership of more than one Insurance Committee at the same time is prohibited, except in special circumstances arid with, the consent of the Commissioners. Any representative of insured persons appointed to more than one Committee con- currently, who does not obtain the consent of the Commissioners, is to continue a member only of the Committee to which he was first appointed. Provision is made for filling vacancies so created (No. 25 of 1913 Eegulations). Defmik. (39) In the event of any default taking place in the election or appointment of representatives of insured persons, the Commissioners may at any time thereafter order that the default be made good by election or appointment in such manner as they may direct. In giving directions for making good any default, the Commissioners will follow as nearly as seems ex- pedient the lines of procedure laid down for ordinary appoint- ments. If the default is not made good by a date in the month of June specified in the Eegulations, the appointmeiit of representatives to supply the default is to be forthwith made by the Commissioners in such manner as they may think proper (No. 26 of 1913 Regulations). • Term of Office. (40) Representatives of insured persons on Insurance Com- mittees hold office for three years. Retiring members are eligible for re-appointment or re-election. - A member appointed to fill a casual vacancy holds office only for the unexpired portion of the three years' period (No. 27 of 1913 Eegulations and No. 2 of Amending Regulations). Disqualification. (41) The choice of representatives of insured persons is not restricted to persons possessing any particular quaUfication, and persons are accordingly eligible who are not themselves insured under the Act or who are not members of the Society appointing them. Where, however, a representative of iiisured persons who, at the date of becoming such, was a member or an official of the " A " Society appointing him or of one of the " B " Societies participating in his election, ceases to be a member or official, as the case may be, of such Society, his tenure of office as a member of the Committee is, if the Society so decides, terminable ten days thereafter, or at such later time as may be fixed by the Society. The Secretary of the Society is to intimate any decision to this efiect to the Clerk by registered post. The Clerk must thereupon send notice of the Society's intimation to the member in question, and must also notify the Commissioners that a vacancy will arise ten days after the date of his receipt of the Society's intimation, or at any later 10 date that the Society may have specified. Forms for giving the intimation and notices are prescribed. The member in question may appeal to the Commissioners against the termination of his tenure of office, and the decision of the Commissioners on his appeal is final. If the member was elected to represent a groap of " B " Societies and has transferred from one Society to another in the group, the Commissioners are required to take this fact into con- sideration in deaUng with the appeal. Pending the decision of the appeal, the member is to continue to hold office if the Commissioners so determine (No. 28 of 1913 Regulations). (42) Six consecutive months' absence from meetings without leave of the Committee involves unconditional disquahfication of a representative of insured persons unless the cause of absence is the member's employment in the naval or military forces during the present war. The six months are counted from the date of the first meeting which the representative failed to attend, and at the end of the period he ceases to be a member of the Committee. " Meeting " is to include meetings of any Sub-Committee of the Insurance Committee as well as meetings of that Committee or any of its Sub-Committees in conference with persons not members of the Committee (No. 2 of Amend- ing Regulations and No. 3 of National Health Insurance (Appointment of Representatives of Insured Persons on Insurance Committees) Amendment Regulations (Scotland), 1914 (No. 2)). VcLcancies. : (43) If a representative of insured persons loses his seat on the Committee (paragraphs 41 and 42), dies, or demits office, the Clerk is to call upon the appropriate body to appoint another representative in his room. Where the vacancy is among the representatives of " B " Societies, the remaining representatives of " B " Societies on the Insurance Committee elect a member of the Committee in place of the former member. The election takes place at a meeting to be .convened by the Clerk to the Committee as soon :as possible after the occurrence of the vacancy. Such meeting must be held within 28 days of the date of the notice summoning it. The place of meeting is determined by the Clerk. The Chairman of the Insurance Committee, or faiUng him, another member of the Committee (not being a representative of insured persons)' to be nominated by him presides at the meeting, and has a casting but not a dehberative vote. Two representatives of the " B " Societies, in addition to the Chairman or other member of the Committee presiding, form a quorum. The nominations are made and the voting conducted in such manner as the meeting may determine. In the event of there being less than two remaining representatives of " B " Societies on the Committee, the pro- 11 •cedure outlined above does not apply. In such circumstances the Commissioners themselves, after such consultation with the " B !' Societies as seems proper to them in the circumstances, appoint a member in place of the former member. If any default in filhng a vacancy takes place, the Com- missioners forthwith fill the vacancy in such manner as they think proper. A member appointed to fill a vacancy retires with the other representatives of insured persons at the end of their three years' term of office (No. 2 of Amending Regulations, 1914). (44) The fact that vacancies may exist among the representa- tives of insured persons does not invalidate the proceedings of the Committee. The remaining representatives are treated as duly representing insured persons until the vacancies are £lled (No. 30 of 1913 Regulations). Technical Errors. (45) Unless the Commissioners so determine, no election held or appointment made under the Regulations is to be in- validated in consequence of any neglect to give proper notice ■or to make prdper advertisement, or of any other technical •defect in the proceedings which has not been prejudicial, in the opinion of the Commissioners, to the interests of any party concerned (No. 34 of 1913 Regulations). Refresentation of Women. (46) In order to secure an adequate number of women repre- sentatives of insured persons, the Commissioners have strongly recommended that where a Society contains both men and women members, or where there is comparatively a consider- iable number of women Deposit Contributors, the question of the appointment of women representatives or, as the case may be, of instructing delegates to vote for women representatives, should be considered by the body electing or appointing the representatives or delegates (Memo. No. 313 I.C). (vi.) Rbpeesentatives of County and Town Councils. (47) The number of duly qualified medical practitioners to be -appointed by the Council of the county or burgh (see paragraph 7) is 1, 2, or 3, according as the total membership of the Insurance Committee is under 60, 60 and upwards, or 80. These members are in addition to the Council's representation extending to one- fifth of the total membership of the Committee (Sec 59 (2) (d) of 1911 Act). (48) Of the members appointed by the County Council or a Town Council at least two miist be women (Sec. 59 (2) (ii.) of 1911 Act). Moreover no person except a medical practitioner may represent the Council unless he or sheis, in the case of a County <^ouncil, a member of a Local Authority within the county under 12 the Public Health (Scotland) Act, 1897, or, in the case of a Town Council, a member of that Council. This requirement is, how- ever, waived so far as women are concerned, if women thus quali- fied are not available (Sec. 80 (7) of 1911 Act). It has been sug- gested to the Councils that it should be made a condition of the appointment of their representatives that they should cease to be members of the Insurance Committee on ceasing to be members of the Local Authority. (49) The Commissioners are empowered to increase the one-fifth representation of any County or Town Council which may have assumed liability to make good one-half of any deficiency in the income available for the administration of medical or sana- torium benefit. The increase is to be met by a corresponding diminution in the representation of insured persons, to be made in the manner and for the period which the Commissioners inay determine (Sees. 15, 17, and 59 (3) of 1911 Act, and No. 33 of Appointment of Representatives of Insured Persons (Scotland) Eegulations, 1913). (vii.) Repeesbntatives Appointed by Medical Peactitionebs. (50) The fijst appointments of their two representatives by the medical practitioners were made in the manner prescribed by the Election of Medical Representatives on Insurance Committees Regulations (Scotland), 1912 (Regulations No. 7). The two members of the Insurance Committee fell to be elected by an association of duly quaUfied medical practitioners, resident in the area of the Committee, formed for that purpose, or, if no such association were formed, by such practitioners at a meeting convened in accordance with the Regulations (Sec. 59 (2) (c) of 1911 Act). (51) The meeting might be summoned by an existing medical association or committee acting within the area of the Com- mittee including in its membership at least one half of the registered medical practitioners resident in the area, or by any accredited official of the association or committee or by any duly qualified medical practitioner resident therein. Written notice of the meeting was required to be posted not less than seven days prior to the meeting to every duly qualified medical practitioner resident in the area whose name appeared in the then current edition of the Medical Register. The notice was required to specify the time and place of meeting, and that the association, if formed, or the meeting itself, might proceed forthwith to the election of two members to serve on the Insurance Committee. Similar notice had to be given by advertisement in a newspaper circulating in the area, at least seven days before the meeting (No. 6 of Regulations). (52) If the meeting were summoned by, or on behalf of, an existing association or committee, the notice had to be sent to all practitioners whether members of the association or 13 committee or not. Non-members could attend the meeting and take part in the proceedings on payment of a sum (not exceeding Is.) fixed by the association or committee to cover expenses and specified in the notice (No. 6 of Regulations). (53) The quorum in a burgh was one-fourth of the duly quaUfied medical practitioners resident in it, but in no case less than five, and in a county, one-sixth of the duly quaUfied medical prac- titioners resident in it, but in no case less than five, except in the counties of Argyll, Bute, Inverness, Orkney, Ross and Cromarty, Sutherland and Zetland, where it was three (No. 6 of Regulations). (54) The meeting was required to appoint a Chairman and Clerk, and the latter was to transmit to the Commissioners a report of the proceedings of the meeting, duly authenticated by the Chairman, and specifying the names of the practitioners present at the meeting, the business transacted, any motions and amendments duly proposed and seconded, and the numbers voting therefor, and the names and addresses of the members, if any, elected to serve on the Insurance Committee (No. 6 of Regulations). (55) Where no election was made the Commissioners might convene by advertisement a meeting of the practitioners (Regulations Nos. 7, 8, and 9). (56) The term of office of these members has not yet been fixed by Regulation, and is meantime determined by the electors. Any medical practitioner whose name is removed from the Register by the General Medical Council ceases ifso facto to be a member of the Committee (No. 10 of Regulations). (57) Any vacancy occurring in the representation of the local medical practitioners is to be filled by the appointment of another member at a meeting summoned in accordance with the Regulations (No. 10 of Regulations). The procedure to be followed is on the lines of that detailed in the foregoing paragraphs (No. 6 of Regulations). (viii.) Representatives of the Commissionees. ' (58) Of the members appointed by the Commissioners to an Insurance Committee, at least two must be women, and at least one must be a duly quahfied medical practitioner (Sec. 59 (2) (ii.) of 1911 Act). The Commissioners have endeavoured to secure that large employers of labour, nursing and other associa- tions, etc., who have an interest in but no direct right of representation under the scheme of National Insurance, should be represented, and, where practicable, that one of their representa- tives should be a chemist resident in the area. In cases where the total medical representation on the Committee under the Act would amount to less than 10 per cent, of members, the Commissioners have agreed to include among the members to be appointed by them such further number of medical representatives as will suffice to raise the total number of medical representatives to the pro- portion mentioned. The term of office of the Commissioners' li representatives has been fixed for the present at a period expir- ing three years after 15th July 1913. Persons appointed subse- quently to 15th July 1913 hold office for the unexpired portion of the three years' period. (ix.) Combination of Committees. General. (59) Any two or more Insurance Committees may, and^ if required to do so by the Commissioners, must, combine for the exercise of any powers or duties under the Acts (Sec. 59 (5) of 1911 Act). The Committees entering into a combination are required to appoint from their respective members a Joint Committee for any purpose in respect of which the combination is effected. The costs incurred by the Joint Committee will form a charge upon the funds of the separate Committees in such proportion as may be agreed to by them. Failing agreement the apportionment will be determined by the Commissioners who will have regard, inter alia, to the number of insured persons residing within the area of each of the Com^ mittees interested (No. 12, Insurance Committees Procedure Regulations (Scotland), 1912). (60) The number of members to be appointed by each of the Committees concerned will be fixed by arrangement between them, or failing agreement, by the Commissioners. The time and method of appointment and the tenure of office of members will be fixed by the Committees respectively appointing them. The proceedings of the Joint Committee are regulated by the Standing Orders of the Committee (No. 12, Procedure Regu- lations). Drug Accounts Committee. (61) All Insurance Committees in Scotland were required by resolution of the Commissioners, dated 12th December 1914, to combine as from 1st January 1915 for certain purposes con- nected with the scrutinising of expenditure on drugs and appliances. Regulations have been issued adapting the provisions of the Act to the combination (National Health Insurance (Drug Accounts Committee) Regulations (Scotland), 1914). Provision is made for the election of a Joint Committee to manage the affairs of the combination, under the title of " The Drag Accounts Committee." (62) The purposes of the Drug Accounts Committee are — (a) to scrutinise the accounts furnished to each Insurance Com- mittee for drugs and appliances suppUed to insured persons, and make such reports thereon as may be necessary for the purposes of the Insurance Committee ; (6) to make and furnish such statistical and other returns and such reports with reference to the accounts as the Commissioners may require ; and 15 (c) to do such other /things as are incideBtal or conducive to the attainment oi the above purposes (No. 5 (1), Eegulations). (63) Insurance Committees are required to forward to the Committee at such times as may be agreed upon all the accounts in respect of drugs and appliances supplied to insured persons. Faihng agreement, the Commissioners fix the times at which the accounts are to be sent to the Drug Accounts Committee. After the accounts have been scrutinised the Drug Accounts Committee are required to return them with reports thereon to the Committees which sent them (No. 5 (2), Regulations). (64) The Drug Accounts Committee consists of fourteen members, of whom ten are members of Insurance Committees, two are medical practitioners, and two are chemists (No. 6, Eegulations). Eight of the Insurance Committee members are respectively elected by eight electoral divisions into which the Committees are grouped (No. 8, Regulations). These must be members of an Insurance Conjmittee in the electoral division they represent (No. 6, Regulations). The Insurance Committee for the Burgh of Glasgow is entitled to appoint two of its members to the Drugs Accounts Committee (No. 7, Regulations). (65) A list showing the composition of the electoral divisions and the value of the vote of each Insurance Committee is given in Appendix II. (B). Each Committee may nominate one candi- date (No. 8 (3) of Regulations). The election is conducted by a Returning Officer appointed by the Commissioners (No. 8 (1), Regulations). Only one vote may be cast by each Committee, but difierent values are assigned to the votes of the various Committees (No. 9 (1), Regulations). If the election is inconclusive owing to the candidates at the top of the poll having an equahty in value of votes, a second poll is taken as between those candidates. If this is similarly incon- clusive, the Returning Officer decides by lot which candidate is to be considered elected (No. 9 (4), Regulations). (66) The medical representatives must be panel practitioners. They are elected by the Panel Committee, but need not be members of a Panel Committee. The chemists' representatives must be persons registered under the Pharmacy Act, 1868, as amended by the Poisons and Pharmacy Act, 1908. They are elected by the Pharmaceutical Committee, but need not be members of a Pharmaceutical Committee (Nos. 6 and 11 (3) (d), Regulations). For the purpose of the election of the medical and chemists' representatives, the Panel and Pharmaceutical Com- mittees are each divided into two groups, viz. Burghs and Counties, and the vote of each Committee is of the same value as the vote of the Insurance Committee for the same area. Glasgow in this case forms part of the Burgh group, and the value of its vote is seven. Each group elects one member of the Drug Accounts Committee. The election is carried otit 16 exactly as if the groups were Insurance Committee electoral divisions, except that in the event of an equahty in value of votes there is no second poll, the Returning Officer deciding by lot (No. 11, Eegulations). (67) Provision is made in the Eegulations that casual vacancies caused by loss of qualification, absence without leave for six consecutive months from meetings, resignation or death, are to be filled by a new election (No. 18 of Regulations). The remaining members may act notwithstanding a vacancy. The term of office of members of the Drug Accounts Committee is three years. The members retire in a body in favour of a new Committee, which must be elected triennially within three months from the expiration of the term of office of representa- tives of insured persons on Insurance Committees (No. 15 of Eegulations). (68) The quorum of the Committee is five (No. 17 of Regvila- tions). The Committee's proceedings are regulated by the Standing Orders prescribed in the Insurance Committees Procedure Regula- tions (Scotland), 1912 (see paragraph (70) below), except where these are inconsistent with the purposes of the Drug Accounts Committee or with the Drug Accounts Committee Regulations (No. 4 of Regulations). (69) The expenses of the Drug Accounts Committee are met by Insurance Committees in proportion to the number of prescrip- tions respectively furnished to each Committee during the year. Where a Panel or Pharmaceutical Committee agrees to make a •contribution towards the share payable by the Insurance Com- mittee of the area of the annual expenses of the Drug Accounts Committee, the Insurance Committee will supply the contribut- ing Committee with such reports by the Drug Accounts Com- mittee as may be agreed upon. The reports wiU enable the pontributing Committee to consider and deal with cases of alleged excessive ordering of drugs under No. 40 of the Medical Benefit Regulations without the necessity of making an exhaustive analytical examination of the drug accounts for themselves. The Commissioners have strongly recommended Panel and Pharmaceutical Committees to take advantage of this provision i(No. 20 of Eegulations). SECTION (11.)— PROCEDURE, OFFICES, Etc. (i.) Standing Orders. (70) The National Health Insurance (Insurance Committees Procedure) Eegulations (Scotland), 1912, embody a set of •Standing Orders in accordance with which the proceedings of every Committee must be regulated, subject to the power of the Committee to suspend any one or more of the Orders in a case of urgency or upon a motion for the purpose provided that two- thirds of the members present and voting so decide (No, 5 of Eegulations). 17 The Standing Orders are as follows : — Meetings. (1) The Committee shall, in addition to the first meeting at which the Committee is constituted and any ad- journment or postponement thereof, hold such ordinary or special general meetings as shall be necessary for the transaction of business. The date, time, and place of meeting shall be fixed by the Com- mittee. (2) The Committee shall, at the first meeting, appoint a Chairman and Vice-Chairman of the Committee. In the event of difficulty arising from an equal division of votes the matter shall be settled by lot. (3) The Clerk may at any time, on the instructions or with the concurrence of the Chairman, or, in cases of urgency, without such concurrence, call a special meeting of the Committee. He shall call a special meeting on receiving a requisition signed by one- fifth of the members of the Committee, which re- quisition shall state the business to be brought up at such meeting. Should the Clerk, fail to call a meeting within seven days after receiving such requisition, the requisitionists shall be entitled themselves to call a meeting. (4) AH meetings shall be called by circular delivered or posted at least seven days before the meeting, except in case of urgency, of which the Chairman or the Clerk shall be the judge. The circular shall specify the items of business so far as known. Order of Business, (5) The order of business at all meetings of the Committee shall be as follows : — (a) The Chairman, or in his absence, the Vice- Chairman, shall take the chair ; if both are absent, the members present shall appoint a Chairman of the meeting. In the event of difiiculty arising from an equal division ol votes the matter shall be settled by lot. (6) The Clerk shall read the circular and the statu- tory authority, if any, for the meeting. (c) The sederunt shall be taken. (d) The minutes of last meeting shall be read, and, when confirmed, signed by the Chairman. (e) Business required by statute to be done at the meeting. (/) Business continued from previous meeting. Ig) Reports of committees or officials. 18 (h). Business of which notice has been given. (i) Special business brought forward by direction of the Chairman. (■/) Any other competent business. The Committee may at any meeting vary the above order, so as to give precedence to urgent business, but not so as to postpone consideration of statutory business. Motions, etc. (6) No motion to rescind any resolution which has been passed within the preceding six months, nor any motion to the same efiect as any motion which has been negatived within the preceding six months, shall be in order, unless notice of the same be given in the circular calHng the meeting. (7) Every amendment must be relevant to the motion on which it is moved. The Chairman shall be the sole judge of relevancy. (8) A relevant motion or amendment once made and seconded shall not be withdrawn without the consent of the mover and seconder thereof, and of the meeting. (9) Every motion or amendment shall be reduced to- writing, and shall be moved and seconded before it is put to the meeting. (10) A member shall not speak more than once on any motion or amendment (save in explanation), but the mover of a resolution may reply. After the mover has been called on by the Chairman to reply, no other member shall speak to the question., The decision of the Chairman on all questions of order, relevancy, and regularity shall be final ; and it shall be the duty of the Chairman to stop any discussion which, in his judgment, is irrelevant or outside the work of the Committee. Voting. (11) Every question shall be determined by a show of hands, unless three members demand a division, in which case the names, for and against the motion or amendment, shall be taken down and entered on the minutes. (12) The Chairman or Vice-Chairman or other member presid- ing in the absence of the Chairman in case of equality shall have a casting as well as a deliberative vote. Employment of Officers. (13) The Committee may appoint officers and servants for the conduct of its business, and shall appoint such officers and servants as are necessary for the carrying out of the powers and duties conferred and imposed 19 on it by the Act, including the keeping of proper records of its proceedings, books, and accounts, and the preparation of reports and returns. The number and remuneration of such officers and servants shall be fixed by the Committee, due regard being had to the provisions of the Act prescribing the sums avail- able for administrative expenses of the Committee, and shall be subject to the approval of the Com- missioners. Vacancies. (14) In the event of the death, resignation, or disability of the Clerk or other official, the Chairman shall make such temporary arrangements as may be necessary for the performance of the duties of the office, and shall, as soon as may be, caU, or cause to be called, a meeting of the Committee to decide what action is to be taken. (15) When there are more than two candidates for any office, and the first voting does not show an absolute majority of the members present and voting in favour of any candidate, the candidate having the least number of votes shall be struck off the list, and a fresh voting shall take place ; and so on, till an absolute majority shall be obtained in favour of one candidate. (16) Personal canvassing of members shall be prohibited by the Committee, who may declare any candidate infringing this rule to be disqualified for election. Signing of Deeds. (17) All deeds, contracts, and writs of importance, granted or entered into by the Committee, shall bfe -in name of the Committee, and may be signed by two members and the Clerk. In addition the Act of 1913 has made it necessary that a Standing Order should be made to provide for the proper custody of the Seal of the Com- mittee, for securing that it shall only be affixed iri pursuance of a resolution of the Committee, and for its proper authentication, which should be by two members and the Clerk as above. Suspension and Alteration of Standing Orders. (18) Any one or more of the standing orders in any case of urgency or upon motion made may be suspended at any meeting, so far as regards any business at such meeting, provided that two-thirds of the members of the Committee present and voting shall so decide. 20 Quorum, (19) The quorum of the Committee in each county and burgh shall consist of the number of persons mentioned in the Regulations (see Appendix II. (A)). (20) If within twenty roinutes or such longer time as the Committee may appoint after the time appointed for a meeting a quorum of members be not present, the Chairman, or in his absence, the Vice-Chairman, shall adjourn the meeting. In the event of the failure of a quorum and the absence of both Chairman a,nd Vioe-Chairman, the Clerk phall minute that owing to the want of the necessary quorum no business was done. (ii.) Offices. (71) Any Committee may, subject to the approval of the Commissioners, provide suitable office accommodation, including accommodation for its meetings. For this purpose it may use any offices belonging to a Local Authority, i.e. an Authority which has power to levy a rate directly or by precept or requisi- tion, including therefore a County Council, Town Council, School Board, District Committee, Landward Committee, and Secondary Education Committee, with the consent and during the pleasure of the Authority with or without payment as may be agreed. No Committee may take steps to acquire premises or accommoda- tion for meetings or offices until it has satisfied itself that accom- modation cannot be obtained in the offices of a Local Authority (No. 6 of Insurance Committee Procedure Regulations (Scotland), 1912). If a majority of the Committee so agree, meetings may be held in premises which are situate outwith the area of the Com- mittee (No. 7 of Regulations). SECTION (HI.)— POWERS AND DUTIES. (i.) Administration op Benefits. (72) The main duties entrusted to an Insurance Committee are the administration of — (a) Medical Benefit, and any additional benefit in the nature of Medical Benefit, of all insured persons in their area except members of the Seamen's National Insurance Society (Sees. 14 and 48 (12), 1911 Act). (6) Sanatorium Benefit of all insured persons in their area except members of the Seamen's National Insurance Society (Sees. 14 and 48 (12), 1911 Act). (c) All the benefits of Deposit Contributors in their area (Sec. 14, 1911 Act). 21 In view of the great importance of these duties, they are dealt , with separately in detail in Chapters IV., V., and VI. respectively of the Handbook. It is here proper to mention, however, that where an Insurance Committee in Scotland thinks it desirable, owing to sparseness of population, difficulties of communication, or other special circumstances, to modify or suspend any benefits for the administration of which it is responsible, it has power to do so if the consent of the Scottish Insurance Commissioners is obtained. Where this power is exercised, the Committee must (with the consent of the Commissioners) make provision for the increase of other benefits or the grant of one or more additional benefits to an amount equivalent to the value of the modifica- tion or suspension (Sec. 80 (9), 1911 Act). As regards Medical Benefit alternative or supplementary arrangements may be made in cases of difficulty (Sec. 11 of 1913 Act). (ii.) Miscellaneous. Reports and Returns. , (73) Insurance Committees are required to make such reports as to the health of insured persons within their areas as the Com- missioners, after consultation with the Local Government Board for Scotland, may prescribe. Insurance Committees must also furnish such statistical and other returns to the Commissioners as they may require. On their own initiative Committees may make such reports regarding the health of insured persons and the conditions affecting the same, with such suggestions in reference thereto, as they may see fit, the reports when made being forwarded by the Commissioners to the Local Authorities affected by or interested in them. The Committees are also to collect information which will enable an analysis and classifica- tion of Deposit Contributors to be made (Sec. 60 (1) (a), 1911 Act). Health Lectures, etc. (74) Another duty placed upon Insurance Committees is the dissemination of knowledge on health subjects by provision for the giving of lectures and the publication of information on questions relating to health. In this connection arrangements may, if the Committee thinks fit, be made with local education authorities, universities, and other institutions (Sec. 60 (1) (6), 1911 Act). Contributions to Hospitals and for Nursing. (7-5) An Insurance Committee may grant such subscriptions or donations as it may think fit to hospitals, dispensaries, and other charitable institutions, or for the support of district nurses, and may appoint nurses for the purpose of visiting and nursing insured persons. Any expenditure thereby incurred is to be 22 treated as expenditure on such benefits under the Act as mav lj,e prescribed by regulations. No regulations on the subject have yet been issued (Sec. 21, 1911 Act). Excessive Sickness. (76) Where it is alleged by the Insurance Commissioners or any Approved Society or Insurance Committee interested that there is excessive sickness amongst the persons for the administration of whose sickness or disablement benefit the Society or Committee lis responsible, and that the excess is due to — (1) The conditions or nature of employment of such persons ; (2) Bad housing or insanitary conditions in the locality ; (3) An insufficient or contaminated water supply ; (4) Neglect on the part of any person or authority (o) to observe or enforce the provisions of any Act relating to the health of workers in factories, workshops, mines, quarries, or other industries, or relating to pubUc health, or the housing of the working classes, or any regulations made under any such Act, or (b) to observe or enforce any pubUc health pre- cautions ; the Commissioners, Society, or Committee may claim from the person or authority alleged to be in default payment of the ■excess expenditure incurred (Sec. 63 of 1911 Act). Faihng agreement on the subject, the Home Secretary or the Local Glovernment Board, as the case may be, may, on the ^ppKcation of the Commissioners, Society, or Committee, appoint a " competent person " to hold an inquiry. The person holding the inquiry is to report to the authority by whom he was appointed {i.e. the Home Secretary, or the Local Gtovern- ment Board), who will consider the report and decide whether any, and, if so, what action is to be taken (Sees. 63 and 80 (11) •of 1911 Act). Should it be proved that the amount of sickness , (1) During a period of not less than three years before the date of the inquiry ; or (2) If there has been an outbreak of any epidemic, endemic, or infectious disease during any less period ; has been in excess of the average expectation of sickness by more than ten per cent., and that such excess was in whole or in part due to any of the causes before-mentioned, the amount of any ■extra expenditure found to have been incurred is to be made good by the following persons or authorities to the respective •extents to which they are found responsible, viz. : — (a) the employer where the excess or part thereof is due to (i.) The conditions or nature of the employment ; (ii.) Any neglect on his part to observe or enforce any of the Acts or Regulations above ■ mentioned : 23 (6) the local authority where the excess or part thereof is due to — (i.) Bad housing ; (ii.) Insanitary conditions in the locaUty ; (iii.) Neglect on the part of the local authority to observe or enforce any of the Acts or Regula- tions or precautions above mentioned ; (iv.) The insanitary condition of any particular premises, and it is found that the local authority is responsible therefor : (c) the owner, lessee, or occupier of premises where the excess or part thereof is due to — The insanitary condition of any particular premises, and it is found that such person is responsible therefor : (d) a local authority, company, or person by whom water is supplied, or who, having imposed on them the duty of affording a water supply, have refused or neglected to do so : — Where the excess or part thereof is due to an in- sufScient or contaminated water supply, unless it is proved that the insufficiency or contamina- tion was not due to any default on their part, but arose from circumstances over which they had no control (Sec. 63 (2) of 1911 Act). The local authority have recourse against the owner, lessee, or occupier of any premises, by whose act or default the extra expenditure may have been caused, provided a notice has been served on such owner, lessee, or occupier by the local authority. It is presumed that the notice would require to be served prior to the time of the inquiry in order that the person served might have an opportunity of being heard if he so wished (Sec. 63 (3) of 1911 Act). The " average expectation of sickness " is to be calculated in accordance with Tables to be prepared by the Commissioners, who will also make Regulations for the procedure at inquiries. .{Sec. 63 (4) and (5) of 1911 Act). An order by the Home Secretary or the Local Government Board dealing with the subject of costs and expenses in con- nection with excessive sickness may, with leave of the Court of Session, be enforced in the same manner as a judgment or order of the Court (Sec. 63 (5) of 1911 Act). Any sum ordered to be paid by a local authority may, in accordance with the regulations of the Secretary for Scotland, with the approval of the Treasury, be deducted from sums pay- able to the local authority out of the Local Taxation (Scotland) Account (Sec. 63 (6) of 1911 Act). 24 Growping of Apprcwed Societies for Valuation. (77) At triennial valuation periods Societies having less than 5000 members, unless they form a voluntary association large enough to bring the total membership up to not less than 5000 (exclusive of married women suspended from receiving ordinary benefits who are not special voluntary contributors an d of members who are not insured persons (Sec. 18 of Act of 1913)), are to be grouped together for the purpose of valuation, and of pooKng surpluses and deficiencies. The Insurance Committee for these purposes only is to act as a central financial committee of the grouped Societies within its jurisdiction. Except, however, so far as relates to the power of refusing to make good any part of a deficiency due to maladministration, no power of control over the administration of the grouped Societies is conferred on the Committee (Sec. 39, 1911 Act). Protection of Insured Persons against Diligence. (78) Other matters committed to the charge of Insurance Committees include the keeping of a special Register of medical certificates granted for the purpose of the protection of sick insured persons against the sale of their goods under warrant for debt or ejectment from their homes for non-payment of rent (Sec. 68 of Act of 1911). Note. — The powers and duties of Insurance Committees in con- nection with finance, including such matters as the payment of the travelling and subsistence expenses of members and the payment of subscriptions to an Approved. Association of Insurance Committees (Sec. 31, 1913 Act), are dealt with in the chapter on Finance. CHAPTER II. CONSTITUTION, PROCEDURE, POWERS, AND DUTIES OF SUB-COMMITTEES OP INSURANCE COMMITTEES. SECTION (I.)— SUB-COMMITTEES, (i.) Medical Service Sub -Committee. Appointment. (79) Every Insurance Committee must appoint one, and may with tlie consent of the Commissioners appoint two or more, Medical Service Sub-Committees (Nos. 45 (1) and (5), Medical Benefit Regulations (Scotland), 1913). The Medical Service Sub-Committee must consist of equal numbers of representatives of insured persons and of representatives of medical practitioners with a neutral Chairman. The minimum membership is seven — three persons to be appointed from and by the members of the Insurance Committee who represent insured persons, one by the Local Medical Committee, and two by the Panel Committee with the Chairman. If there is no Local Medical Committee, or it that Committee does not exercise its right of appointment, the Panel Committee appoints three members. With the consent of the Commissioners the number of representatives of insured persons may be increased by one or two {i.e. to make a total of four or five), but in such a case the number of members appointed by the Panel Committee must be increased to the same extent. Unless one of the members appointed by the Local Medical Committee or the Panel Committee is a woman, the representa- tives of insured persons must include a woman in their selection. Where this is necessary the woman so appointed need not herself be a member of the Insurance Committee (No. 45 (2) (i.) of Regulations). Chairman. (80) The Chairman must be selected by the members of the Sub-Committee from among those members of the Insurance Committee who were appointed by the Council of the County or Burgh and by the Commissioners respectively, and who are neither insured persons, practitioners, nor registered pharmacists. In default of a selection by the members of the Sub-Committee the Chairman must be appointed by the 3 26 persons who are eligible themselves to become Chairman. The Insurance Committee may provide for the appointment of a Viee-Chairman in the same manner as that in which the Chair- man is appointed. The Vice-Chairman will act as Chairman when the latter is not present, and may attend meetings at which the Chairman is present, but has then no vote and must take no part in the proceedings (No. 45 (2) (ii.) and (4) of Regulations). Member Interested. (81) If in the opinion of the Chairman any member of the Medical Service Sub-Committee is interested, or is partner or assistant to a practitioner interested, in a question referred to them, that member is debarred from taking any part in the hearing. Another person having the same qualification, if any, as the member who has withdrawn, must be appointed for the piirpose by the remaining members who represent practitioners or insured persons respectively, as the case may be, and the Chairman (No. 45 (3) of Regulations). Committee's Jurisdiction. (82) Any question arising between a practitioner on the panel and a person entitled to treatment from him, as to the treatment given (including the granting of certificates) or as to the conduct of the person while receiving treatment, stands referred auto- matically to the Medical Service Sub-Committee (No. 45 (1) of Regulations). Any question raised by an Approved Society as to the action of a practitioner on the panel with regard to any certificate which he is required under his agreement with the ComTnittee to furnish to a member of the Society, is to stand similarly referred to the Sub-Committee. In addition the Insurance Committee may refer to the Sub-Committee any other question arising in connection with the administration of medical benefit or to the discharge by the practitioner of his duties under his agreement (No. 45 (1) and (15) of Regulations). Procedure. (83) Any person desiring to have a question raised for the hearing of the Sub-Committee, must state in writing to the Clerk of the Committee the substance of the question (No. 45 (6) of Regulations). The Clei-k must, within 3 days,* send copies of the state- ment to the person in respect of whom the question is raised and to the Chairman of the Sub-Committee, and must, upon receipt of any reply or further statement made by either party, send copies thereof to the other party and the Chairman. Not less than 7 days" * notice of the meeting at which the question * The cletafls of procedure depend on the rules actually adopted by the Committee and approved by the Commissioners. 27 is to be considered must be given to both parties, and each member of the Sub-Committee must be supplied at the meetiag with copies of the statement and the reply, if any, thereto, and of any further statement made by either party (Model Eules for Administration of Medical Benefit No. 5, see Appendix III.). The Sub-Committee must meet at regular intervals and special meetings may be called (Rules No. 4). Either party is entitled at the hearing to make such statement and produce such evidence, whether written or -otherwise, as he may think fit (Rales No. 5). Admission to Hearing. (84) The proceedings at a hearing before the Medical Service Sub-Committee are private, and no person shall he admitted i except — (a) the person raising the question and the person with respect to whom the question arises ; (b) the secretary or other officer of the Society, if any, to which the insured person belongs ; (c) the secretary or other officer of the Panel Committee ; (d) such other person, not being counsel or a solicitor or other paid advocate, as the Sub-Committee may upon the application of either party admit by reason of the fact that his attendance is required for the purposes of the proceedings or to assist either party in the presentation of his case ; and (e) such officers and servants of the' InsTiiance Committee as they may appoint for the purpose. (No. 45 (7) of Regulations.) Quorum, etc. (85) Subject to the above provisions, the quorum of the Sub- -Committee, their term of office, the procedure with regard to the hearing of any question, the nature of the evidence admitted, and so on, are matters for the determination of the , Committee, with the approval of the Commissioners (No. 45 (8) of Regu- lations). Report. (86) The duty of the Sub-Committee is to draw up a report stating such relevant facts as appear to them to be established by the evidence placed before them, together with a recommenda- tion as to the action, if any, which should be taken, and to present the report to the Insurance Committee. Any finding of fact contained in the report is to be accepted by the Com- mittee as conclusive (No. 45 (9) of Regulations). Range of Medical Service. (87) Where in the course of any investigation it appears to the Sub-Committee that a question arises as to whether an 28 operation or other service is of a kind whicli can consistently with the best interests of the patients be properly undertaken by a general practitioner of ordinary competence and skill, they must refer the question to the Local Medical Committee for decision. The decision of that Committee, if acquiesced in,, or of Medical Referees, is binding on the Sub-Committee (No. 45 (14) of Regulations). The question is more fully treated in paragraphs (177) and (178). (88) The powers of the Committee and the action which may be taken following on the report, are dealt with in Chapter IV. Section (V.), paragraphs (259) to (276). (ii.) Phaemaceutical Seevice Sub-Committee. (89) The provisions relating to this Sub-Committee are similar to those applying to the Medical Service Sub-Committee. Every Insurance Committee must appoint one, and may with the consent of the Commissioners appoint two or more, Pharma- ceutical Sub-Committees (No. 46 (1) and (4), Medical Benefit Regulations (Scotland), 1913). Constitution. (90) The Pharmaceutical Committee must consist of six persoDS (exclusive of the Chairman and Vice-Chairman), and there is no discretion allowed to increase this number. Its constitution is as follows : — (i.) Three persons appointed by and from the members of the Insurance Committee who represent insured persons ; (ii.) Three registered pharmacists appointed by the Pharma- ceutical Committee ; (iii.) A Chairman selected from the neutral members of the Insurance Committee (i.e. members appointed by thfr Council of the County or Burgh and the Commissioners , respectively, who are neither insured persons, practi- tioners, nor registered pharmacists). The selection must be made by the persons appointed to be members of the Sub-Committee, or in default of selection being^ made by those persons, by the members of the Insur- ance Committee who are qualified themselves to become Chairman. Unless one of the persons appointed by the Pharmaceutical Committee is a woman, at least one of the persons appointed by the representatives of insured persons must be a woman, and in the latter case the person appointed need not be a member of the Insurance Committee (No. 46 (2) of Regulations). (91) Paragraph (80) above, applying to the Chairman and Vice-Chairman of the Medical Service Sub-Committee, and paragraphs (81), (83), (84), and (85), relating respectively to the dis- quaUfication of members interested in questions referred to the- 29 Medical Service Sub-Committee, admission to the hearing, the conduct of proceedings of the Sub-Committee, and the quorum, etc., also apply, with the necessary alterations, to the Pharma- ceutical Service Sub-Committee (No. 46 (3) and (5) of Regu- lations). Ditties. (92) The function of this Sub-Committee is to deal with any complaint made by a person entitled to treatment from a panel practitioner against a person supplying drugs or appliances. Such a complaint may relate to the quahty of the drugs or apphances supplied or to the failure to supply them within a reasonable time. Any question of this nature is to stand re- ferred from the Insurance Committee to the Sub-Committee (No. 46 (1) of Regulations). The Sub-Committee's powers are restricted to reporting on such complaints and submitting recommendations in regard to them. As in the case of the Medical Service Sub-Committee any finding of fact contained in the report must be accepted as conclusive by the full Committee (No. 46 (5) of Regulations). (iii.) Joint Services Sub-Committee. Constitution. (93) A Joint Services Sub-Committee must be constituted by every Insurance Committee, to consist of 6 persons, exclusive of the Chairman and Vice- Chairman. Two practitioners, 2 registered pharmacists, and 2 representatives of insured persons are to be appointed by and from among the members of the Medical Service Sub-Committee, the Pharmaceutical Service Sub-Committee, and the representatives of insured persons on the Insurance Committee respectively. There must be at least one woman upon the Joint Services Sub-Committee, and, unless either of the two appointing Sub -Committees select a woman fo^; one of their members, the representatives of insured persons must do so. In the latter case the woman need not herself be a member of the Insurance Committeee (No. 47 (1) of Regulations). Chairman. (94) The Chairman and Vice-Chairman (the latter appoint- ment is optional) are to be selected in the same manner, and to have the same powers, as the corresponding officers of the Medical Service Sub-Committee (see par. (80), and No. 47 (4) of Regulations). Disqualification of Member Interested. (95) Any member of the Sub-Committee who is, in the opinion •of the Chairman, interested in a question referred to it, or is a partner or assistant to a person so interested, is not allowed 30 to take part in tte hearing of the question. His place must be filled temporarily by a person with the same qualifications as himself, to be appointed by the remaining members of the class to which he belongs and the Chairman (No. 47 (2) of Regulations). Quorum, etc. (96) The quorum, term of office, procedure, etc., of the Sub- Committee must be determined by the Insurance Comniittee, subject to the approval of the Commissioners. The provisions detailed in pars. (83) to (86) as to the hearing and reporting of proceedings, and the persons entitled to be present at the pro- ceedings, of the Medical Service Sub-Committee are applicable to the Joint Services Sub-Committee, except that the secretaries or other officers of both the Panel and the Pharmaceutical Com- mittees are entitled to be present (No. 47 (4) of Regulations). Duties. (97) To the Joint Services Sub-Committee must be referred all matters which lie at the same time within the proviaces of the two constituent Sub-Committees. That is to say, where in the opinion of the Medical Service Sub-Committee any matter before it involves also a question relating to a person supplying drugs or apphances, or where in the opinion of the Pharmaceutical Service Sub-Committee any matter before it involves also a question relating to a practitioner on the panel, that Sub- Committee cannot deal with the matter itself, but must refer it to the Joint Services Sub-Committee (No. 47 (3) of Regulations). Re'port. (98) As in the cases of the other statutory Sub-Committees, the final decision is reserved for the full Committee, and the Sub -Committee's duty is to submit a report and recommendation, but the finding of the Sub-Committee on questions of fact is to be held conclusive (No. 47 (4) of Regulations). (iv.) GrENEEAL. Other Sub-Committees. (99) In addition to the statutory Sub-Committees which are directed to be established, an Insurance Committee may appoint such other Sub-Committees as it may think expedient (No. 8, Insurance Committee Procedure Regulations (Scotland), 1912). In general the Committees have found it convenient to set up a Sanatorium Benefit Sub-Committee, a Medical Benefit Sub-Committee, a Deposit Contributors Sub-Committee, and a Finance and General Sub-Committee. Go-option of Menders. (100) Sub-Committees may consist wholly or partly of members of the Committee as the Committee in its discretion may decide, 31 but a majority of the members of every Sub-Committee must consist of members of the Committee. This requirement does not, however, apply to any Sub-Committee appointed with advisory powers only, or appointed to supervise or report upon the administration of benefits, or for any purpose where no power of incurring expenditure is conferred upon it (No. 9, Procedure Eegulations). Representation of Interests. (101) In the appointment of Sub-Committees and the selection of persons to serve on them, a fair apportionment of duties and work between all members of the Committee should be arranged, and the balance of representation of interests provided by the Act in the case of the Committee itself must be secured where reasonably practicable (No. 10, Procedure ^Regulations). (102) Every Sub-Committee formed for the purpose of deahng with the administration of any benefit must contain at least one woman member (Sec. 30 (2), National Insurance Act, 1913). Proceedings. (103) The proceedings of Sub-Committees are regulated mutatis mutandis by the Standing Orders of the Committee as set forth in paragraph (70) above (No. 11, Procedure Regulations). General Powers of Remit. (104) No expenditure may be incurred by a Sub-Committee without the previous consent of the Committtee, and powers and duties in regard to the following matters may not be delegated with full powers to any Sub-Committee, and may not be delegated at all to a Sub-Committee appointed to act within a portion only of the area of the Insurance Committee : — (a) The arrangements for the treatment of tuberculosis. (&) All negotiations with practitioners or Local Medical Committees or pharmacists or chemists in regard to the terms on which, and the general conditions under which, medical treatment, medicines, and appliances will be supplied. (No. 8 (1) and (2), Procedure Regulations.) Powers of Remit in Sanatorium Benefit. (105) Special attention should be directed to (6) in the last para- graph, in so far as it relates to Sanatorium Benefit. The general efiect of the Regulations is that a Committee may remit to a Sub-Committee to make all necessary enquiries as to — (a) action being taken by the Public Health Local Author- ities and negotiations with such Authorities for the provision of treatment ; (6) accommodation available for sanatorium treatment ; 32 (c) the terms on whicli insured persons may be admitted to sanatoria or other institutions if recommended for treatment ; (d) the provision which it is possible to make for the treat- ment of insured persons otherwise than in sanatoria or other institutions ; (e) the terms on which such treatment can be obtained ; (/) the procedure to be followed generally in dealing with applications for either sanatorium or domiciliary treatment. (106) These powers cannot in any case be remitted without re- servation to a Sub-Committee. The Committee itself must have ultimate control, and rules should therefore be made by the Committee prescribing the exact preUminary procedure to be ioUowed in such matters as, for example, the following : — (o) evidence that the apphcant is an insured person ; (&) certificate from the regular medical attendant ; (c) report by the Medical Officer of Health or other medical adviser as to the case and the treatment required ; (d) report by an expert adviser appointed by the Com- mittee to report on all cases reported by the Medical Officer of Health or other medical adviser as suitable for sanatorium treatment. This may be unnecessary where the Medical Officer of Health or other medical adviser is himseU an expert. (107) The Sub-Committee should report whether the case com- phes with the requirements and is one to be recommended for treatment ; the method of treatment to be recommended ; and if sanatorium treatment is to be recommended, any special grounds for selection of the case — such as prospect of cure or need for isolation. (108) Although arrangements may be tentatively made by the Sub-Committee in order to secure immediate admission to a sanatorium on the Insurance Committee recommending the case, the Sub-Committee should have no power on its own initiative to recommend cases for immediate treatment, to arrange for actual admission to a sanatorium unless the expert medical adviser has certified the case as one in which immediate treat- ment is necessary ; or to bind the Insurance Committee to con- tinue treatment in the sanatorium, granted under such a certifi- cate of urgency, beyond the date of the next meeting of the •Committee. A Sub-Committee taking action on ground of urgency as above described should be required immediately thereafter to submit a special report of such action to the full 'Committee. (109) It should be explicitly provided that a Sub-Committee must not in any case arrange for admission to a sanatorium on higher terms than may have been agreed on by the Insurance Committee. 33 Duty to Report. (110) The detailed work of Sub-Committees other than the statutory Sub-Committees will be found in the succeeding chapters. It is here only necessary to add that every Sub- committee is required to report its proceedings to the Com- mittee at such times and in such manner as the Committee appoints (No. 8 (31), Procedure Regulations). SECTION (II.)— DISTRICT INSURANCE COMMITTEES. (111) The Act of 1911 and the Regulations dated 8th July 1912, made by the Commissioners, required the Insurance Committee of every county to prepare and submit for the approval of the Commissioners within six months of the commencement of the Act (that is, prior to 15th' January 1913), a scheme for the establishment of District Insurance Committee.s— except in cases where, owing to special circumstances, the Commissioners con- sidered it unnecessary. (112) As regards the areas to be allotted to the District Com- mittees, Section 59 (4) of the Act placed upon Insurance Com- mittees the duty of prescribii^g such areas as part of their schemes. Subject to the proviso that a District Committee should be appointed for every burgh within the county (that is, every burgh with less than 20,000 inhabitants), power was given by the Act to the Committee to group any adjoining areas with a burgh, and for this purpose to include small burghs in the adjoining areas which might be grouped with other burghs. On general grounds it was suggested to Insurance Committees that "they should have regard to — (a) the securing of economy and efficiency in administra- tion ; and (b) the fact that, for purposes of local government, coun- ties are already divided into districts, the areas of which it might in some cases be expedient to adopt. (113) As regards the composition of District Committees, the ■Commissioners intimated that they would be prepared to ap- prove schemes which provided for District Insurance Committees being composed, either wholly or partly, of the members of the Insurance Committee. The Commissioners recommended to the consideration of Insurance Committees the expediency of providing for small Committees (say from 9 to 15 in number), and also the desirability of securing, wherever and so far as practicable, that — (a) the various interests represented on the Insurance Com- mittee should also be represented on the District Insurance Committee ; (6) at least one person appointed to the District Committee should also be a member of the Insurance Committee ; 34 (c) at least one woman should be appointed ; (d) the members should reside within the area of the district. (114) It is not a condition of approval of any scheme that it should provide that members must necessarily be members of the appointing bodies, although if such a provision is included it is necessary to make it a condition of membership of the District Insurance Committee that such membership should cease on the member ceasing to be a member of the appointing body. (115) A District Committee is empowered, with the approval of the Insurance Committee and the Commissioners, to appoint such officers or servants as it may consider necessary for exercis- ing its powers and carrying out its duties. The fixing of the salaries to be paid is in the hands of the Insurance Committee, subject to the consent of the Commissioners (No. 6, District Insurance Committees Regulations (Scotland), 1912). (116) These and other administrative expenses are to be met by the allocation to the District Committees by the Insurance Com- mittee of such proportion of their income as may be necessary (No. 7, District Insurance Committees Regulations (Scotland), 1912). The utmost care is called for to ensure that the money available for administrative expenses of the Insurance Committee is used to the best advantage. For this purpose it was suggested that the schemes for the constitution of District Committees should require them to submit periodical estimates of expenditure and to keep proper accounts. (117) District Insurance Committees have no duties or powers specifically assigned to them by either the Acts or Regulations. This matter was left entirely to the discretion of the Com- mittees which constitute them, with the same quahfications (see paragraph (104)) as in the case of Sub-Committees (No. 8, District Insurance Committees Regulations (Scotland), 1912). (118) The provisions as to reporting to the Committee and as to procedure are also the same as in the case of Sub-Committees (see paragraphs (103) and (110) above, and Nos. 8 (3) and 9 of the District Insurance Committees Regulations (Scotland), 1912). C H A P T E R III LOCAL MEDICAL COMMITTEES, PANEL COMMITTEES, AND PHARMACEUTICAL COMMITTEES. SECTION (I.)— LOCAL MEDICAL COMMITTEE. Statutory Sanction. (119) Statutory provision was made by the Act of 1911 for the recognition, if duly formed, of Local Medical Committees representative of all duly qualified medical practitioners resident in the area of an Insurance Committee or District Committee. The initiative in forming such a Committee rests with the practitioners themselves. The Committee's function is, broadly speaking, to represent the views of such practitioners on all general questions affecting the administration of medical benefit in the area (Sec. 62 of 1911 Act). Recognition. (120) Before a Local Medical Committee is entitled to be con- sulted by the Insurance Committee or District Committee on these matters, it has to secure the recognition of the Commis- sioners and the Joint Committee (Sec. 62, 1911 Act, and Joint Committee Regulations, 1911, No. 16 {d)). Committees were recognised originally for a period terminating not later than 1st March 1914, when recognition was extended, on application by the Committees, to 1st March 1915. For the period of the war, special consideration is given by the Commissioners, with a view to avoiding work and difficulties in the application of the ordinary requirements. (121) The number of Local Medical Committees in Scotland which have been recognised is fifty-two. A hst of the Commit- tees is given in Appendix (IV.) (122) The Commissioners require to be satisfied that the Committee is in fact representative of all duly qualified medical practitioners resident in the area. To some extent the personnel of the Local Medical Committee and of the Panel Committee may be identical, and it was provided by the Amending Act of 1913 that in any area in which, within six months of the date of passing the Act (15th August 1913), no Local Medical Committee 36 Lad been recognised, the Panel Committee might itself be recog- nised as the Local Medical Committee for that area (Sec. 32, 1913 Act). Constitution. (123) The Commissioners before awarding recognition required that a regular form of constitution providing for the election of the Committee and governing its proceedings should be adopted by the practitioners at a meeting called on due notice. Two Model Forms of constitution were, at the request of the prac- titioners, proposed by the Commissioners for their guidance. The constitutions finally adopted follow one or other of these models very closely. (124) The Local Medical Committee was composed under Model A. of the whole body of the duly qualified medical practitioners resident in the area, and under Model B. of selected individuals appointed by and representative of such practitioners. Functions. (125) The Local Medical Committee is entitled to be consulted by the Insurance Committee (or the District Insurance Committee) on all general questions affecting the administration of medical benefit, including the arrangements made with medical prac- titioners giving attendance and treatment to insured persons (Sec. 62, National Insurance Act, 1911). The Committee is, moreover, at liberty to make any representations on such matters to the Insurance Committee or to the Commissioners. The nature of the questions which will arise is described fully in the following paragraphs relating to Panel Committees, and the powers and duties therein set out are common to the Local Medical Com- mittee and the Panel Committee. The exceptions are the making of arrangements for the supply of drugs and appliances by a practitioner, the examination of the accounts of persons supplying drugs and appliances, the rate at which advances are to be made to practitioners, and remuneration is to be cal- culated, arrangements for enabling insured persons to be assigned to a practitioner on the panel (Reg. 21 (4)), and the defraying of the expenses of the Panel Committee. Those are points which affect more particularly the payment of panel practitioners. With them the Local Medical Committee is not concerned. (126) The Local Medical Committee has in addition certain specific duties of a very responsible kind. In the first place, it has the duty of considering any complaint made by one practitioner on the panel against another, involving any question of the efficiency of the medical service of insured persons. It may make application to the Commissioners to remove the name of the practitioner against whom the complaint is made from the panel (No. 48, Medical Benefit Regulations (Scotland), 1913). (127) In the second place, if an Insurance Committee is of 37 opinion that a question tas arisen or may arise as to wtether an operation or other service is of a kind which can, in the words of the practitioner's agreement, " consistently with the best interests of the patient be properly midertaken by a general practitioner of ordinary professional competence and skill," it must refer the question to the Local Medical Committee. Such a question ijaay also arise in the course of the proceedings of the Medical Service Sub-Committee, and, if so, it is similarly to be referred to the Local Medical Committee (No. 50, Medical Benefit Regulations). (128) If the Insurance Committee and the Local Medical Com- mittee are unable to agree upon a decision in the case, or if the Commissioners in any event so determine, the provisions of the Regulations as to the appointment of referees come into force. These provisions are dealt with at length in Chapter IV. If an agreement is reached by the two Committees, the Insurance Committee is bound to report the matter to the Commissioners, who may, if they think fit, themselves refer it to referees for consideration (No. 50 of Medical Benefit Regulations). SECTION (II.)— PANEL COMMITTEE. Sanction. (129) Section 32 of the National Insurance Act, 1913, provides for the appointment of a Panel Committee for every Insurance Committee area by the medical practitioners who are under agreement with the Insurance Committee. Election. (130) The method of election for the first Panel Committees and the number of members thereof for the various areas were prescribed by Regulations (Panel^ and Pharmaceutical Committees Regulations (Scotland), 1913). Membership. (131) The number of members for each area is set out in Appendix V. Not less than two-thirds of the members were required to be practitioners on the panel for the area, while the remainder might be duly quahfied medical practitioners whether on the panel or not and whether or not resident in the area. The electors were the practitioners under agreement with the Insur- ance Committee for the area as at 13th October 1913. A Re- turning Officer was appointed by the Commissioners in each case (Nos. 3 and 4, Panel and Pharmaceutical Committees Regula- tions (Scotland), 1913). Vctcancies. (132) The first members of the Committee hold office until 31st March 1916, when a new Committee will be constituted in accordance with Regulations which will be made for that purpose. 38 Should tlie war not have terminated by March 1916 Regulations -will be made postponing the election till the termination of hostihties . Casual vacancies arising before that date must be filled hy the remaining members of the Committee, who are within three months to appoint a duly qualified person. In default of an appointment by the Committee within that period, the Com- _ mission ers will fill the vacancy. Where the member whose ' place has been vacated was at the time of his appointment a panel practitioner for the area, the person appointed in his place must also possess the qualification. In any case a new member will hold office only until 31st March 1916. The existence of a vacancy is not to invahdate the proceedings at any meeting of the Committee (Nos. 8, 16 (4), and 17 of Regulations). (133) A vacancy will arise if a member dies, or submits his resignation in writing to the Secretary of the Committee (who is to communicate it to the Clerk to the Insurance Committee), or if the member — (a) was at the time of his appointment a practitioner on the panel for the area, and subsequently ceases to be such ; (6) is absent without leave of the Committee from its meet- ings for a period of six consecutive months commenc- ing from the date of the first meeting from which he was absent, unless the absence is due to employment in the naval or military forces during the present war. (No. 16 of Regulations and Panel and Pharmaceutical Com- mittees Amendment Regulations, 1915). Qiiorum. (134) The quorum fixed for each Committee is given in Ap- pendix V. (No. 15 of Regulations). Secretary. (135) Every Panel Committee was required to appoint a Secre- tary at its first meeting, who was under the obligation to notify his appointment to the Commissioners. If it is necessary to appoint a new Secretary on account of death or resignation, the appointment must be similarly intimated to the Commis- sioners. The names and addresses of the Secretaries of Panel Committees in Scotland are given in Appendix V. (No. 14 (2) of Regulations). Powers and Duties. (136) The position of the Panel Committee is in the main that of an advisory body which is to be consulted by the Insurance Committee, where it is the duty of the latter to ascertain, in respect of any matter affecting the administration of medical benefit in its area, the opinions and wishes of the panel practi- tioners. The Panel Committee has in addition any powers and duties whioh may be conferred upon it by the Commissioners. 39 It will be recalled {see par. (122)) that where, within six months of the passing of the Amending Act (i.e. before 15th February 1914), no Local Medical Committee has been recognised, the Panel Committee may be recognised as the Local Medical Committee for the area (See. 32, 1913 Act). The Panel Committee for the County of Orlaiey was so recognised on 1st April 1914. Consultation hy Committee. (137) The Medical Benefit Eegalations impose upon all In- surance Committees the duty of consulting the Panel Committees for their areas before exercising any of the following powers : — (a) Embodying in a draft agreement the terms upon which it is proposed to invite practitioners to undertake the treatment of insured persons (No. 5 (1), Medical Benefit Regulations (Scotland), 1913). (6) Submitting to the Commissioners any alteration in the terms of service of practitioners (No. 16 (1)). (c) Fixing, varying, or abolishing an income limit for the receipt of medical benefit under arrangements made by the Committee (No. 14 (2)). {d) Making Rules under Section 14 of the Act of 1911 with regard to the administration of medical benefit (No. 81, Medical Benefit Regulations (Scotland), 1913). (e) Preparing the Kst of drugs and appliances, known as the Drug Tarifi ; or making any alteration of the Drug Tariff, or of the terms upon which the supply of drugs and appHances is to be undertaken (Nos. 8 and 18 (1)). (/) Making arrangements, with the consent of the Com- missioners, where an insured person is resident in a rural area at a distance of more than one mile from the place of business of the nearest chemist, for the supply to that person by the practitioner attend- ing him of such drugs and appUances as would other- wise ordinarily be supphed by a chemist (No. 12 (1)). Arrangements for Medical Benefit. (138) The Commissioners will, before approving the arrange- ments proposed by the Insurance Committee for the administra- tion of medical benefit, consider any representations on the subject from the Panel Committee (No. 82, Medical Benefit Regulations). Consideration of Chemists' Accounts. (139) With regard to the accounts of persons supplying drugs and apphances, the Panel Committee is entitled to require that such accounts shall be submitted to them, together with any report made by the Pharmaceutical Committee, and if the Panel Committee take objection to any items in the accounts or 40 to any recommendation contained in the report, the Insurance Committee must decide as to the validity of the objection. The Panel Committee may, either with or without an examina- tion of the accounts, indicate their willingness to accept all or any of them, and in so far as they are accepted they will be binding on all the practitioners on the panel. These powers also apply to the provision of medicine to temporary residents (Nos. 39 (3) and (4) and 42 (8), Medical Benefit Regulations). , Excessive Prescribing. (140) Moreover, where it appears to the Panel Committee that, owing to the character or amount of the drugs ordered for in- sured persons by any practitioner or practitioners on the panel, the cost of the supply of those drugs and appliances is in excess of what may reasonably be necessary for the adequate treatment of those persons, the Panel Committee may, and, if any re- presentation to the efiect indicated is made to them by the Pharmaceutical Committee, must, make an investigation into the circumstances, and, after hearing the Pharmaceutical Com- mittee and any practitioner concerned, report to the Insurance Committee (No. 40, Medical Benefit Regulations). The reports should deal with the question of whether there has been excessive prescribing, and if so, whether in character or amount and to what extent, and may include a recommendation as to surcharge. The decision as to surcharge and the amount thereof rests with the Insurance Committee. Income Limit. (141) In the event of an income limit being fixed, the Panel Committee is entitled, by giving notice in writing, to dispute the right of any insured person to receive medical benefit vmder the arrangements made by the Insurance Committee on the ground that his income exceeds the limit so fixed (No. 14 (3), Medical Benefit Regulations). Advances to Practitioners. (142) The rate at which advances are to be made to each practi- tioner after the end of each quarter is to be a matter of arrange- ment between the Insurance Committee and the Panel Com- mittee (No. 37, Medical Benefit Regulations). Scheme for Treatment. (143) One of the most important duties of the Panel Committee is to make arrangements with the Insurance Committee to enable an insured person, who is not on the list of a practitioner, to obtain on appUcation treatment without delay and to be assigned to a practitioner (No. 21 (4) of Regs.). The adoption of such a scheme is a preliminary to a scheme for the apportionment 41 amongst and payment to the practitioners of the balance of the Practitioners Fund (Reg. 35 (1)). Complaints. (144) The Panel Committee have certain rights in regard to the appointment and proceedings of the Medical Service Sub-Com- mittee and the Joint Services Sub-Committee, and the conduct of any inquiry as to a complaint against a practitioner. The Commissioners are bound to hold such an inquiry on a sufficient representation from the Panel Committee (Parts V. and VI. Medical Benefit Regulations). Expenses. (145) As regards administrative expenses the Insurance Com- mittee may, if requested to do so by the Panel Committee and the Pharmaceutical Committee or either Committee, allot for this purpose a sum or sums not exceeding in all one penny for each insured person entitled to obtain treatment from insurance service practitioners. The amount is to be determined by the Insurance Committee with the consent of the Commissioners (Sec. 33 (2), National Insurance Act, 1913). (146) If the two Committees decide to put forward such a request it is desirable that they should come to an agreement as to how the amount to be allotted to them is to be divided. If one Committee only makes application the Commissioners require that the application should be submitted to the other Committee for its observations. SECTION (III.)— PHARMACEUTICAL COMMITTEE. Sanction. ' (147) The appointment and recognition of Pharmaceutical Committees was provided for by Section 33 of the National Insurance Act, 1913. General. (148) The provisions relating to Pharmaceutical Committees are similar to those in the case of Panel Committees. (Parts III. and IV., Panel and Pharmaceutical Committees Regulations (Scotland), 1913.) Special Regulations have been made to meet the case of Zetland County. Membership. (149) The number of members of the Pharmaceutical Com- mittee for each area is given in Appendix VI. Not less than two-thirds must be registered pharmacists, and all must be electors. The electors for the first Committee consisted of the pharmacists and others, and one representative of each firm and body corporate, under agreement with the Insurance Committee as at 13th October 1913, to supply drugs, medicines, 4 42 or appliances to insured persons, whether or not their place of business or residence was within the area of the Committee (Nos. 9 & 10 of Regulations). Term of Office. (150) The first members hold office until 31st March 1916. Casual vacancies must be filled by the remaining members of the Committee within three months, or in default by the Commissioners. The term of office of all members expires on 31st March 1916. Where a person whose seat is vacated was at the time of his appointment a person supplying drugs or apphancea in the area, the person appointed in his place must have the same <3ualification (Nos. 12 and 17 of Regulations). Vacancies. (151) A casual vacancy will occur if a member dies, or resigns in writing addressed to the Secretary of the Committee (who is to notify the Clerk to the Insurance Committee of the resigna- tion), or where a member — (o) was at the time of his appointment a person supplying drugs or appliances in the area, and has subsequently ceased to be such ; or (&) has been absent without leave of the Committee from its meetings for a period of six consecutive months, commencing from the date of the first meeting from which he was absent, unless the absence is due to employment in the naval or military forces during the present war. (No. 16 of Regulations and Panel and Pharmaceutical Committees Amendment Regulations, 1915.) Quorum. (152) The quorum fixed for each Committee is given in Appendix VI. (No. 15 of Regulations). Secretary. (153) A Secretary to the Committee was appointed at the first meeting, and was required by the Regulations to notify his appointment to the Commissioners. Similar intimation must be given by any new Secretary appointed (No. 14 (2) of Regulations). The names and addresses of the Secretary of each Committee are given in Appendix VI. Consultation by Committee. (154) The Insurance Committee is bound to consult the Pharma- ceutical Committee for its area in regard to the following matters : — (a) The preparation of the Drug TarifE for ordinary drugs and prescribed appliances, and the method by which 43 payment for drugs not included in the Tariff is to be calculated (No. 8, Medical Benefit Eegulations). (6) Any alterations wHcli it is desired to make in the Drug Tariff or in the terms upon which the supply of drugs and appliances is undertaken ,(No. 18 (1), Medical Benefit Eegulations). (c) Arrangements proposed to be made, with the consent of the Commissioners, where an insured person is resident in a rural area at a distance of more than one mile from the place of business of the nearest chemist for the supply by a practitioner of drugs and appliances which would ordinarily be suppUed by a chemist (No. 12 (1), Medical Benefit Eegulations). (d) Fixing, varying, or aboUshing an income limit (No. 14 (2), Medical Benefit Eegulations). Dnig Accounts. (155) If the Pharmaceutical Committee so require, the accounts incurred for drugs and appliances must be submitted to them ior examination, and they will make a report stating which items in the accounts ought, in their opinion, to be accepted, and which, if any, ought to be reduced or disallowed. The recom- mendations of the Committee are binding on the persons furnishing the accounts. If, however, the accounts are con- sidered by the Panel Committee objections may be made by them to any item of an account or recommendation of the Pharmaceutical Committee. The Insurance Committee must decide as to the validity of any such objection. The Pharmaceutical Committee may at any time make representa- tions to the Panel Committee that the character or amount of the drugs ordered for insured persons is in excess of what may reasonably be necessary for adequate treatment (Nos. 39 ^(2) and 40, Medical Benefit Eegulations). Complaints. (156) It is the duty of the Pharmaceutical Committee to con- sider any complaint made by a person supplying drugs and appli- ances against any other such person, involving any question as to the efficiency of the service, and they may apply to the Commis- sioners to remove from the par el fist the name of the person against whom the complaint has been made (No. 49, Medical Benefit Eegulations). Panel List. (157) The Insurance Committee is required to submit its hst ■of persons who have agreed to supply drugs and appliances to "the Pharmaceutical Committee before it is issued in any year. The arrangements proposed for the administration of medical "benefit must be submitted to the Commissioners, who will 44 before approving them consider any representations of the , Pharmacetitical Committee (Nos. 11 (1) and 82, Medical Benefit Regulations). Income Limit. (158) The Committee has the right at any time to dispute the title of an insured person to receive medical benefit under the arrangements made by the Insurance Committee on the ground that the person's income exceeds any limit which may have been fixed (No. 14 (3), Medical Benefit Regulations). Advances to Chemists. (159) The sums to be paid in advance to persons supplying drugs and appliances, on rendering their accounts, are to be agreed upon between the Pharmaceutical Committee and the Insurance Committee (No. 39 (8), Medical Benefit Regulations). CHAPTER IV. MEDICAL BENEFIT. General. 1(160) The most important duty of an Insurance Committee is that of making proper arrangements for the adrninistration of Medical Benefit within its area. By Section 8 of the Act of 1911 Medical Benefit is de- fined as Medical Treatment and Attendance, including the pro- vision of proper and sufficient medicines and such medical appliances as may be prescribed by Regulations to be made by the Commissioners. Medical Benefit is declared by Section 8 (6) of the Act not to include any right to medical treatment or attendance in respect of a confiiiement. (161) In terms of Section 15 (1) of the 1911 Act every Insurance Committee is bound, for the purpose of administering Medical Benefit, to make arrangements with duly qualified medical practitioners in accordance with Regulations made by the Commissioners. Under Section 15 (5) every Committee is further required to make provision for the supply of proper and sufiicient drugs and medicines and prescribed appliances also in accord- ance with Regulations made by the Commissioners. Regulations. (162) The Medical Benefit Regulations at present in force are the National Health Insurance (Medical Benefit) Regulations (Scotland), 1913, dated Uth November 1913, and the Medical Benefit Regulations (Scotland), 1914, dated 22nd October 1914. Copies of the Regulations may be obtained from H.M. Stationery Office (Pubhcations Branch), 23 Forth Street, Edinburgh, at the price respectively of 4d. and Id. per copy, iacluding postage. (S.O. references to be quoted, H.C. 28 and H.C. 42 respectively.) (163) Generally, in pursuance of the requirements of Section 15, the provisions of the regulations secure that insured persons, including exempt persons entitled to medical benefit under Section 9 of the Act of 1913, shall be enabled to receive adequate medical attendance and treatment. The regulations require the adoption by the-Insurance Committee of such system as will secure — • [a) the preparation and publication of lists of (i.) medical practitioners who have agreed with the Insurance Com- mittee to treat insured persons, and (ii.) persons. 46 firms, and bodies corporate who have agreed to supplj drugs, medicines, and appliances to insured persons ; (b) a right oti the part of any duly qualified medical prac- titioner or of a person, firm, or body corporate who is desirous of being included in such list of being so included ; (c) a right on the part of any insured person of selecting, at such periods as may be prescribed, from the appropriate list, the practitioner by whom he wishes to be attended and treated, subject to that practi- tioner's consent ; (d) the distribution amongst, and so far as practicable- under arrangements made by, the several practi- tioners whose names are on the lists, of the insured persons who after due notice have failed to make any selection, or who have been refused by the practitioner whom they have selected ; (e) the provision of medical attendance and treatment on the same terms as to remuneration as those ar- ranged in regard to insured persons to members of societies who were at the date of the passing of the principal Act entitled as such members to medical attendance and treatment, and who were either over sixty-five years of age at the commencement of the- Act, or were at that date, on account of permanent disablement, not qualified to become insured persons. The main features of the Regulations are referred to in the Sections which follow. (164) The Medical Year has been fixed by the Commissioners as the calendar year, i.e. 1st January to 31st December, and the Quarters as the periods commencing on 1st January, 1st April, 1st July, and 1st October (Reg. 2). SECTION (I.)— ARRANGEMENTS WITH PRACTITIONERS AND INSTITUTIONS. (i.) Peactitionees. (A) Panel List. (165) If a duly qualified medical practitioner, other than one- whose name has been removed by the Commissioners from the panel of an Insurance Committee in the United Kingdom, at any time makes application to a Committee for that purpose, the Committee must include his name in their panel list (Reg. 17). For the purpose of providing treatment for insured persons a Committee is required to enter into written agreements with such practitioners as are willing to undertake the treatment of insured persons on the terms of the agreement (Reg. 4). Bach Committee must cause to be prepared and issue at least fourteen days before the end of the medical year a medical list of the 47 practitioners who have entered into agreements with it (Eegs. 6 and 17). (166) The list is to contain the name of each practitioner, his private address, the address of any surgery, dispensary, or other place at which he undertakes to attend for the purpose of treat- ing insured persons, and particulars of the days and hours at which he undertakes to be in attendance at each place. If the Committee so decides the exact area in which each practitioner undertakes treatment may be shown. Where practitioners are in partnership a reference to the partnership may appear in the list (Regs. 6 and 5). Steps must be taken to enable insured persons to iilspect an up-to-date copy of the list at the Com- mittee's oEices, at any Post Office, and at any other suitable places, and a copy must also be sent to the Commissioners and to every person, fiim, or body corporate supplying drugs or appli- ances or both. The Commissioners must also be informed as soon as possible of any alteration on the list (Regs. 6 (4) and 17 (5)). (B) Conditions of Service. (167) The Medical Benefit Regulations prescribe certain condi- tions which must form part of every agreement, and the Regulations themselves are also deemed to be incorporated in the agreement. Insurance Committees are bound to consult with Local Medical Committees and Panel Committees, and to prepare for the approval of the Commissioners a draft agree- ment upon the terms of which practitioners are to be invited to take service (Reg. 5 and First Schedule). A copy of the Model Form of Agreement between the Committee and the practitioner forms Appendix VII. Places and Times of Attendance. (168) The practitioner's agreement must state the places and hours at which patients may attend and receive treatment, but in addition any patient on the doctor's list whose condition is such that a visit is required is entitled to be so visited. Ordin- arily the patient will be at the address given when he was ac- cepted by the doctor, but the agreement provides that a visit shall be paid if necessary even when he is elsewhere, provided that the distance by road from the doctor's residence does not exceed the number of miles which may be specified in the agree- ment. The places, days, and hours of attendance may be altered by the practitioner with the consent of the Committee (which cannot be unreasonably withheld), but in such an event he must take steps to the satisfaction of the Committee to bring the changes to the notice of the persons entitled to obtain treatment from him (First Schedule, 4 and 5). Practitioner's List. i (169) Every practitioner on the panel must be supplied by the Committee with a list of the persons for whose treatment he is 48 Tesponsible, i.e. of tke persons accepted by him or assigned to Mm by the Committee. An approved institution has a right to Teceive corresponding information (Reg. 25). Deputy. (170) In normal circumstances the practitioner is bound to give treatment personally. If, however, this is impossible, owing to urgency of other professional duties, temporary absence from home, or other reasonable cause, he must to the best of his ■abihty provide for some other practitioner to act as his deputy. Although the places at which treatment may be given by a deputy may be altered, due regard must be had to the con- venience of the patient (First Sch. 7). Breach of Agreement. (171) The practitioner is liable to make good any expense or loss which the Committee or a patient may sufEer owing to a breach on his part of the agreement. The amount involved may be recovered by deduction from any sums due to the practitioner under the agreement, or in any other competent manner, but unless the Medical Service Sub-Committee or the Joint Services Sub-Committee have already had the matter before them, the Committee must refer it to the Medical Service Sub-Committee before taking action. In any case the prac- titioner or his legal personal representative has a right of appeal to the Commissioners within fourteen days after he has received notice of the Committee's decision (First Sch. 9). A dispute or question between a Committee and a practitioner as to the construction of the agreement or their respective rights and liabilities is referred to the Commissioners unless other machinery for its settlement is specially provided by the Regulations, e.g. Medical Service Sub-Committee (Reg. 45) Referees (Reg. 50), etc. (First Sch. 10). Alteration of Conditions. ( 1 72) An Insurance Committee may, after consultation with the Local Medical Committee and the Panel Committee, and subject to the approval of the Commissioners, make alterations in the conditions of service. The proposals will, after being submitted' to the ■ Commissioners and approved by them, take efEect at the beginning of the following year, or from such later •date as the Commissioners may determine. Six weeks' notice prior to the commencement of the year must be given by the ^Committee to the practitioner (Reg. 16). Withdrawal from Panel. (173) Unless a practitioner gives written notice to the Committee at least four weeks before the beginning of the year that he desires to withdraw, his agreement will stand for the following year, subject to any alterations of which notice may have been given to him. If intimation of withdrawal is received four 49 weeks or more before the end of the year the practitioner's name must be removed from the list at the end of the year (Keg. 17). (174) Withdrawal may take place during the course of the year only under the following circumstances : — (a) If both panel and other practice is to be discontinued in the area to which the practitioner's agreement applies, he may have his name removed from the list on giving due notice to the Committee. The Committee may, if it thinks fit, refuse to remove the name before two months have elapsed from the date of the notice. (&) The Committee may, if it wishes, consent to the removal of the name even where the practitioner proposes to continue his other practice and desires to dis- continue his panel practice only. (c) The name of any practitioner who dies or whose name is directed to be removed from the hst by the Com- missioners should be removed at once. In the case of death, the legal personal representative may appoint a practitioner (who need not be on the panel) to undertake the treatment of such persons as do not apply to be transferred to the list of another practitioner, as if he were a deputy of the deceased practitioner. Notice of the desire to adopt this course must be given by the representative within seven days of the death, and treatment under such ' arrangement may be given for such period as the Committee thinks fit. (See also par. 241.) {Reg. 17.) (C) Supply of Drugs by Practitioners. (175) If an Insurance Committee is satisfied that a person en- titled to medical benefit will have difficulty in obtaining drugs or appliances from a chemist on the panel, it must, if the practitioner concerned so desires, make arrangements for the supply of the drugs and appliances by the practitioner attending him. The Committee has, moreover, a discretionary power to make similar arrangements after consultation with the Panel Com- mittee and Pharmaceutical Committee and subject to the con- sent of the Commissioners, where a person is resident in a rural area at a distance of more than one mUe from the place of business •of the nearest panel chemist. The Commissioners' decision on any question arising under the regulation is final (Reg. 12). The^distance of one mUe is to be measured by road or path. The arrangements made by the Committee with a practitioner as above will stand until the end of the medical year even if a ^ihemist should start business within such a distance of the person's residence that the necessity for the special arrangement no longer exists (Reg. 12). If, however, the insured person •changes his place of residence during a year to a place within a 50 mile of a chemist under agreement with the Committee the doctor is not entitled to continue to dispense. (176) The Committee must also arrange with panel practitioners to supply in all cases drugs which are necessarily or ordinarily administered by a practitioner in person, and drugs and appliances required for immediate administration or application, or required for use before a supply can conveniently be obtained in the ordinary way through a panel chemist (Eeg. 12 (3)). (D) Range of Service. (177) The treatment which the practitioner is required to give is " of a kind which can consistently with the best interests of the patient be properly undertaken by a general practitioner of ordinary professional competence and skill," but he is bound to advise the patient as to what steps should be taken to obtain any treatment beyond this which the condition of the patient may demand. The practitioner is not required by his agreement to give, or entitled thereby to charge for, treatment to any person in respect of a confinement. The conditions of the Parliamentary Grant to the Committee require that the domiciliary treatment of persons on panel-lists recommended for sanatorium benefit shall be undertaken by the practitioners by whom they are attended. (First Schedule to Agreement.) (178) The question of whether a particular operation or other service can consistently with the best interests of the patient be properly undertaken by a general practitioner of ordinary pro- fessional competence and skill is one for determination, having regard to the conditions and practice of the locality and the degree of urgency of the patient's need. No rules for rigid application can be stated, but for the guidance of Committees certain general principles on which the practice appears to proceed may be indicated : — (a) Special experience and sldll of a particular practitioner on the panel is not to be exploited. {b) The standard of competence and skill is, however, that of the average general practitioner, and the in- competence of a particular practitioner is not a ground for excluding a particular operation or service, or for reducing the general standard of the service. (c) The exigencies of service in districts removed from hospital practice demand a degree of competence and skill in a general practitioner as regards operations and other services which, in the interests of the patient, may in more favoured districts be better left to hospital or specialist treatment. (d) In any district urgent need for immediate treatment will extend the range of service. The matter is, in each instance, one for consideration in the first place by the Local Medical Committee, and as has been men- 51 tioned in paragraph (87) may arise out of a complaint dealt with by the Medical Service Sub-Committee. The Insurance Com- mittee and the Local Medical Committee may agree upon the- decision, but, in the event of failure to come to an agreement, or where the Commissioners do not agree with a decision of both the Local Medical and Insurance Committees, the Commissioners will appoint three referees to hear evidence and decide the question at issue. The referees comprise two practitioners in actual practice in Great Britain and a member of the Faculty of Ad- vocates or enrolled law-agent, in actual practice. The procedure in connection with an inquiry has been prescribed by Rules, dated 3rd September 1914, which are printed in Appendix VIII. The referees may decide any question by a majority, and subject to the Regulations and Rules may determine their own procedure^ The decision must be reported to the Insurance Committee, and by them to the Commissioners, and the referees must state whether in arriving at their decision they have had regard to any custom or practice of the medical profession which is peculiar to the area (Reg. 50). (E) Standard of Treatment. (179) The conditions of the Special Parliamentary Grant to the Committee of 2s. 6d. per person entitled to medical benefit require that the general arrangements made by the Committee shall be such as to secure to insured persons a standard of treatment satisfactory to the Commissioners. (F) Remuneration. (180) The basis of payment for services is explained in Chapter VI. It is to be noted that a practitioner is precluded from accepting any fee or other remuneration in respect of treat- ment which he is required to give under his agreement except as the agreement provides. ((?) Medical Records. (181) It is a condition of the payment to the Insurance Com- mittee of th,e special Parhamentary Grant that the practitioner shall keep such records of the diseases of his patients as is required by the Commissioners. In view of the importance of the statistics of diseases which it is hoped to obtain from this source thenecessity for making the records both complete and accurate cannot be too strongly emphasised. There are two alternative forms of record — the Medical Day- Book and the Medical Record Card. Only one system may be in use in any Committee area, and the choice is a matter for decision by the Panel Committee, subject to the ap- proval of the Commissioners. The records of a practitioner who is on the panel for two or more adjacent Insurance Committee areas, whether in book or in card form, must be iept separate. (182) Medical Day Boohs are issued by the Insurance Committee. Each page of the book is current for a calendar month, and 52 contains spaces for details regarding 30 patients. All attend- ances and visits (including special visits, etc.) upon persons entitled to medical ' benefits must be entered. The page is divided into three portions, the left hand portion for notes to be retained by the practitioner, the middle portion to be sent to the Insurance Committee within 14 days of the end of the month to which it refers, and the right hand portion to be sent to the Com- missioners within the same period. Two points of detail may be mentioned, attention to which will obviate much correspond- ence. In the first place, if two or more pages are used in any month, each portion of the first page should be lettered " A," each portion of the second page " B," and so on. In the second place, if the treatment of a particular p&,tient did not terminate during the month, the nature of the illness, even if diagnosed, should not be entered for that month, but the patient's name should be carried forward at once to the next month, and in the space for " nature of illness " in the first month there should be inserted the serial letter of the page and the number against which the name of the patient is entered in the second month. It is possible that a patient whose name is carried forward may not require any attendances or visits during the second month. If this is the case, a zero should be entered in the appropriate column, and if the" practitioner is still of opinion that treatment is not concluded, the name should again be carried forward and a reference to re-entry made. In dealing with the month of December a modification of this procedure is necessary for statistical purposes. For that month both the nature of illness and a reference to the re-entry in January should be given in cases which are not concluded. It is important that a return should be made although no patients may have been seen during any month. Where a panel practitioner is acting as deputy say for an absent colleague, treatment given to persons on the absent colleague's panel list should appear on the records of the absent colleague. (183) Each Medical Record Card is applicable to a single patient and is current for a complete calendar year. There are two portions — one to be sent to the Insurance Committee, and one to the Commissioners, between 1st and lith January of the year following that to which the card refers. A practitioner will not require to write a Record Card for any person unless and until that person receives treatment, and not more than one Record Card should be initiated in respect of any person in the same year. The cards are self-explanatory, and no " reference to re-entry " is necessary. Before they are despatched to the Commissioners the name of the Insurance Committee, and of the practitioner, should be entered in the spaces provided. The Card system has many advantages in practice over the Day Book one, and its use is steadily extending. There is no doubt that it presents advantages to the practitioner, and is 53 adaptable to other uses than simply keeping records, but like all card systems regular and timeous use is essential to its success. The form of card in use is shown in Appendix IX. (H) Certification of Incapacity. (184) It is a further condition of the Special Parliamentary Grant to Insurance Committees that certificates shall be furnished to every insured person, where he so desires and requests, in such form, on such occasions, and generally in such manner as the Commissioners may determine, for the purposes of any claim made by him for sickness or disablement benefit or for the purpose of determining or calculating the period during which siclmess benefit is or would, but for any Section of the Act dis- entitling him, have been payable, or of calculating arrears. The Commissioners have made Eules for the giving of such certificates and have issued model forms of first, intermediate, and final certi- ficates. The new uniform system of certification came into force on 1st January 1915. It was fully explained in Memo. 211 I.C., issued by the Commissioners for the information of doctors and Approved Societies, and a copy of that Memorandum -with the Rules and Model forms of Certificates appended is printed in Appendix X. (ii.) Systems or Institutions. (185) Under Section 15 (4) of the Act of 1911 any system or institution which provides medical attendance and treatment and which was in existence at the date when the Act passed (16th December 1911) can apply through its Board of Manage- ment or other authority for approval by the Insurance Com- mittee or Committees affected and the Commissioners. Where such approval is given medical attendance and treatment (in- cluding the provision of drugs and applicances) given through it to persons entitled to medical benefit is treated as medical benefit, and a contribution towards the cost is made from the funds of the Committee. The application must be made in the first instance to the Committee, who are required to inform the Commissioners whether they approve the system or institution, and to supply certain particulars of its management, rules, finances, staff, the scope of treatment, etc. The essential conditions for the approval or the continued approval of the Commissioners are — (a) that the system or institution shall make such alterations in and* additions to its rules as the Commissioners may require, and shall not make any alterations or additions affecting the rights of insured persons except with the consent of the Commissioners ; (b) that it shall be conducted in such a manner as to comply with anyconditions for the receipt of the Parhamentary Grant applicable to the giving of treatment by panel 54 practitioners {e.g. the keeping of records of diseases and treatment given) ; (c) that any person under the system or institution shall be entitled, if he so elects at the prescribed date, to obtain medical benefit in the ordinary way from a practitioner on the panel in place of from the institution. No institution has been approved in Scotland. Post Office System. (186) The Post Office Medical System is the only system ap- j)roved in Scotland. A list of the Insurance Committee areas for which it has been approved is given in Appendix XI. Under it members of the Post Office stafi entitled to free medical attendance are generally placed on the " capitation list " of the medical officer attached to the office at which they are employed. In respect of each officer on his list the medical officer receives from the Department a fee of 8s. 6d. per annum, in return for which the staS under his care are entitled to receive at his surgery (or at the Post Office when the medical officer attends there) advice -and treatment such as a general medical practitioner is accus- tomed to render to his patients in the course of ordinary practice, including the domicUiary treatment of tuberculosis in the case -of persons recommended for such treatment under Sanatorium Benefit, and also such medicine as they may require. Officers who ^re too unwell to leave home are entitled to be visited at their home if they live within the medical officer's visiting area, which is measured by a circle of three miles radius described round the office "to which the medical officer is attached, or in the case of a medical officer attached to a group of rural offices by circles of three miles radius round each office. Officers living outside the visiting area of the medical officer of the office at which they -are employed are treated exceptionally, and are placed on the " capitation list " of the medical officer nearest to their homes if they live within his visiting area. Officers normally entitled to free medical attendance, but not attached to any definite headquarters, as, for example, labourers in the Engineering Department, are not placed on capitation hsts, but are allowed to avail themselves of the services of the medical officers of the districts they are employed in when they fall ill, and the privilege of consulting the neigh- bouring medical officer is also conceded to officers who fall ill -while absent from their headquarters on official business. The payments made to medical officers for attendance on such " itinerants " are at the rate of 2s. 6d. per visit to or by the patient, subject to a maximum payment of 8s. 6d. per half-year ior each officer attended. 55 SECTION (II.)— ARRANGEMENTS WITH CHEMISTS AND PHARMACISTS. General. (187) The general pro-visions of the Acts and Regulations as to the steps to be taken by the Insurance Committee to arrange for the supply of drugs, medicines, and appliances follow very closely those relating to medical treatment. Thus in virtue of Section 15 (5) (&) of the Act of 1911 any person, including a firm, or body corporate has the right to have his name placed on the panel hst of the Committee, and to enter into an agreement with the Committee for the purpose of supplying such drugs and appliances or any of them as he is legally entitled to supply unless the Commissioners and the Joiat Committee after inquiry are satisfied that the inclusion of the name on the panel, either initially or after removal by the Com- missioners from any panel in the United Kingdom, would be prej a- dicia] to the efficiency of the service. No person is, however, en- titled to dispense medicines under the agreement except a chemist who undertakes that all medicines supplied shall be dispensed either by a registered pharmacist, or under the direct supervision of a registered pharmacist, or by a person , who, for three years immediately prior to 16th December 1911, acted as a dis- penser to a duly qualified medical practitioner or a public institu- tion. " Chemist " is the term used in the Medical Benefit Regulations to mean any person, firm, or body corporate entitled to carry on the business of a chemist or druggist under the pro- visions of the Pharmacy Act, 1868, as amended by the Poisons and Pharmacy Act, 1908, and by " registered pharmacist " is meant a person who is registered as a chemist or druggist under the Pharmacy Act, 1868 (Regs. 9 and 19 (1)). Panel List. (188) A person may enter into an agreement to supply drugs only, including or excluding scheduled poisons or appliances only, or both, and may or may not be entitled to dispense medicines. A list of names and addresses of persons who have entered into agreements must be prepared by the Insurance Committee, and must distinguish between the persons entitled to supply drugs only, appliances only, and to dispense medicines (Reg. 10). (189) The list must be submitted to the Pharmaceutical Com- mittee before it is issued, and must be issued at least 14 days before the beginning of each medical year. A copy must be sent to the Commissioners and to every practitioner on the panel, and a copy kept up to date must also be available for the inspection of insured persons at the office of the Committee, and such other places {e.g. Pos.t Offices) as the Committee think fit. Any alteration which takes place must be communicated to the Commissioners as soon as possible (Reg. 19). 56 Notice. (190) Every person on the list must exhibit at his place of business a notice in the following form so far as applicable :^- National Insurance Acts, 1911 to 1913. {Name of Person or Firm contracting). Under contract with the Insurance Committee for the County (or Burgh) of To dispense medicines. To supply drugs. To supply drugs (except scheduled poisons). To supply appliances. (Reg. 11 (3) and Fourth Schedule.) Form of Agreement. (191) A draft agreement embodying the conditions upon which persons are invited to undertake the supply of drugs and appliances must be prepared by each IiJsurance Committee after consultation with the Pharmaceutical Committee, and sub- mitted to the Commissioners for approval. The agreement must include the conditions set forth in the Third Schedule of the Regu- lations and the Drug Tariff (Reg. 10). A Model Form of Agree- ment has been issuedfor the guidance of Committees, and is printed in Appendix XII. Conditions of Agreement. (192) The conditions of the agreements for the supply of drugs and appliances are mutatis mutandis similar to those applicable to agreements between the Committee and panel practitioners. (See Appendix VII.) Disputes and questions regarding the agreements are to be settled in the same manner. The provisions worthy of special notice are those requiring the chemists (1) to supply drugs and appliances of good quality ; (2) to supply with reasonable promptness ; (3) to supply the drugs and appliances free of charge to the person entitled to medical benefit ; (4) to provide, free of charge to the insured person, proper bottles or other vessels for any substances to which Section 5 of the Poisons and Pharmacy Act, 1908, or the Regulations made under Section 1 of the Pharmacy Act, 1868, relate ; (5) to provide proper bottles or vessels in other cases on the price being deposited by the insured person, which will be refunded upon the return of the bottles or vessels in a clean condition. Drug Tariff. (193) The " Drug TarifE " is the list of the prices prepared by the Committee after consultation with the Local Medical Committee, the Panel Committee, and the Pharmaceutical Committee, on the basis of which the sums to be paid for the drugs ordinarily supplied and for the prescribed 57 appliances are calculated. The method of ascertaining the amount of the payment by the Committee to the chemist for drugs not included in the Tariff is also incorporated in the agreement and is determined by the Insurance Committee after consultation with the Committees mentioned (Reg. 8). Both the Tarifi and the method of pricing non-tarifi drugs and medicines are subject to the approval of the Commissioners. In order to avoid the difficulties and anomalies which it was feared might be attendant on different tariffs in different areas in Scotland the Pharmaceutical Standing Committee for Scotland prepared and submitted to the Commissioners a Model Form of Tariff which was adjusted and issued to Committees for their guidance. The Model Form has been adopted in all areas in Scotland. Emergency Provisions. (194) Owing to the outbreak of war certain drugs were subject to a considerable rise in price. To meet the hardship to chemists attendant on extreme fluctuation of prices, a special grant was made available by the Government in 1914 which permitted an increase on the contract price to be allowed in the case of certain drugs. In the 1915 Tariff drugs which it was anticipated would be subject to substantial fluctuation in prices were "starred," and arrangements were made for a monthly revision of the price. Proper and Sufficient Medicines. (195) Questions with reference to what are to be regarded as proper and sufficient drugs and medicines were dealt with in Circular No. 389 and Memo. 587, issued by the Commissioners for the assistance of Committees. Certain drugs and medicinal substances are relatively cheap, while others are comparatively costly. Even of drugs which are in common and necessary use a number are somewhat expensive. In normal circumstances expense, however, by itself should never be a bar to the supply of a drug under National Insurance. The insured person, subject to the provisions of the Acts, is entitled to receive proper and sufficient medicines, but in order that he may do so restrictions must be imposed on improper or excessive prescribing. During the period of the war, when the suppHes of certain drugs are restricted, care is especially necessary in order that the available supply may be made use of to the best advantage. Preparations which are the same in substance may figure under different titles, varying in cost according to the proprietary or other names by which they are designated in prescriptions. In this connection Circular 389 was issued by the Commissioners for the general guidance of Insurance Committees and others in endeavouring to arrive at a decision with regard to particular questions which might emerge, and in cases of reasonable doubt the Commissioners have been prepared to advise Committees, if requested to do so. 58 without prejudice to their own position in determining matters iformally submitted to them as a dispute. If the Panel Committee in any Insurance area, acting as expert advisers on methods of prescribing, desire to inform the Insurance practitioners of the method which they as a Committee propose to adopt in the scrutiny of prescriptions, and it it be their con- sidered opinion that certain preparations should not be supplied, or that certain others should only be prescribed in a particular form or under a particular name, they would in the view of the Commissioners be entitled to declare their method and expresstheir opinion by means of a circular issued by them to practitioners on the panel. The specific compounds or preparations which the Panel Committee regard with disfavour will necessarily vary to some extent with local medical custom, and the views of the Panel Committee could not be held as binding on a particular doctor in the administration of a particular 'form of a remedy to a particular patient ; but if the doctor, knowing the opinion of the Panel Committee to be opposed to the use of the particular form, and being advised of the method which they propose to adopt in scrutinising prescriptions-, elects to prescribe the remedy in the particular form, it would devolve upon him to justify his procedure and to show cause why he should not be surcharged. Panel Committees in a number of Scottish areas have already taken useful action by circularising their practitioners on these matters. In any area where the Panel Committee desire to take this course, the Insurance Committee should ofier them every facility, by conference and otherwise, towards carrying out their Emergency Drugs and Appliances. (196) In approving schemes of Committees for the issue to their practitioners of a supply of emergency drugs and appliances the Commissioners have required that the quantities ordered at one time should be restricted within definite limits. Their object in so determining has been to enable Committees to control the frequency and amount of such orders by reference to the number of insured persons on the panel lists of practitioners and other relevant circumstances. Appliances. I ' ( 197) The medical and surgical appliances which maybe supplied as part of medical benefit are in terms of Section 8 (1) of the Act, such as may be prescribedin regulations made by the Commissioners. The following have been prescribed (Reg. 7 and Second Sch.)-: — Bandages — • Calico, bleached. Calico, unbleached. Crepe. Domette. Elastic-web. Bandages — continued- Flannel. Indiarubbex. Muslin. Plaster of Paris. Open-wove. 59 Gauzes — Cotton Wool Unmedicated. Unmedicated. Boric. Boric. Carbolic. Sal-alembroth. Cyanide. Iodoform. Wood wool. Picric. Tow, plain. Sal-alembrotli. Oiled silk. Sublimate. Oiled paper. Oiled cambric. Gutta-percha tissue Adhesive plaster. Ice-bags — Lints — Indiarubber. Unmedicated. Check sheeting. Boric. Splints. Sal-alembroth. Catheters. Gum elastic. Soft rubber. Where loan would be practicable, the Committee may make provision for lending any of these appKances, and if this has been done and the practitioners and chemists have been informed of the fact, an insured person is not entitled to the appliance ■otherwise than under the lending arrangement (Keg. 22). (198) The Drug TarifE under the Medical Benefit Regulations is the list of prices for drugs ordinarily supplied, and for prescribed appliances. There are ex-list drugs, not on the TarifE, which may "be ordered also, and the manner of calculating payment for these is provided for in the Eegulations (see paragraph (193) above) ; but the only appliances which may be supplied are those named above. It has come under notice that in certain areas such appliances as douches, sjo^inges, trusses, nebulisers, throat brushes, and jaconette have been ordered. Articles of this kind are not prescribed appliances ; and if supplied should not be paid for by an Insurance Committee. Tuberculosis and the Drug Fund. (199) Consideration of the prescriptions investigated in course ■of inquiries has indicated a certain amount of overlapping between Medical and Sanatorium Benefits. When substances commonly regarded as remedies for consumption figured in large quantities under the Drug Fund, the question emerged whether owing to the failure of practitioners to write the appropriate index marks on prescription forms, the medicines of patients recommended for domiciliary treatment under Sanatorium Benefit were being improperly charged to the Drug Fund, or whether patients who were qualified for domiciliary treatment under Sanatorium Benefit were being retained for any reason under Medical Benefit. 60 On either alternative the Drug Fund would be called upon to bear a burden from which it should be immune and the general tendency to shortage would be accentuated. The Commissioners have expressed the opinion that procedure under this head is worthy of careful consideration by Committees. Temporary Residents. (200) Similar precautions should be observed in the case of temporary residents receiving medical treatment within the area of a Committee. Care should be taken by practitioners to mark prescriptions for such persons in the manner directed by the Committee, in order that the cost may be duly charged against the Central Medical Benefit Fund. The Commissioners have recommended Committees to take steps with a view to protecting their Drug Funds against improper claims from this source. Shortage of Drugs owing to State of War. (201) Serious questions regarding the supply of drugs and medicines have arisen in consequence of the state of war now existing in Europe, the efiect of which has been to produce in this country a shortage in the supply of certain drugs and prescribed appliances. In the case of some preparations it is probable that no further consignments can be obtained until the termination of hostilities ; in the case of others it may be possible to procure quantities from sources not hitherto drawn upon. The duration of shortage will vary with different substances, to an extent which it is not possible at this juncture to foresee. The question at issue with regard to the use of such articles is not wholly or mainly one of price. Nor is it one which solely affects the Insurance Medical Service. Apart from these con- siderations, it is essential at present that all existing stocks of remedies for disease should, as far as possible, be husbanded, by reserving drugs in which there is a shortage for cases to whose treatment they are indispensable, and endeavouring to provide for the needs of others by other remedies of similar action. The position has been brought under the notice of prac- titioners and Insurance Committees for their part should, as far as possible, co-operate with Panel Committees in the adoption of any recommendations or other measures which may seem likely to prove of service. Facilities. (202) Arrangements must be made by the Insurance Committee with the Pharmaceutical Committee to secure that in its area so far as practicable one or more places of business of persons supplying drugs and appliances shall at all reasonable times be open to persons entitled to obtain drugs or appliances (Eeg. 10 (3)). 61 Alterations in Agreements. (203) The Committee must, after consultation with the Local Medical Committee, Panel Committee, and Pharmaceutical Com- mittee, submit for the approval of the Commissioners a statement of any alterations which they may desire to make in the Drug Tarifi, or other conditions in the agreements for the supply of drugs or appliances. No alterations can, however, take place before the beginning of the following medical year, and if any such alterations are approved by the Commissioners due notice must be given by the Committee to each person, etc., con- cerned not later than six weeks before the beginning of the year (Keg. 18). In the year 1915, however, this is subject to the special emergency arrangements due to the war of a monthly revision of the prices of " starred " drugs, and to a right to revise the contracts once during the course of the year if the Commissioners so approve (Medical Benefit Eegulations, 1914). Termination of Agreement. (204) If a person, includiag a firm or body corporate desires to cancel his agreement he may do so by giving notice to the Com- mittee in writing at least four weeks before the beginning of any medical year, and the agreement will then terminate at the end of the current year. Unless such notice is given the person, firm, or body corporate will be deemed to have continued the agreement, subject to any alterations in the conditions which may have been notified to him or them under the last paragraph. The agreement cannot be determined at any time during the year except with the consent of the Committee. In the event of death the person's name is removed from the list at once, pro- vided that where the business of the person is carried on in accordance with the provisions of the Pharmacy Act, 1868, as amended by the Poisons and Pharmacy Act, 1908, by a person who is his executor or administrator or the trustee of his estate within the meaning of Section 16 of the former Act, that person is deemed to be on the list so long as these conditions continue (Keg. 19). SECTION (III.)— THE REGISTER. (i.) Gbneeal. (205) Bach Insurance Committee must prepare and keep to the satisfaction of the Commissioners a Register of Persons resident in its area entitled to Medical or Sanatorium Benefits and all Deposit Contributors so resident. The Register consists of three lists : — (a) Approved Society members, including members of the Navy and Army Insurance Fund ; (6) Deposit Contributors ; (c) Exempt persons. 62 The lists must show the addresses of the persons whose names are included therein, and must distinguish between those entitled to (i.) Medical and Sanatorium Benefit; (ii.) Medical Benefit only; (iii.) Sanatorium Benefit only ; (iv.) neither Medical nor Sanatorium Benefit. Approved Society members must be distinguished as (i.) members of the Navy and Army Fund ; (ii.) members of other Societies. Deposit contributors must be distinguished as having or not having attained the age of 70 years at the commencement of the current medical year (No. 3 of Payments to Insurance Committees Regs., 1914). The Register is necessary in order that the Com- mittee may know who are the persons for whom arrangements in regard to medical treatment must be made. To prepare and maintain the Register it is necessary that the Committee should be supplied with information as to the members of Approved Societies, Deposit Contributors, and Exempt Persons entitled .to benefit who are resident in its area. This information is supplied by Approved Societies for their members and by the Com- missioners for Deposit Contributors and Exempt Persons. A card system of Register has been adopted by every Committee. The Register, in addition to constituting a record of insured persons entitled to medical and to sanatorium benefits, or either of them, is also utilised in connection with the administration of sickness, disablement and maternity benefits of Deposit Contributors and with the finance of the Committee, as ex- plained in the Section dealing with that subject. (ii.) Pkeparation of Register. (206) The Register includes (a) the Index Register ; (6) the Sus- pense Register; and (c) Deposit Contributors not entitled to Medical or Sanatorium Benefit. The Index Register. (207) The Register is comprised of notifications on thin cards of uniform size called " Index Slips." In order that they may be readily distinguished index slips of Society members entitled to medical and sanatorium benefits are in colour — white for men and blue for women. Deposit Contributors' Index Slips are yeUowfor men and green for women. The index slip of the exempt person is red. Further, members of Societies entitled to medical benefit only, viz. the special married women voluntary contributors (classes of contribution card H^ and H^) are distinguished by pink slips. Members of Societies who having entered insurance at 65 or over, on attaining the age of 70, have less than 27 contributions properly paid in respect of them lose their right to medical benefit, and are shown in the Register by means of mauve slips. Deposit Contributors who attain the age of 70 retain their title to medical and sanatorium benefit provided they comply with the con- ditions of the Deposit Contributors Benefits Order, 1914 (No. 2) 63 (see paragraph (371)). Voluntary Contributors, it may be noted, under Section 10 of tte Act of 1913, are not allowed to receive medical benefit if their total income from all sources exceeds £160 a year, the contribution which would otherwise be payable being in that case reduced by one penny. Suspense Register. (208) Where the index slip of an insured person who has estab- lished his title to benefit cannot readily be traced a " Suspense Slip " is prepared by the Committee. Slips so written are kept apart from the slips comprising the Index Eegister. Arrangement of Register. (209) For ease in access and handling index slips are usually arranged in a filing cabinet under — 1. Societies, 2. Deposit Contributors, and 3. Exempt Persons, in alphabetical order according to the surname of the insured persons, and are further subdivided into men and women. Some Committees arrange slips for Societies with Branches under branch subdivisions. (iii.) Keeping of Begisteb. The Index Register is kept up to date in the following manner : — Afproved Society Members. (210) New Members.— An index slip should be sent by the Society to the Committee of residence not later than seven days after a person is admitted as an insured member (Reg. 29 (4)). In the case of a person in Class B (Soldiers, Sailors, and Marines in the service of th^ Crown, who are not- entitled to medical or sanatorium benefit), the index slip is not sent until the member transfers from Class B to some other Class and becomes eligible for these benefits. (211) Failure on the part of the Society to send the index slip on admission of the member to insurance will result in delay in the issue of the medical card to the member, who may thus be prejudiced in obtaining medical benefit. Efiective member- ship begins on the date subsequent to entry into insurance from which the Society undertakes to admit the insured person. The index slip should be forwarded without delay, and on no account must its despatch be deferred until the Contribution Card has been received. In the case of a voluntary contributor, however, the Society should satisfy itself that the contributor has entered insurance by the payment of at least one contribution. (212) Transfers. — The fact that a person has transferred from 64 another Society or Branch, or from the Deposit Contributor or Exempt Person Classes, should be noted in the appropriate space on the back of the index slip sent by the Society. (213) Deaths and changes of status affecting' the position of members of Societies in regard to medical or sanatorium benefit are notified to Insurance Committees by means of orange slips and pink slips. The former slips are used for intimating cessa- tion of membership owing to death or resignation, and suspension from benefit owing to joining army or navy, removal abroad, or ceasing insurance on marriage, the latter for notifying that the persons in respect of whom they are issued are no longer employed owing to marriage, have elected to become Special Voluntary Contributors, and have ceased to be eligible for sanatorium benefit. (214) On receipt of an orange slif from the Society, the corre- sponding index slip should be traced and destroyed in cases where the member has died, is suspended from benefit, or has ceased to be insured. Where the person has been expelled or has resigned (otherwise than on transfer) the fact of expulsion or resignation should be noted on the index slip, which should be retained pending certification from the new Society or the Commissioners. Where the Committee does not hold an index slip, but has prepared a suspense slip the Society should be requested to state to what Committee the index sUp was sent, .and steps should be taken to recover the index slip and destroy dt. The doctor or institution and the insured person should be notified and the medical index amended. On receipt of a fink slip the corresponding blue index slip must be destroyed. The doctor or institution should be notified of the new name and address and the Medical Index amended. Where removal from the area has taken place the pink slip, will be transmitted on receipt of the half medical card. Where it is noted on the index slip that the person was formerly a member of another Society, the index slip of the former Society must be destroyed. If the person was formerly a Deposit Contributor or an Exempt Person the index slip must be returned to the Commissioners. (215) Under the medical card system the index sUp of an Approved Society member who removes temporarily (i.e. for a period up to 3 months) to 20 20 J> 21 21 1) 22 22 J) 23 23 JJ 24 24 S5 25 25 )» 26 26 }) 27 27 3> 28 28 )i 29 29 9} 30 30 >5 31 31 3) 32 32 >> 33 33 i) 34 34 »J 35 35 » 36 36 >? 37 37 t> 38 38 J> 39 39 JS 40 40 JJ 41 41 fa 42 42 S3 43 43 93 44 44 9) 45 45 33 46 46 )9 47 47 » 48 Weekly Weekly Contribution Contribution for Men. for Women. (2) (3) s. d. s. d. 7 6 7 6i q, 7i 64 a n 6i n 6i n 64 n 64 n 64 74 64 8 7 8 7 8 7 8 7 8 7 8 7 8i 74 8i 74 84 74 Si 74 9 8 9 8 9 8 n 8 n 84 n 84 H 84 10 9 10 9 104 94 10* 94 11 10 11 10 106 (d) Volimtary 48 an d under 49 49 }) 50 50 51 51 52 52 53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 61 62 62 63 63 64 64 65 65 66 66 67 67 68 68 69 69 70 Contributors- —continued. s. d. s. d. in Hi oi lOi 11 oi Oi 1 11 114 1 H 1 04 2 n 3 1 04 1 1 1 14 4 1 2 1 24 4* 1 24 1 3 5 1 3 5 1 3 5 1 3 ^ 1 2 H 1 2 H H 1 2 1 2 44 1 2 (e) Late Entrants. Employed Deposit Contributors aged 17 or upwards entering Insurance after ISth. October 1913, wliose time has not been spent in a school or college or in indentured apprenticeship or otherwise in instruction without wages or otherwise in the completion of their education, and who wish to quahfy for full benefit must pay an additional weekly contribution according to the following tables : — MEN. WOMEN. 17 and under 18 . d. 17 and under 18 . d. 04* 18 19 . 04* 18 19 . . 04* 19 20 . 04* 19 . , 20 . 04* 20 21 . 04* 20 21 . . 04* 21 22 . 04* 21 22 . . 04* 22 23 . 04* 22 23 . . 04* 23 24 . 04* 23 24 . . 04* 24 25 . 04* 24 25 . . 04* * In these oases there being no id. insuranoe stamp, a Id. insurance stamp should be affixed every other week. 107 (e) Late Entrants — continued. MEN. WOMEN. d. d. 25 and under 26 . . 25 and under 26 . 26 27 .. 26 27 . •27 28 .. 27 28 . 28 29 .. 28 29 . 29 30 .. 29 30 . -30 31 .. 30 31 . 31 32 .. 1 31 32 . • 14 32 33 .. 1 32 33 . 14 33 34 .. 1: 33 34 . 14 34 35 .. 1 : 34 35 . 14 35 36 .. 2 35 36 . 2 36 37 .. 2 36 37 . 2 37 38 .. 2 37 38 . 2 38 39 .. n 38 39 . 2 39 40 .. n 39 40 . n 40 41 .. n 40 41 . n 41 42 .. n 41 42 . 24 42 43 .. 3 42 43 . 3 43 44 .. 3 43 44 . 3 44 45 .. H 44 45 . •34 45 46 .. H 45 46 . 34 46 47 .. 4 46 47 . 4 47 48 .. 4 47 48 . 4 48 49 .. 4i 48 49 . 44 49 50 .. 44 49 „ 50 .. 44 50 51 .. 5 50 51 . . 5 -51 52 .. H 51 52 .. 5 52 53 .. 54 52 53 .. 54 53 54 .. 6 53 54 .. 6 54 55 .. 64 54 55 .. 64 55 56 .. 7 55 56 .. 64 56 57 .. 74 56 57 .. 7 57 58 .. 8 57 58 .. 74 ■58 59 .. 84 58 59 .. 8 59 60 .. 9 59 60 . 84 '60. 61 .. 94 60 61 . . 84 61 62 .. 94 61 62 . 9 -62 63 .. 10 62 63 . . 9 63 64 .. 10 63 64 . 9 >64 65 .. 10 64 65 .. S 108 (e) Late i^wirawis— continued. MEN. d. WOMEN. d 65 and un del- 66 . n 65 and under 66 . 8 66- „ 67 . n 66 67 . 8 67 68 . H 67 68 . 8 68 69 . 9i 68 69 . 8 69 70 . 94 69 70 . 8 (f) Mercantile Marine. The ordinary rate of contribution applies in the case of seamen when serving on home trade ships. In the case of men serving on foreign-going ships and ships engagod in regular trade between foreign ports the employed rate and the employer's contribution are each reduced by a penny. The employer's share of the contribution is payable in respect of every. week in which the seaman is employed, but every four contributions paid by the 'seaman in any calendar year are treated as five. There is credited to the contributor's account a sum equal to two-fifths of the amount of the contributions actually, paid in respect of him, and an equal sum is treated as having been expended on sickness benefit, the Parliamentary Grant being paid thereon (Sec. 48 (2), proviso (6)). SECTION (II.)— REFUNDS. (i.) On Permanently ceasing to ebside in the United Kingdom. (353) Where a Deposit Contributor shows that he has per- manently ceased to reside in the United Kingdom, he is entitled to a refund of 4:/7ths (or | in the case of a woman) of the amount standing to his credit in the Deposit Contributors Fund (1911 Act, Sec. 42 (g)). The refund cannot be made, however, antil the contributor has permanently ceased to reside in the United Kingdom. It can be paid either to the contributor or to some person in the United Kingdom nominated by him. Where the remittance is sent abroad the cost is in all cases deducted from the amount to be refunded.* (354) A Deposit Contributor who intends to leave the United Kingdom and desires to claim a refund should apply to the Insurance Committee in whose area he is resident for the forms necessary for making the claim after h? has left the United Kingdom. (These Forms are 174, 175, and 198.) (355) When the Committee has satisfied itself that the con- tributor has permanently ceased to reside in the United Kingdom, a certificate to that effect (Form 332) is prepared and forwarded to the Commissioners, together with the Index Slip. The refund * N.0 refund will be made to an alien enemy. 109 is then made and the Committee notified on Form 394B/A.G.D. (Scotland). (356) As relmid is made in some cases to the contributor himself after he has gone abroad it is necessary that the Clerk should furnish on Form 332 the full postal address of the con- tributor so that the letter containing the Money Order or Postal Order may not be returned on account of insufficient •address. (ii.) On the Death of a Deposit Conteibutoe. (357) Section 42 (f) of the 1911 Act provides that on the death of a Deposit Contributor 4/7ths (or ^ in the case of a woman) of the amount standing to his credit in the Deposit Contributors Fund shaU be paid to his nominee, or in default of a nomination to the person who would be entitled to receive the sum, as if it were money payable on the death of a member of a registered Friendly Society. (358) When, therefore, an Insurance Committee receives inti- mation of the death of a Deposit Contributor, the Clerk should immediately notify the Commissioners. (359) Where a Deposit Contributor has nominated a person to whom the4/7ths (or ^ in the case of a woman) of the amount standing to his credit is to be paid at his death, the nomination will be in the custody of the Commissioners, who will pay the money over to the nominee on receiving a certificate of death in proper form. An outstanding claim for benefit whether made by the contributor or, after his death, by his legal representative would be met in priority to the claim of the nominee. (360) Where the contributor has made no nomination but has left a will, the Commissioners cannot in general pay the portion of the sum standing to his credit in the Deposit Contributors Fund (which he might have disposed of by nomination) to his executor without production of confirmation. The Commissioners have no power to dispense with proof of title however small the estate. (361) Where the Deposit Contributor has died intestate and without making any nomination, the Commissioners will pay the appropriate sum to any person who has been appointed Executor-Dative and has duly confirmed to the estate; but where no Executor-Dative or other legal representative has been •appointed, the Commissioners are empowered to distribute the money among those persons who appear to them to be entitled ly law to receive it (i.e. to the husband or wife, or children, or other next of kin). (362) In a case where no nomination has been made, the Com- missioners may have to obtain the assistance of the Insurance Committee in ascertaining whether the deceased contributor — (a) has left a will upon which executors have obtained con- firmation ; or no (&) tas died intestate and an Executor Dative lias been appointed and taken out confirmation ; or (c) has died intestate and no Executor Dative has been appointed ; in which last case the Insurance Committee will be asked to- ascertain who are legally entitled to the money. (363) It should be borne in mind that unless the amount stand- ing to the credit of the contributor, together with the value of the stamps on the last contribution card, exceeds 5s. 4d. in the case of a man and 8s. 2d. in the case of a woman, the repre- sentatives of the deceased will probably consider that it is not worth while incurring the cost of a certificate of death (viz. 3s. Id.), and if in any such case a claim is intimated to the Committee it should be pointed out to the applicants that the amount payable will not exceed the cost of the certificate. (364) If in connection with the death of a Deposit Contributor the Insurance Book and Contribution Card of the deceased should come into the hands of the Committee, they should at once be sent to the Commissioners. SECTION (III.)— RULES. (365) Insurance Committees are required to make rules, subject to the approval of the Commissioners, with regard to the admini- stration by the Committee of the benefits of Deposit Contributors. A model form of Rules was issued by the Commissioners for the assistance of Committees (Appendix XVII.), and has been generally adopted (Section 14 (3) of 1911 Act). SECTION (IV.)— MEDICAL AND SANATORIUM BENEFITS. (366) The medical and sanatorium benefits of Deposit Contri- butors are administered by Insurance Committees under the same general conditions as those of members of Approved Societies. Reference should therefore be made to Chapters IV. and V. (367) The cost of these benefits is, however, defrayed in a different way. The cost of all the benefits of a Deposit Con- tributor (sickness, disablement, and maternity, as well as medical and sanatorium) is met from the amount standing to his credit in the Deposit Contributors Fund. In the case of British subjects seven-ninths of the cost (three-quarters in the case of a woman) is defrayed by the contributions paid on behalf of the contributor and the remainder is met from the State grants. (368) The right to benefits is suspended when the sum standing to the credit of a Deposit Contributor is exhausted. An In- surance Committee may, however, allow a Deposit Contributor to continue to receive medical benefit or sanatorium benefit after the expiration of the period for which his account has been debited. in (369) Under the Deposit Contributors Scheme, unless the con- tributor accumulates in one period a sufi&cient credit to ensure medical and sanatorium benefits in the next, he will lose those benefits, and Committees in administering benefits should see that this is explained to contributors, e.g. it would not be desirable to grant sickness or maternity benefit as so to exhaust the credit of the contributor, and thus disentitle him to benefits during the ensuing year without previously warning him of the effect on his right to medical and sanatorium benefits. While the contributor has anything at his credit, the Committee, however, has not the right to withhold payment of sickness or maternity benefit to which he may be entitled, if, after having been duly warned, he insists on his claim. It is, however, pro- vided by the Deposit Contributors Benefits Order, to which reference is made in paragraph (371), that towards the end of the year no payment on account of sickness or maternity benefit is, unless the Commissioners otherwise determine, to be made to any contributor of an amount greater than -the excess (if any) of the amount standing at his credit over the sums payable for medical and sanatorium benefits and administration expenses for the succeeding year — any unpaid balance of benefits being paid as soon after the beginning of the year as possible. (370) Section 42 (e) of the 1911 Act provides for the deduction at the beginning of each year of the sums payable in respect of a Deposit Contributor for medical and sanatorium benefit and administration expenses from the amount standing to his credit in the Deposit Contributors Fund. If at the commencement of any year he has not sufficient to provide these charges he will not be entitled to any benefits during that year unless the Insurance Committee consents, except so far as may be authorised by the Deposit Contributors' Benefits Order. The Insurance Com- mittee may attach conditions to the payment of benefits provided with its consent. (371) To meet the case of a considerable number of deposit contributors who, while not having sufficient at the beginning of the year at their credit to pay for a full year's medical and sana- torium benefits, had either th'en or later on in the year sufficient to provide themselves with these benefits for a part of the year, the terms of Section 42 have from time to time been modified by Orders of the Commissioners made under Section 78 of the 1911 Act. According to the Order applicable to 1915, the year was divided into quarters, and each deposit contributor who had not sufficient at the commencement of the year to pay for the full year's benefits was provided with niedical and sanatorium benefits for such quarters as could be paid for out of the sum at his credit. To meet the case of new entrants into insurance during the first half of 1914, it was provided that each person returning a stamped card for that half year was to be entitled to medical and sanatorium benefits for the first quarter of 1915 irrespective of the amount at his credit. After the first quarter. 112 however, he only got those benefits for such of the remaining quarters as after taking account of the charge for the first quarter «ould be paid for out of the sum at his credit. The Order is No. 94 (Scotland), and its full title is the National Health Insurance (Deposit Contributors' Benefits) Order (Scotland), 1914, No. 2. (372) Section 3 of the Act of 1913 provides that contributors ■do not cease to be entitled to medical benefit at the age of 70, provided that, in the case of persons 65 years of age or upwards -on entry into insurance, at least 27 contributions have been paid. If less than 27 contributions have been paid, the contributor ceases to be entitled to medical benefit although still eUgible for sanatorium benefit except, under the said Order, where he attained 70 after 5th July 1914, in which case he need only have been in insurance for over 26 weeks. If a contributor, 65 years of age or upwards on entry into insurance, has paid less than 27 contributions on attaining the age of 70, but has been at least 27 weeks in insurance, it will be ■open to him, by the payment of arrears, to bring the number of his contributions up to 27, and thus qualify for medical benefit after attaining the age of 70. A contributor aged 65 or upwards on becoming insured, who has not been in insurance at least 27 weeks, cannot, however, in any circumstances qualify to receive medical benefit after attaining the age of 70. SECTION (V.)— SICKNESS BENEFIT. (A) QUALIFICATIONS. (373) Sickness benefit is payable under certain conditions in Tespect of total incapacity for work resulting from a specific disease or a bodily or mental disablement. A contributor in order to be entitled to benefit must possess the following qualifica- tions : — (i.) He must have been in insurance for 26 weeks, (ii.) He must haive paid 26 weekly contributions, (iii.) He must be resident in the United Kingdom. ,(i.) and (ii.) call for no comment. (iii.) Eesidencb. (374) Where a Deposit Contributor becomes temporarily Tesident in some place outside the area of the Committee, but m the United Kingdom, or in the Isle of Man, or in the Channel Islands, the Committee, if satisfied that his residence outside the area of the Committee is temporary only, may take into con- ■sideration any appUcation by him for the payment of any sickness ■or maternity benefit. If a Deposit Contributor is resident outside the United Kingdom elsewhere than in the Isle of Man or the Channel Islands, and at the date of his leaving the United Kingdom was in receipt of sickness benefit, the Committee may allow him whilst so resident to continue to receive sickness benefit. 113 . (B) SUSPENSION OR MODIFICATION. (375) Moreover, there are certain circumstances in whicli pay- ment is suspended or modified. These include the following, which are farther described in the paragraphs below : — (iv.) When the contributor is in receipt of or entitled to compensation or damages in respect of the injury or disease causing incapacity, (v.) When the contributor is in a poorhouse, or in a charity or rate-supported hospital, asylum, con- valescent home, infirmary, or sanatorium, (vi.) When the contributor enters insurance on or after 13th October 1913, and is on the date of entry of the age of 17 or upwards and not entitled to the benefit of Section 9 (4) of the 1911 Act {see paragraph (390)). (vii.) When the contributor is unmarried and under the age of 21. (viii.) When the contributor is an ahen. (ix.) When the contributor is insured under Section 47 of the 1911 Act. (x.) When the contributor is in the Mercantile Marine, (xi.) In the case of a woman contributor suspended from ordinary benefits on marriage or who returns to employment after suspension. (xii.) In the case of a woman contributor incapacitated as a result of a confinement, (xiii.) When the contributor has become a seaman, marine, or soldier. (iv.) Payment of Compensation or Damages in Eespbct OF THE Incapacity. (376) The Act of 1911 (Sec. 11) provides that sickness or dis- ablement benefit shall not be paid to an insured person in respect of any injury or disease where the insured person has received or recovered, or is entitled to receive or recover, compensation or ■damages under the Workman's Compensation Act, 1906, or any scheme certified thereunder, or under the Employers' LiabiUty Act, 1880, or at Common Law, if — (1) the weekly sum ; or (2) the weekly value of any lump sum paid or payable is equal to or greater than the benefit which would otherwise be payable to such persons. (377) The Act further provides that where any such weekly sum or the weekly value of any such lump sum is less than the benefit in question, sach part only of the benefit will be paid as, together with the weekly sum, or the weekly value of the lump sum will be equal to the benefit. Thus, if a Deposit Contributor ■otherwise entitled to sickness benefit at the rate of 10s. per week, "were receiving or were entitled to receive compensation amount- . 114 ing to 10s. or more per week, no sickness benefit would be payable in respect of the incapacity. Tf, however, the con- tributor were entitled to receive as compensation, say, 8s. per week, and his rate of sickness benefit were 10s. per week, he would be entitled to receive as sickness benefit 2s. per week, that being fhe difference between the amount of the compensation and his rate of sickness benefit. (378) Sickness benefit maybe advanced to a contributor pend- ing the settlement of the question of compensation on the under- standing that any sums so advanced shall be refunded by the contributor if and when compensation is received. The amount advanced may be recovered by deduction from or suspension of future benefits. (379) As regards the duration of benefit, it should be noted that where partial sickness benefit is paid as described in paragraph (377), the maximum duration of such benefit is still 26 weeks. Thus, if a contributor is continuously sick and is receiving 2s.. per week benefit and 8s. per week compensation, not more than 26 weekly payments of 2s. can be made to him. (380) Where, however, the contributor has been in receipt of such partial benefit, then recovers from his illness, and subse- quently again becomes ill, special provision is made in the 1913 Act as to the calculation of continuing illness. In the ordinary case where full benefit is paid, two unconnected periods of iUness are reckoned as continuous for the purpose of calculating when the 26 weeks' duration of benefit expires, unless the periods are separated by at least 12 months. (381) If partial benefit only was paid, however, the con- tributor is treated as having been in receipt of benefit not for the whole period during which partial benefit was paid but for a period which bears to the whole period the same proportion as the amount of partial benefit paid bears to the full benefit to which the contributor would otherwise have been entitled. The period so calculated is to be treated as continuous, and as having expired on the last day of incapacity for which the partial benefit was paid. Thus, suppose the contributor has received 8s. per week com- pensation and 2s. per week sickness benefit for 10 weeks, and then recovers. For the purpose of " hnked-up " sickness he would be held to have received sickness benefit for two weeks, the two weeks expiring on the last day of his incapacity. If the compensation is greater than the sickness benefit would have been, and consequently no benefit at all is paid, the period is not to be counted towards the 26 weeks. Territorials and Special Reservists. (382) Section 11 of the Act of 1911 will normally not apply to- members of the Territorial or Special Reserve Forces injured while in training at drills, at the annual camp, etc. During such 115 training the contributor is employed in the Military Service of the Crown, which employment is specifically excepted from the provisions of the Workmen's Compensation Act and the Employers' Liability Acts. No compensation is, therefore, payable, and although the Army Regulations allow the payment of certain sums in cases of injury, such payments are entirely ex gratia, and sickness benefit should not be withheld. (v.) Contributor in a Poorhouse, Etc. (383) The following statement shows the efEect of the special provisions of the Acts where a Deposit Contributor is in a poor- house, hospital, asylum, convalescent home, or infirmary sup*- ported by any public authority, or out of any pubhc funds, or by charity, or by voluntary subscriptions, or in a sanatorium or similar institution approved under the Acts.* If the contributor is an inmate of an institution which does not fall within the above definition, e.g. a private nursing home, the ordinary provisions as to payment of benefit apply. (381) No sickness benefit must be paid to any person during any period when he is an inmate of any institution as above defined. It should be noted in this connection that the word " inmate " will not ordinarily extend to a nurse in the hospital in which she is employed or to persons regularly employed in or about a hospital, who are accustomed to receive there such treatment and attendance as they may require. (385) Where the contributor has dependants, the sickness benefit which he would otherwise receive must be applied for the rehef or maintenance of the dependants after consultation, wherever possible, with the contributor. (386) If the contributor is an inmate of a poorhouse, hospital, asylum, convalescent home or infirmary, and he has no depend- ants, the benefit may be used to provide any surgical apphances required on his behalf, or otherwise for his benefit when he ceases to be an inmate. The amount still outstanding must be paid in cash to the contributor after he leaves the institution, either in a lump sum or in instalments, as the Committee thinks fit. (387) All sums paid or expended in any of the ways above referred to are to be treated as payments in respect of sickness benefit for the purpose of determining the rate and duration of that benefit. (vi.) Late Entrants. (388) A Deposit Contributor who being 17 or over at the tinie becomes an Employed Contributor after 12th October 1913, will be entitled to sickness benefit at the rates shown in the Table below. * A list of sanatoria and other similar institutions approved by the Local Government Board for Scotland, under Part I. of the National Insurance Act, 1911, will be found in Appendix XIV. 116 Table showing the reduced rate of sickness benefit for employed contributors entering into Insurance after 12th October 1913 : — Age next Kate of Sickness Benefit. birthda}?- after entry into ' insurance. Men. Women. s. d. s. d. 17 No reduction. No reduction. 18 No reduction. 7 19 9 6 6 20 8 6 6 21 8 5 6 22 8 5 23 7 6 5 24 7 , 5 25 7 5 26 6 6 5 27 6 6 5 28 6 5 29 6 5 30 5 6 5 ' Over 30 5 5 1 (389) An Employed Contributor may qualify for the pay- ment of sickness benefit at the full rate (10s. a week for men and 7s. 6d. a week for women) by paying an additional weekly contribution from the date of his entry into insurance. The increased contributions applicable to various ages are given in the Table in paragraph (352). Since, however, a Deposit Contributor is entitled to benefit only so far as the amount standing to his credit will allow, the payment of the additional contribution will not be of full benefit to him until he joins a Society. (390) A Deposit Contributor who being 17 or over becomes •an Employed Contributor after 12th October 1913, is entitled to sickness benefit at the full rate (so far as the amount •standing to his credit allows), if he can prove that his time since he became 17 has been spent in a school or college, iii indentured apprenticeship or otherwise under instruction mtkont wages, or otherwise in the completion of his education. (vii.) Unmarried Minors. (391) A Deposit Contributor under the age of 21, who is un- married and has no dependants, is entitled to sickness benefit 117 at the rate of 68. a week (women 5s. a week) with, a reduction to 5s. a week (women 4s.) after the first 13 weeks, A contributor under 21 who is married or has any member of his family wholly or mainly depending on him is entitled to sickness benefit as though he were over 21. (viii.) Aliens. (392) The rates of sickness benefit applicable to aliens are seven- ninths of the ordinary rates in the case of men and three-quarters invthe case of women. It should be observed, however, that British women contributors who marry aliens are treated as British subjects and receive full benefits according to date of entry in respect o| their own insurance. (ix.) Sections 47 and 53. (393) Where a person is insured under Section 47 of the 1911 Act his employer undertakes to pay full wages during the first- 6 weeks of sickness, and sickness benefit is not payable during this period. It is deemed to have been paid, however, and accordingly commences in ordinary circumstances at the be- ginning of the seventh week of sickness (not on the fourth day of the seventh week) {see paragraph (399) below), and continues for twenty weeks from the first day for which sickness benefit Is paid, i.e. it ordinarily terminates at the end of the twenty-sixth week of actual incapacity. As regards the precise period for which the employer is hable, it may generally be stated that contributors imder Section 47 if engaged by their employer for a term of less than six months certain cannot claim sickness benefit until they have been ill for six weeks in all in any period of 12 months. They then receive their ordinary sickness benefit, and may continue to receive it for 20 weeks (provided they have suf&cient standing at their credit), at the end of which the benefit stops even though they are still ill. If engaged for a term of not less than six months certain they are not entitled to sickness benefit until they have been ill for six weeks in succession, unless their employment terminates during an illness which has been going on for less than six weeks, in which case benefit become payable on the termination of the employmenti They then receive ordinary sickness benefit and may continue to receive it (provided that the amount standing at their credit is sufiicient) up to the ex- piration of 20 weeks from the commencement of sickness benefit. (394) Section 53 applies these provisions to certain persons em- ployed under the Crown, not excepted under Part II. (&) of the First Schedule to the 1911 Act, and provides that where f only of the remuneration is payable for a period of not less than 3 months in any year, f shall be substituted for full wages, and 3 months for 6 weeks. The contributor is, however, deemed to have re- 118 ceived Sickness Benefit for 6, not 13 weeks, for the purpose of •calculating the duration of benefit. (x.) Mercantile Marine. (395) Under Section 48 of the 1911 Act a master, seaman or apprentice is not entitled to receive sickness benefit while the owner •of the ship is hable for the cost of his medical attendance and maintenance. The Act of 1913 (Section 23 (1)), however, provides "that if a Deposit Contributor serving on a home trade ship has de- pendants and the owner, though Kable for his maintenance and medical attendance, is not liable to pay wages to him, the Committee may pay the sickness benefit in whole or in part to the dependants or apply it for their relief or maintenance in such manner as the Committee (after consultation wherever possible with the contributor) thinks fit. (396) Whether the contributor has or has not dependants the whole period of incapacity during which the owner has maintained him is to be treated as if he had been in receipt of sickness benefit for the purpose of calculating the rate and •duration of sickness benefit (Section ■48 (1)). (xi.) Suspension from Ordinary Benefits on Marriage. (397) A woman Deposit Contributor is suspended from ordinary benefits on ceasin g to be employed on or after marriage. Two- thirds of the sum standing to her credit in the Deposit Con- tributors Fund may be apphed in providing a sum of 5s. a week on confinement during a period not exceeding four weeks on any one occasion ; or under certain conditions and in the discretion of the Committee, in providing payments during any period of sickness or distress (1911 Act, Section 44 (4), and Married Women's Consolidated Regulations, 1915). If at any time after suspension she again becomes employed she will be entitled to ordinary sickness and maternity benefits only after the usual wait- ing period of 26 weeks, and after payment of 26 contributions. (xii.) Incapacity due to Confinement. (398) An unmarried woman is not entitled to sickness benefit for a period of four weeks after her confinement unless she is suffering from an illness not connected directly or indirectly with her confinement (1911 Act, Section 8 (6)). Subject to the above condition, no distinction should be drawn as regards the payment of sickness benefit between incapacity due to pregnancy and incapacity due to other causes. The additional maternity benefit for insured married women {see paragraph (409)) is given in lieu of sickness benefit in respect of the four weeks after confinement. (xiii.) Seamen, Marines, and Soldiers. (399) Seamen, marines, and soldiers are not entitled to siclaiess benefit during service. On discharge, they are treated, subject 119 to the provisions of Sec. 79 of the Act of 1911, as employed contributors (unless, being qualified, they become voluntary contributors), and they therefore become entitled to the ordinary benefits subject to the usual conditions. A discharged man whose state of health would prevent him from gaining admission to an Approved Society will normally not return to Deposit Insurance, but will become entitled to the ordinary benefits out of the Navy and Army Fund. (C) PAYMENT. (400) Sickness benefit is ordinarily payable as from the fourth day of the incapacity. It should be noted in this connection that a Sunday is not treated as a day of incapacity for the purposes of the waiting period unless the insured person would, but for the illness, have worked pn that day (1913 Act, Section 13). Where, however, a Deposit Contributor has received sick- ness benefit for one illness and falls ill again within 12 months of his recovery, his second illness is to be treated as a continua- tion of the first, i.e. sickness benefit begins from the first day and can only continue until 26 weeks' benefit {including the first illness) has been paid (but see paragraph (381)) above for pro- cedure in compensation cases where only partial sickness benefit is paid in respect of the first incapacity) (1911 Act, Section 8 (5)), as amended by 1913 Act, Section 12)." (K) PROCEDURE IN DEALING WITH CLAIMS. (401) The procedure to enable a Deposit Contributor to claim sickness benefit is as follows : — The contributor (like a member of a Society) will be fur- nished by his doctor with a certificate on Form Med. 40 in lieu of the certificate at the back of the ordinary claim form (Form 27/1. C.) which was used prior to 1st January 1915. When the contributor receives a first certificate of incapacity on Form Med. 40 he should complete it and send it to the In- surance Committee, who will thereupon send him Form 27/1. C. with instructions for its completion and return with the next certificate received. When the contributor receives a second (Intermediate or Tinal) certificate, he should complete the front page of Form 27/1. C, attach the certificate to it, and forward both to the Insurance Committee together with his insurance book and current contribution card. The Committee should furnish its certificate to the Commissioners (39 Buckingham Terrace, Edinburgh) on Form 335/A.G.D. If the illness continues after the date of the second medical certificate the contributor should fill up the right hand side of the further certificates received from the doctor and send them to the Committee. Further claims on Form 27/1. C. are not necessary. (402) A copy of Form 625/A.G.D., notifying certain changes 120 in procedure, should be attached by the Committee to each Form 27/I.C. issued, the doctor's certificate forms and the first four instructions on the back of that form being can- celled before issue. When returned by the contributor, the Form 27/I.C. should be retained by the Committee. (403) In examining claims prior to certification the Insurance Committee should satisfy itself — (a) that the medical certificates are duly signed and in order ; (6) that the incapacity for work is not due to an accident or disease in respect of which compensation would seem to be payable, (c) that the contributor if employed under Section 47 or_53 (which is generally shown by the rate of contribution on his card) has received payment of wages according to that Section. Where it is ascertained that a contributor is in receipt of com- pensation at a lower weekly rate than that of the sickness benefit to which he would otherwise be entitled the claim should be certified in the usual way, and the rate of compensation stated on the certificate. (404) Since it has been the experience of the Commissioners that confusion has arisen at various times between two persons of the same name and resident at the same address (more especi- ally in the case of Model Lodging Houses), the Committee should in every case insist on the contributor forwarding his insurance book with his claim. Where the insurance book is not available the Deposit Contributor's number should be stated, failing which Form 301D/A.G.D. should be completed by the contributor in order that his identity as a Deposit Contributor may be estab- lished. It is also essential that the current contribution card should be obtained and forwarded to the Commissioners. (405) Should the Committee receive an apphcation for sick- ness benefit from a person in respect of whom it does not hold an index shp, Form 335/A.G.D. should be noted " No index slip received," and forwarded to the Commissioners together with the contributors insurance book or Form 301D/A.G.D. SECTION (VI.)— DISABLEMENT BENEFIT. (406) When a contributor's right to sickness benefit has been exhausted, i.e. after 26 weeks' sickness benefit has been paid, he becomes entitled to Disablement Benefit if properly qualified. The qualifications necessary are that the contributor must have been in insurance for 104 weeks and have paid 104 contributions. The benefit commences immediately sickness benefit ceases. Owing to the basis of the deposit scheme, however, these con- ditions can be fulfilled at present only by a Deposit Contributor who has been transferred from an Approved Society from which he has received Disablement Benefit or Sickness Benefit for a period approaching the maximmn. ' 121 SECTION (VII.)— MATEENITY BENEFIT. General. (407) Maternity Benefit is a payment in respect of a confine- ment, the word " confinement " meaning labour resulting in the issue of a living child or labour after 28 weeks of pregnancy resulting in the issue of a child whether alive or dead. (408) The amount of the payment is 30s. in ordinary cir- cumstances, and where the sum standing to the credit of the contributor permits of the full benefit being paid. In the case of aliens, the amount is reduced by fths if the benefit is in respect of a man's insurance, and by Jth if in respect of a woman's insurance (1911 Act, Section 45). It should be noted, however, that this reduction does not apply in respect of the insurance of an alien whose wife before marriage was a British subject, and of such a woman's own insurance (1913 Act, Section 20). (409) Where a woman is married (or in the case of a posthumous child a widow) and uninsured, one Maternity Benefit is payable in respect of her husband's insurance. An insured woman is entitled to receive two Maternity Benefits, one in respect of her own insurance and one in respect of her husband's. If her husband is not insured or not qualified for Maternity Benefit on account of insufiiciency in number of contributions paid or in the sum standing to his credit she may receive two Maternity Benefits from her own insurance (1913 Act, Section 14). Thus if the husband is or was a member of a Society, but Maternity Benefit is not payable owing to the qualifying con- tributions not having been paid, or to arrears, the woman, if she is a Deposit Contributor is entitled to two Maternity Benefits if, and so far as, the balance in her account in the Deposit Con- tributors Fund admits (1913 Act, Section 14 (2) (as)). If the husband is a Deposit Contribator but the amount standing to his credit is insufficient to provide the full Maternity Benefit in respect of his insurance, the wom^n, if she is a Deposit Contributor is entitled (if, and so far as, the balance in her account admits) to both Maternity Benefits less the amount paid from her husband's iijsurance (1913 Act, Section 14 (2) (6)). (In connection with the payment of these claims see paragraph (412) below). (410) In this connection it should be observed that a woman receiving a second Maternity Benefit must abstain from remunera- tive employment during the four weeks following her confine- ment under the Eules made by the Committee in pursuance of Section 14 (3) of the 1913 Act. Any penalties imposed for breaches of this rule should not exceed in the aggregate the sum payable in respect of the Maternity Benefit. (4tl) Maternity Benefit is in all cases the mother's benefit, whether payable in respect of her husband's or her own insur- 122 ance, and the Committee must administer it in the interest of the mother and child in cash or otherwise as they think fit. If the benefit is to be paid to the husband, the wife's authority for making the payment to him must be obtained before the cer- tificate of payment is sent to the Commissioners. Qualifications. (412) The necessary quaUfications for any payment of Maternity Benefit are as follows : — • (a) The contributor must have been in insurance for 26 weeks (in the case of a voluntary contribator for 52 weeks). (b) He must have paid 26 contributions (in the case of a voluntary contributor 52 contributions). (c) In the case of a male contributor, either he oi his wife must be resident in the United Kingdom, or in the case of a female contributor, she must reside in the United Kingdom (but see paragraph following). (413) Where Maternity Benefit is payable in respect of the husband's insurance it will be paid if either he or his wife is in the United Kingdom at the time of the confinement. It will be payable from the husband's insurance if he is at the time of the confinement temporarily living in the Isle of Man, or the Channel Islands, even although the wife is resident abroad. Where the benefit is payable in respect of the wife's insurance, it will be paid if, at the time of the confinement she is in the United King- dom, or temporarily hving in the Isle of Man or the Channel Islands, but not if she is abroad. (414) With regard to contributors who have emigrated, but whose wives have remained in this country, it must be remem- bered that no benefit is payable in respect of any contributor who has ceased to be an insured person. The first question to be determined, therefore, is whether he is, or is not, still an insured person. If it is known that he is only abroad temporarily, he remains an insured person ; and the fact of his wife's continuance in the United Kingdom may ordinarily be taken as sufiicient evidence that he has not yet permanently taken up his residence abroad. If, however, he has definitely removed his residence no benefit is payable in respect of his insurance unless he does in fact return to the United Kingdom under circumstances that indicate that his absence was temporary and did not involve cessation of insurance. In the meantime he is treated as being out of insurance, and in consequence his wife, if she is herself an employed contributor, is entitled both to ordinary and to second maternity benefit from her own Society. Modifying Circumstances. , (415) There are certain circumstances under which, although the qualifications mentioned in paragraph (412) above mav be 123 satisfied, Maternity Benefit is not payable, or at least is payable only subject to modifications as described in the paragraphs following. These circumstances are : — (d) when the woman to whom benefit is payable is in a poorhouse, or charity or rate-supported hospital, asylum, convalescent home, infirmary, or sana- torium {see paragraph (383) above). (e) When arrangements are made for providing the ser- vices of a midwife or doctor as part of the benefit. Benefit ivhen the Mother is in Hospital, etc. (416) No payment can be made on account of Maternity Benefit while the mother is in any charity or rate-supported institution as defined in paragraph (383) above. (417) If the mother has dependants, it must be apphed in whole or in part for the relief of such dependants in such a manner as the Committee thinks fit after consultation with the mother wherever possible. Where, however, an additional Maternity Benefit is pay- able as well as the primary benefit (e.g. in the case of the insured married woman) provision for the wife's dependants is made out of the additional Maternity Benefit. The primary benefit is not available for dependants. (418) If the woman to whom benefit is payable is an inmate of a hospital, asylum, convalescent home, or infirmary, any of the benefit which is not paid to dependants may be applied in the provision of surgical appUances. If not so expended it must be paid in cash to the contributor when she leaves the institution, either in a lump sum or in instalments, as the Committee thinks fit. Provision of Midivife or Doctor. (419) Under Section 18 of the Act of 1911 Insurance Committees have power to administer Maternity Benefit " in cash or other- wise." A Committee may, therefore, if it thinks fit, instead of paying the whole of the benefit in cash, administer part of it by arranging that the mother will have the services of a midwife possessing the qualifications prescribed in the Qualifications of Midwives (Scotia- c.) Regulatiors, 1912, or a doctor. The value •of the services rendered will then be part of the Maternity Benefit, and the balance will be available for payment in cash ■or otherwise. (420) In any such arrangements, however, due efiect must be given to the proviso to Section 18 of the 1911 Act that the mother shall have free choice in the selection of the doctor or midwife by whom she is to be attended, and for this purpose it will be necessary for the Committee to supply to Deposit Con- tributors on application Usts of the doctors or midwives whose services are available. 124 Peooedure. (421) Claims for Maternity Benefit may be made according to the circumstances as follows : — (a) by a husband from his own account ; (b) by a wife from her husband's account ; (c) by a wife or unmarried woman from her own account ; (d) ' a wife may claim further benefit from her own account because — (1) her husband is a member of a Society, but nothing has been paid by his Society as he is not qualified ; (2) her husband is a Deposit Contributor, but full Maternity Benefit has not been paid in respect of his insarance ; (3) her husband is not insured. (e) by the wife of a sailor or soldier on service in respect of her husband's insurance. (422) In every case notice of the confinement should be given to the Insurance Committee within seven days, and where the claim for Maternity Benefit is in respect of the husband, it should be accompanied by a copy of his marriage certificate or such other evidence of the marriage as the Committee may think fit. (a) Claim by Husband. (423) When a Committee receives intimation of a claim for benefit, a Form 27B/I.C., should be issued to the husband. If the husband is an aUen, information should be obtained as to the wife's nationality before maniage (see paragraph (408) above). On receipt of the completed form the Committee should certify the claim on Form 341/A.G.D. and forward it to the Commissioners with the current Contribution Card and Insurance Book, or Form 301D as in the case of claims for Sickness Benefit (see paragraph (404) above). (See also paragraph (411) above in regard to authority for making payment of Maternity Benefit to the husband.) (b) Claim by Wife from Husband's Account. (424) Where the wife claims Maternity Benefit from the husband's account a Form, 27B/I.C., should be sent to the wife, and the husband's signature to the claim obtained. If for any reason this cannot be procured, the Committee should ascertain his present address and request an extract certificate of marriage {see paragraph (422) above). On receipt of the claim it should be certified on Form 341/A.G.D. as described in the preceding paragraph. If there is no evidence to show that the husband is aware of the claim, he should be informed that Maternity Benefit is being claimed, so that if he should have a prior claim for Sickness 125 Benefit lie may be able to inform tbe Committee. In this case the certificate on Form 341/A.G.D. should not be sent to the Commissioners until a week has elapsed after the date of the notification sent to the husband. (c) Claim by Mother from own Account. (425) A Form 27C/I.C. should be issued to and com- pleted by the claimant and certified by the Committee on Form 341A/A.G.D. (d) Further claim hy Wife from own Account. (1) Husband Society Member. (426) A signed statement from the husband's Society should be obtained from the wife showing that he is not entitled to Maternity Benefit and giving the reason. A supplementary certificate on Form 341A/A.Gr.D. should then be forwarded to the Commissioners. (2) Husband Deposit CorUributor. If the husband is a Deposit Contributor, but full Maternity Benefit has not been paid in respect of his insurance as in case {d) (2) above the husband's number as a Deposit Con- tributor should be obtained and a supplementary certificate submitted in the ordinary way. (The Committee will ordinarily be able to satisfy itseU that less than the full amount has been paid in respect of the husband's insurance by reference to the notifications of payments received from the Commissioners.) (3) Husband not Insured. Where the wife claims further payment from her own account because her husband is not insured, a certificate should be obtained from the husband to the following efiect, " I declare that I am the husband of Deposit Contributor No that I am not hable to compulsory insurance under the National Insurance Acts, and that I am not insured thereunder as a voluntary contributor." A supplementary certificate on Form 341A/A.G.D. should then be forwarded to the Commissioners. (427) The Committee should in no circumstances delay forward- ing the certificate for payment of the wife's claim for payment of benefit from her own account because a supplementary claim in respect of the first Maternity Benefit is pending, or is under investigation. (e) Claim by Wife of Soldier or Sailor in respect of HusbancTs Insurance. (428) (ffl) // the husband is a Seaman or Marine, Active Service rating, application for a claim form should be made by the wife to the Accountant General of the Navy, Admiralty, London, S.W. The form contains full instructions as to how to make the claim. 126 (b) If he is a regular Soldier (including those now enlisted for the period of the war), application for a claim form should be made by the wife to the Paymaster by^whom the wife's Separation Allowance is paid. The form contains full instructions as to how to make the claim. (c) // he is a Naval Reservist or Naval Volunteer, or entered in the Navy for the period of the war, or an Army Reservist or Territorial, application should be made by the wife to the Secretary, National Health Insurance Com- mission, 29 Queen Anne's Gate, London, S.W. To avoid delay in the payment of benefit it will be well to apply about a month before the expected date of confinement. It is desirable that information should be given when the application for the claim form is made, as to whether any cards were stamped for him before service, and if so, how each card was disposed of. If he has a Deposit Contributor's Insurance Book it should be enclosed with the application where possible, or his number as a Deposit Contributor should be quoted in the letter. To avoid delay it is important that all appHcations and letters should show the husband's full name, his ship or regiment, his rating or rank, and his official or regimental number. SECTION (VIII.)— ADMINISTRATIVE PROCEDURE IN CON- NECTION WITH DEPOSIT CONTRIBUTORS. (429) With the view of relieving Insurance Committees of a large amount of administrative detail, the accounts of Deposit Contributors are kept on a centraUsed system at the offices of the Commissioners. On an account being established in respect of a Deposit Contributor an index slip is issued by the Commissioners to the Insurance Committee of the area in which such Deposit Con- tributor is resident. The slips are sent out in batches under cover of Form 311 A.Gr.D. Should any of the index slips sent to an area be found to be in respect of Deposit Contributors resident in other areas, the index sHps should be sent to the proper area and the Commissioners notified by attaching to the receipt for the index slips (Form 311 A.G.D.) a Form, 312 A.G.D., giving the numbers of the index shps reallotted. A separate Form, 312 A.G.D. , should be used for each new area. Should any index slips be forwarded to an area which are not applicable to that area, and for the reallotment of which there is insufBcient knowledge the index slips should be returned to the Commis- sioners with a list on Form 313 A.G.D. (430) On a Deposit Contributor intimating a change of address which involves a change of area, a removal aUp giving the old and new addresses is sent to the Insurance Committee of the 127 new area. It falls to this Committee to see that the contributor surrenders his medical card, the appropriate part of which should be forwarded to the former Insurance Committee, who will then send the index slip to the Commissioners. They will have the change recorded and the slip sent to the new Committee who will issue a new medical card. (431) When a Deposit Contributor is suspended from benefits an orange slip is sent to the relative Insurance Committee, who should inform the contributor and the doctor. After having had further contributions credited to his account a Deposit Contributor may be reinstated in benefits. A list of all such cases is sent to the Insurance Committee, who advises the doctor and the contrib- utor. If, on receiving notification of suspension or reinstate- ment an Insurance Committee has a removal slip showing that, the Deposit Contributor has recently removed to the area, the steps indicated above in respect of change of address should be expedited. Should, however, an Insurance Committee find that it has neither index sUp nor removal slip, the suspension slip or reinstatement notice should be returned to the Commissioners with a statement to that effect. (432) When a Deposit Contributor joins an Approved Society, the Insurance Committee is notified by means of the removal slip. In this instance search should be made as to whether an index shp has been received from the Society to which the Deposit Contributor has transferred. If the Society Index Slip is traced the Deposit Contributor's Index Shp should be returned to the Commissioners at once, but, should the Society Index SHp be missing, the Deposit Contributor's Index Slip should be retained, the Society communicated with, and the Deposit Contributor's Index Slip returned to the Commissioners on receipt of the Society Index slip. (433) In cases where an Insurance Committee receives intima- tion that a Deposit Contributor is deceased or has passed out of Insurance, or where by receipt of a Society Index SUp duly noted as being in respect of a former Deposit Contribiitor it comes to their knowledge that a Deposit Contributor has joined an Approved Society, the Deposit Contributor's Index Shp should be returned to the Commissioners with a reference to the name of the Society and the membership number therein. There should never be any necessity for an Insurance Com- mittee to retain in its Index Register a suspense shp in respect of a Deposit Contributor. On apphcation to the Commissioners the Committee will be advised whether an account for the contributor has been opened, and if so where the index slip is. CHAPTER VII. FINANCE AND ACCOUNTING OF INSURANC ^. COMMITTEES. (434) Repeeenob is made in dealing with this division of the subject to the following Regulations : — (1) National Health Insurance (Payments to Insurance Committees) Regulations (Scotland), 1914 ; (2) National Health Insurance (Medical Benefit) Regula- tions (Scotland), 1913 ; (3) National Health Insurance (Accounts of Insurance Committees) Regulations, 1915 (issued in Draft, and dated 3rd August 1915). Throughout the Chapter the first of these is referred to as the '" Paragraph (F) Regulations " from their being framed imder the provisions of Section 28 and Paragraph (P) of the First Schedule ito the National Insurance Act, 1913 ; the second " the Medical ^Benefit Regulations," and the last " the Accounts Regulations." SECTION (I.)— INCOME. (435) The income of Insurance Committees is dealt with under the following heads : — (1) Medical Benefit, including Ordinary and Special Income ; (2) Sanatorium Benefit ; (3) Administration ; (4) General Purposes ; (5) Transfer between Funds. 1. MEDICAL BENEFIT INCOME. (a) General Medical Benefit Fund. (436) This fund is established by the Commissioners in accordance with the provisions of Part IV. of the Medical Benefit Regulations. Into the fund are carried all the sums at the disposal of Insurance Committees for the purposes of medical benefit. They include the sums available under Sections 15 (6) and (8) and 42 (d) and (e) of the Principal Act And Sections 1 and 9 of the Act of 1913. 128 129 (436) The annual cost of a full year's medical attendance and treatment of each insured person entitled to benefit is at present as follows : — Charge to Societies and Deposit Contributors and for exempt persons, (less State Grant s. d. in case of British subjects) . . . . . . 6 Special Parliamentary Grant (including Aliens) . . 2 6 Transfer from sanatorium income for domieihary treatment . . . . ■ . . . . . . . . 6 (437) The major part of the income raised by these debits is the sum derived from the charge made against Societies and Deposit Contributors and for exempt persons in respect of the cost of medical benefit. Of the actual amount, which, in terms of Article 32 of the Medical Benefit Regulations, is reached by agree- ment between Societies and Insurance Committees, or in the other two cases is fixed by the Commissioners, there is charged to the Society 7/9ths in respect of male and 3/4ths in respect of female members who are British subjects. These amounts are supple- mented by the State's proportion of 2/9ths and l/4th as the case may be, as provided by Section 3 of the 1911 Act. The full amount is charged to the Society in respect of Aliens (Section 45 (1) (d) of 1911 Act). (438) In the case of Societies the method of ascertaining the sum payable is, under the provisions of Article 5 of the Para- ^aph (F) Regulations, as follows : — (a) The Commissioners ascertain the number of insured persons (other than persons who are masters, seamen, or apprentices on foreign-going ships in the Mercan- tile Marine) whose contribution cards for the first half-year of the year in respect of which the cal- culation is made have before a date to be deter- mined by the Commissioners been forwarded by each Society to the Commissioners, and who were for the whole or any part of that half-year entitled to medical benefit. (b) Each Society ascertains, as on a date to be determined by the Commissioners, and furnishes to the Com- missioners a return of (i.) the number of members of the Society who were at the commencement of the said year of the age of seventy and upwards, and were during the first half-year of that year entitled to medical benefit, and (ii.) the number of members, being masters, seamen, or apprentices in foreign- going ships in the Mercantile Marine in respect of whom contributions were paid for that half-year, and who were during the whole or any part of that half- year entitled to medical benefit. (c) The sum of the three numbers so obtained is the number upon which the amount to be debited to each Society is based. 130 Cards whicli are surrendered after tlie date lixed by the Com- missioners are included when surrendered in the numbers for the year then under calculation. (439) Alternatively, a Society may, if the Commissioners so' allow or require, be charged on the ascertained number of its members entitled to medical benefit at the end of the first half- year of any year and the sum payable by the Society in respect of Medical benefit for that year will then be calculated on the basis of the number so ascertained. (440) Power is reserved to the Commissioners to make (a) such adjustments as may be necessary to secure that the sum debited to each Society is equal to the amount which is determined to be payable, and (6) such further adjustments, if any, as are in their opinion required to meet the case of insured persons who have in the course of the year been transferred from one Society to another, or being Deposit Contributors have become members of Societies or vice versa, or who during the year become or cease to be insured under the provisions of Section 46 of the Principal Act as amended by the National Insurance (Navy and Army) Acts of 1914 and 1914 (Session 2). (See List of Acts, Appendix I.> (6) Distribution of Central Pool to Committees. Apportionment of Fund. (441) The General Medical Benefit Fund or Pool having thus been formed, its apportionment among the various Insurance Committees takes place as follows : — (1) In the case of each Committee the number of insured and exempt persons included in the Eegister of the Committee at the commencement of each quarter of the year and entitled at that date to medical benefit, as ascertained by the quarterly Counts made by the Committee but subject to any adjustments in terms of Article 29 of the Medical Benefit Regulations, is calculated and the sum of the four numbers divided by four. (2) Subject to any adjustments between the General Medical Benefit Fund and any similar funds under the control and management of the English or Welsh Insurance Commissioners, made by the Joint Committee under the powers conferred on them by Sub-Section (2) of Section 83 of the 1911 Act, and to any deductions made in respect of persons the cost of whose medical benefit is defrayed out of the Central Medical Benefit Fund, in accordance with any Regulations for the adminis- tration of medical benefit made by the Commissioners and for the time being in force, the sums in the General Medical Benefit Fund are to be apportioned amongst the several Committees in proportion to the number obtained in the ease of each Committee 131 under tlie provisions of the preceding part of this paragraph, and the sum so apportioned to each Committee is the sum available to that Committee for the purposes of medical beneiit in that year. (Par. (F), Eegs. 12.) (442) As it is thus in practice not possible to constitute the Fund and to pay or credit at the commencement of each year to each Cornmittee the income available to it, provision is made by Article 5 (2) of the Paragraph (F) Regulations for a provisional debit to Societies in any year of an amount calculated by refer- ence to the amounts payable by the Society for the previous year, or in the case of a new Society calculated in such manner as the Commissioners may determine. Advances to Committees. (443) In order that Insurance Committees may not be without funds, advances are made to them out of the G-eneral Medical Benefit Fund of such sums as may be required for the purpose of medical benefit to an extent such that the advances do not exceed the proper proportion of the sums estimated to be due to the Committee. In the event of any Committee requiring money before any sums have been credited to the General Medical Benefit Fund the Commissioners may, if they think fit, make such advances from the General Balances in the Scottish National Health Insurance Fund as appear to them to be reasonable, pending the ascertainments of the accounts due to be credited to its several accounts (Par (F), Regs. 11). (c) Medical Benefit Fund Account. (444) All moneys payable to an Insurance Committee out of the General Medical Benefit Fund, including the State Grant and the Special Parliamentary Grant of 2s. 6d. per insured person, but excluding the Special Drug Fund and Mileage Fund are carried to the credit of the Committee's Medical Benefit Fund Account (Medical Benefit Eegs. 33 (1)). In practice it is also found convenient to carry to the credit of this fund before distribution the sum payable from the Sanatorium Benefit Account in respect of the obligation to treat cases recommended for domiciliary treatment of tuberculosis. The allocation of the Fund by Committees is dealt with under Section II. of this chapter. (e^) Centeal Medical Benefit Fund. Constitution. (445) The fund is established for the purpose of defraying the cost of the medical benefit of temporary residents (Medical Benefit Regs. 41). A temporary resident is a person who has moved into 132 the area with the intention of residing there fof a period of less than three months. (446) The following is an outUne of the system under which this fund is worked. Medical treatment given to persons tem- porarily resident outwith the area of their home Insurance Committee (except persons making own arrangements) and to all persons in possession of " travellers' vouchers " is paid for upon the basis of the scale of fees set out in the Fifth Schedule to the Medical Benefit Regulations. It should be kept in mind that the capitation fees (including the domiciliary 6d.) in respect of persons holding travellers' vouchers are not credited to Committees, but are carried direct to the Central Medical Benefit Fund. (447) To facilitate financial -adiustments between the funds of individual Committees, a special system has been devised. A " case value " obtained by dividing the amount of the Panel Service Fund by the number of cases of disease or disable- ment of persons upon panel lists who receive treatment through- out the year is annually ascertained by the Commissioners in respect of each Committee. The basis of the calculation is the information derived from the Medical Records kept by the prac- titioners. Similar " case values " are also ascertained for persons entitled to receive treatment through approved institutions. (448) The Committee will then be debited with the relative " case value " in respect of each person for whose treatment it is responsible, who has obtained any treatment as a tem- porary resident during the year. Careial note is kept of the methods of receiving treatment in his home area selected by each such "temporary resident," in order that the debits against the Committee may be placed against the appropriate funds, Practitioners and Drug Funds, or Institutions Fund, as the case may be (Medical Benefit Regs. 41). (449) The debits referred to, other than those for international temporary residents, together with any sums similarly receivable irom the other Commissions in respect of English, Welsh, or Irish insured persons who have received treatment in Scotland, are carried to the Central Medical Benefit Fund, and the total, including capitation fees in respect of travellers, is subdivided into Central Panel and Central Drug Funds, in the proportions of 13/17ths and 4/17ths respectively (Medical Benefit Regs. 41 and 42). Distribution to Committees. (450) The accounts, presented by the Insurance Committees whose panel practitioners and chemists have given treatment, drugs, and appliances to " temporary residents " or " travellers " are then considered and the amounts thereof ascertained. (451). The accounts of doctors and approved institutions for treatment should be calculated in accordance with the scale in the Fifth Schedule to the Medical Benefit Regulations and those 133 of chemists, doctors, and institutions for drugs according to the Drug Tarifi. The sums so ascertained should be credited to the practitioners, chemists, and institutions by the Committee, and an account thereof be sent to the Commissioners within one month after the end of the year (Medical Benefit Eegs. 42 (1)). (452) The Central Drug Fund is first applied as far as it will go in crediting Committees with the amounts of the drug bills pre- sented, and so much of the resulting balance, if any, as does not exceed one-fourth of the amount originally carried to the Fund is transferred to the Central Panel Fund, but any further balance remains to the credit of the Central Drug Fund in the ensuing year (Medical Benefit Regs. 42 (3) and (4)). The principle of the " floating sixpence " is thus applied to the Central Medical Benefit Fund. (453) The Central Panel" Fund augmented as above is then divided amongst Committees in proportion to the amounts of doctors' bills submitted by each, and the amounts so ascertained are advised to Committees as special credits. It is to be noted that the sums paid to Insurance Committees from the Central Medical Benefit Fund do not pass into ^he Panel Service Fund for the general purposes of that fund, but are to be carried to the Temporary Residents Fund Account, and paid direct to the in- dividual doctors who have given treatment to temporary residents. Distribution to Doctors and Chemists. (454) The procedure to be adopted by Insurance Committees in allocating to individual doctors and chemists the amounts credited out of the Central Panel and Central Drug Funds is as follows :^ (455) In the first place the chemists' accounts are met either in full or to such lesser extent as the sum transferred from the Central Drug Fund will permit (Medical Benefit Regs. 42 (3)). (456) The sums obtained from the Central Panel Fund are to be distributed to practitioners or institutions giving treatment to temporary residents in proportion to the amounts of accounts submitted. The amounts so paid may involve a discounting of the accounts or a dividend thereon, but the whole sum available is distributed annually, and the rate of discount or bonus is a flat one for the whole country, whether the temporary residents are of Scottish, English, Welsh, or Irish origin (Medical Benefit Regs. 42 (7)). (e) Diagram. (457) The diagram which is printed in Appendix XVIII. displays graphically but not exhaustively the passage of medical benefit moneys through the various accounts. It illustrates the passage of the money from its various sources to its ultimate destina- tions, but no attempt has been made to illustrate the respective funds by comparison. It has to be kept in view that some of the funds are central ones others local. . 134 (/) Special Income foe Medical Benefit. (458) The ordinary income of the Committee for medical benefit, iacluding the Special Parliamentary Grant of 2s. 6d. per insured person and the sum of 6d. per insured person, specially transferred from sanatorium benefit has been dealt with above. In addition there is available for Committees the following additional sources of special income : — (1) Parliamentary Special Mileage Grants. (2) Parliamentary Special Drug Grant. Special Mileage Grants. (459) Special Mileage Grants have been provided for Highland and Lowland County Committees. The Grant for the Highlands and Islands, iacluding the Highlands of Perthshire, was in the past made to the Commissioners and distributed by them to the Committees under a scheme approved by the Treasury. {See Appendix XIX.) In future this Grant wUl form part of the monies placed at the disposal of the Highlands and Islands Board for the improvement of the Medical Service iu the Highlands and Islands, and falling to be distributed under a scheme to be approved by the Secretary for Scotland and the Treasury. The Grant for the Lowland Counties amounted to £16,000, being the share allocated to Scotland of a Grant of £50,000 to the National Health Insurance Joint Committee. The Scheme under which the sum of £16,000 was distributed -to the Committees was approved by the Treasury and is printed in Appendix XIX. The circumstances of each Committee were fuUy considered by the Commissioners following on inquiry into the circumstances of each area, and grants made accordingly. These amounts are disbursed by the Committees to the doctors in the area for mileage and special charges under the scheme. A distinct record of the expenditure out of these grants must be kept by Committees. For 1915 the Grant to the Joint Committee is £54,000, aud the share apportioned to Scotland £20,000, the additional £4000 or such part thereof as is necessary being applied, for the improvement of the medical service of sparsely populated and necessitous districts in the lowlands. Special Drug Grant. (460) The Special Drug Grant of £30,000 per annum for the whole United Kingdom was voted by Parliament to meet deficits on drug funds of Committees due to special charges consequent on the outbreak of an epidemic of disease in the area or other abnormal conditions. It is to be administered under a scheme prepared by the Joint Committee and approved by the Treasury. 135 2. SANATORIUM BENEFIT INCOME. (a) General Sanatorium Benefit Fund. Constitution of Fund. (461) The income under this head is derived from the charges made to Societies and Deposit Contributors, being the amount of Is. 3d. per insured person resident in the area of each Insurance Committee which is made available by Section 16 (2) of the Act of 1911, together with the premium of the same amount in respect oi each exempt person in terms of Section 9 of the Act of 1913. In terms of Sections 3 and 45 (1) (d) of the 1911 Act there is contributed except in respect of aliens from monies provided by Parhament 2/9ths in the case of men and l/4th in the case of women of the amount due for the cost of sanatorium benefit. Societies and Deposit Contributors with certain exceptions and the Exempt Persons Fund are accordingly charged with the remaining 7/9ths pr 3/4ths, and the amounts arrived at, together with the State proportion, are carried to an Account in the Commissioners books known as the General Sanatorium Benefit Fund. The method of forming this General Fund or Pool is set out in Part III. of the Paragraph (F) Regulations. (462) Under Section 61 of the 1911 Act it is provided that " all sums available for sanatorium benefit ... in any year shall be paid or credited to the Insurance Committee at the commence- ment of that year.", In view of this provision and of the fact that the amount of a Committee's Sanatoiium Benefit Income is not like its Medical Benefit Income determined by agreement but fixed by the Statute itself, it follows that, under the 1911 Act, the Sanatorium Benefit Income of the Committee required to be fixed for any year by reference to the number of insured persons resident in the area at the beginning of the year without adjustment either in respect of any fluctuations in the insured population of the area occurring subsequently during the year or in repect of any increase during the year of the insured popula- tion throughout the whole country. (463) Part III. of the Paragraph (F) Regulations, however, in virtue of the terms of Section 28 of the 1913 Act, embodies an important modification in the basis of -crediting Insurance Com- mittees with their Sanatorium Benefit Income. Under the Regulations, the credits to Committees for sanatorium benefit are based, like those for medical benefit, upon a mean calculation of the insured population of each area and of the country as a whole during the year. Distribution of Fund amongst Committees. (464) The General Sanatorium Benefit Fund as made up is thus allocated to Insurance Committees by the same method as that employed in the case of the General Medical Benefit Fund already described, save that the basis of calculation is the number 136 of insured persons entitled to sanatormm benefit instead of the number entitled to medical benefit. The sums so apportioned to Committees are subject to deductions to meet " case values " which fall to be credited to the Central Sanatorium Benefit Fund in respect of "Strays" as explained in the immediately following paragraphs, and also to the transfer to medical benefit of 6d. per insured person in respect of the obligation of practi- tioners on the panel to afford domiciliary treatment of tuberculous persons on their lists if recommended by the Committee, and to the transfer by the Committee to its Administration Account of a reasonable sum to cover cost of administration. (b) Central Sanatoeidm Benefit Fund. Provision for " Strays." (465) While provision is made as above described for the income of Committees being adjusted to the fluctuations in their insured population due, inter alia, to removals in and out of the area, financial machinery is established under Part IV. of the Paragraph (F) Regulations whereby further adjustments are effected in respect of a particiTlar class of removals which deserve special consideration. (466) It has been found that difficult questions are apt to arise as to the liability of Committees to entertain applications for sanatorium benefit from insured persons temporarily resident in, or having recently removed into, a given area, and as to the principles determining, in any given set of circumstances in which an insured person desired to exercise his undoubted right under the National Insurance Acts of applying for the benefit, the Committee upon whom devolves under those Acts the -corre- sponding duty of considering and dealing with his application. A procedure has accordingly been devised whereby a " case value " adjustment is effected, subject to certain conditions, in respect of a class of insured persons termed for the purpose of the regulations " removal cases." (467) Experience suggests that in the case of persons who • become tuberculous there is a distinct tendency to migrate soon after infection, and this in many cases not with any intention to return, but with the object of escaping from the surroundings in which the disease was contracted, securing more favourable cUmatic conditions, taking advantage of more efficient treat- ment, or for other reasons which differentiate their case from that of the " temporary resident " under medical benefit. In such cases it would appear that the area to which the tuberculous person removes is at a distinct disadvantage as against the area which has hitherto derived benefit from his contributions daring health, and the system of case value adjustment is accordingly applied not, as in the case of medical benefit, to those insured persons who enter the area with the intention of not remaining for more than three months, but (subject to the exceptions in- 137 dicated below) to those persons who apply to the Committee for sanatorium benefit within three months of their removal into the area. In a " removal case," therefore, recommended by a Committee for sanatorium benefit, a case value will (subject to the exceptions specified later) be debited against the Committee . from whose area the removal took place. (468) The adjustments as between Scottish Insurance Com- mittees in this connection fall to be made on the basis of a national case value arrived at by dividing the total expenditure on sana- torium benefit (exclusive of payments to doctors for treatment of domiciliary cases and sums transferred to the administration accormt) by the total number of cases recommended for all kinds of treatment. International adjustments will be made between the Scottish Central pool and the Central pools in England, Wales, and Ireland, the respective debits being adjusted between the Commissions. (469) The case value debits, when ascertained, along with the monies available in respect of travellers, as after mentioned, are pooled in a Central Sanatorium Benefit Fund. This Fund as finally constituted in respect of the year will be distributed amongst Insurance Committees in the proportions which the number of each Committee's recommendations of cases of removal into the area for which a case value debit is made against another Committee, and of travellers, soldiers, and sailors after mentioned bears to the total number of recommendations of such cases. (470) For the proper protection of the funds of Insurance Committees some exceptions require to be made from the general rule that a case value debit is payable in respect of every insured person who is recommended for sanatorium benefit on an applica- tion made within three months of his removal into the area. It would obviously be unreasonable that an insured person whose case had already been under consideration by one Com- mittee, and who was entitled under their recommendation to the form of treatment nominated by them, should be at liberty to create a charge upon the funds of that Committee by voluntarily withdrawing himself from the treatment afiorded and by making apphcation elsewhere with the hope of getting some other or inore desired form of treatment. Again, even if the insured person's removal was imavoidable and was not dictated by any such motives, it would be unfair that the Committee of origin, who had already given, perhaps,'a considerable amount of treat- ment, and who would have continued the treatment had the patient been able to remain, should be burdened in addition with a case value charge upon their funds. (471) For these reasons, under Article 21 (2) of the Para^apb (F) Regulations no case value adjustment is made in respect of any removal case "if at the date of his removal he was entitled to treatment under any recommendation for sanatorium benefit." (472) An insured person, again, not. already entitled to sana- torium benefit by virtue of any Committee's recommendation, 10 138 might conceivably apply for the benefit to a Committee in whose area he did not propose to stay for more than a few days or weeks. If a case value adjustment were to be made in such a case some inequity would result. The Committee would by their recommendation be responsible for causing a full case value to be debited against the Committee of origin, although the liability they would incur by considering the case would be strictly hmited in time ; and, further, on the insured person's return to Ibhe area of the Committee of origin, that Committee would become responsible for the cost of his treatment (although they had abeady been debited) without themselves becoming entitled to any share of the Central Fund. Article 21 (2) also provides, therefore, that no case value adjustment should be m.ade unless the applicant expresses his intention of remaining in the area for a period of at least three months from the date of his removal thither. (473) In effect every " removal case " who gives rise to a case value adjustment automatically becomes, for the purposes of registration and medical benefit, a permanent resident in the new area. On apphcation, therefore, being made by a " removal case " who expresses his intention of remaining in the area beyond the period of three months from removal, the index shp falls to be recovered from the Committee of origin, and a new medical card issued in substitution for the old. Sanatorium Benefit of Travellers. (474) The sums available in respect of the sanatorium benefit (excluding domiciliary treatment) of travellers are also pooled in the common Central Sanatorium Benefit Fund, together with the case valuas debited in respect of " removal cases," payment being made in both classes of case on the Unes indicated in para- graph (469) above. Further, provision is made for a payment from the Central Sanatorium Benefit Fund in respect of the recommendation for benefit of an insured person who has ceased to be a " traveller," but whose apphcation was made within three months of the cancellation of his yellow voucher. Soldiers, Sailors, etc., applying for Sanatorium Benefit shortly after Discharge. (475) In the case of soldiers and sailors who are members of Approved Societies or Deposit Contributors, and whose benefit is paid for on the insurance premium basis (i.e. at Is. 3d. per head per annum), some hardship has been occasioned in the past by the fact that, on discharge from the mihtary or naval hospital in which they were treated prior to discharge, they usually make application to the Insurance Committee for an area with which they have only an accidental association. In these cir- cumstances Committees affected, who have not, of course, previously received any contributions paid in respect of the applicants, may be placed at a serious financial disadvantage by 139 the proper discharge of their obligations. The ease of such insured persons is not, however, difierent in nature from that of the " removal cases " ; and provision is made for a payment to the Committee afiording treatment from the Central Sanatorium Benefit Fund in respect of each soldier or sailor recommended on an application within three months of his discharge. There is, however, in this case no Committee of origin against whom a case value can be debited ; but as the General Sanatorium Benefit Fund contains, on normal insurance assumptions, the sum representing the average amount contributed in respect of healthy insured persons towards defraying the liabiUty of Committees in respect of tuberculous insured persons, the Regulations provide for a sum being transferred from the General Sanatorium Benefit Fund to the Central Sanatorium Benefit to meet the cost of such additional payments. Owing to special difficulties arising out of the war an emergency arrangement in supplement of that of Part IV. oi the Paragraph (F) Eegulations has been made. This is described iu paragraph (320) above. 3. ADMINISTRATION INCOME. {476) The income under this head may be subdivided into — (1) General Administration chargeable as follows : — (a) members of Societies in terms of Section 61 (2) of the Act of 1911 at the rate of Id. per insured person resident in the area of an Insurance Committee. Supplemented by the Government Grant, this sum becomes 1yd. in the case of men and IJd. in the case of women ; (6) Deposit Contributors who had not before the commence- ment of the year attained the age of 70, and members of the Navy and Army Fund. The cost of administra- tion in both these cases has been fixed at Is. 9d. per annum per insured person — in the former by Order of the Commissioners and in the latter by arrangement with the Authorities controlling the Navy and Army Fund; (2) Medical Benefit Administration derived from (a) charges made against Societies in terms of Section 15 (6) of the 1911 Act, together with the due proportion payable by the State in the case of British subjects. By the existing agreements between the Societies and the Committees the sum payable to the Committee per annum was fixed at l|d. per member entitled to benefit, subject to an increase up to 2f d. if necessary. (b) Deposit Contributors who had before the commencement of the year attained the age of 70, and exempt persons. In these cases the rate has been fixed by the Commissioners at 3d. and i^d. respectively per head per annum. 140 (3) tte amount carried from the Sanatorium Benefit Fund as representing the cost of administration of sana- torium benefit. (477) The General Administration Fund which receives the aggregate of the amount under the foregoing heads is distributed among Insurance Committees by the same method of apportion- ment as that followed in the case of the General Medical Benefit Fund and the General Sanatorium Benefit Fund already referred to. (478) An additional source of administrative income also requires to be noted. In relief of the liability imposed on Approved Societies and others for the cost of administration of medical benefit in respect of insured persons under the prO' visions of Section 15 (6) of the principal Act, a Special Parha- mentary Grant is given under conditions framed by the Treasury. This special Parliamentary Grant is distributed among Com- mittees according to the following sliding scale : — No. of members of Approved Societies entitled to Medical Benefit residing in the area of Annual Grant at the the Committee. rate of Not exceeding 10,000 £22, 10s. per 1,000 Exceeding 10,000 £22, 10s. per 1,000 for the first 10,000, and then £3 per 1,000. (479) The number of members of Approved Societies resident in the area of the Committee is, for the purpose of the special grant, the same number as that determined for the purpose of the credit to the Committee for the cost of medical benefit ; and the grant ■ represents yf^^jths of the amount credited for medical benefit exclusive of the transfer of the domiciUary 6d. from Sanatorium Benefit in respect of members of Societies up to £4,250 and jf ^ths of such amount in excess of £4,250. (480) The scheme, under which the grant is distributed, empowers the Commissioners to make additional grants in the following circumstances if satisfied that a Committee's admini- strative expenditure is reasonable : — (a) Where the total inconie of a Committee for administrative purposes from all sources (excluding sums paid by Approved Societies in respect of travelling under Section 61 (2) proviso of the National Insurance Act, 1911) is less than £300, a further grant may be made sufficient to raise the income of the Committee to a sum not exceeding £300, strictly subject to the qualifications mentioned above. In the case of certain Highland and Island Committees, where it is shown to the satisfaction of the Commissioners that : ■ special circumstances exist, they may, to such extent and subject to such conditions as they think necessary, 141 authorise the payment of an additional grant not- withstanding that the income of the Committee exceeds £300. (6) Where the tfavelUng expenses of members of the Com- mittee at the approved rates exceed the maximum amount available for the Committee under the proviso to Section 61 (2) of the National Insurance A.ct, 1911, a further grant equal to the difference may be given. (481) To permit of the repayment of the travelhng expenses of members, County Insurance Committees, in terms of Section 61 (2) of the 1911 Act, receive, in addition to their apportionment of the foregoing funds, the proceeds of a special levy on Societies not exceeding Id. per member resident in the area of the Com- mittee, as authorised by the Commissioners. (482) The power of the Commissioners to authorise the repay- ment of travelhng expenses of members of County Insurance Committees in special circumstances has by Section 31 (2) of the Act of 1913 been extended to Burgh Committees. The circum- stances of burghs will, however, seldom necessitate payment of travelling expenses to members, and no expenditure under this h^ad wiU thus ordinarily arise. (483) In terms of Section 31 (1) of the Act of 1913 an Insurance Committee may also pay to its members subsistence allowance and compensation for loss of remunerative time, in accordance with a scheme to be prepared by the Committee and approved by the Commissioners. Only members of Insurance Committees are entitled to pay- ment under such schemes, and attendance at meetings of In- surance Committees and of Sub-Committees only may be taken into consideration for this purpose. No charge can therefore be made under the terms of the scheme for expenses incurred by delegates in attending general conferences with representatives of other bodies. Subsistence allowance should be separated from compensation for loss of time, and a member may be allowed to claim under each head in respect of the same attend- ance if qualified to do so. Members of Committee who reside .beyond the County or Burgh area are entitled to claim only on the basis of the amount which would have been charged had their residence been at the boundary of the County or Burgh area. In those cases in which Committee meetings are held outside the area of the Committee, the Commissioners are prepared to take the special circumstances of the Committee into consideration when the details of the schemes are submitted for approval. In the case of Burghs it is seldom necessary to pay subsistence allowances or compensation for loss of re- munerative time, especially the latter, if the meetings are held in the evening. (484) As regards subsistence allowances a member of an Insur- ance Committee is not required to prove actual expenditure on subsistence, the scale adopted by Committees providing only 142 for repayment of such expenses as would reasonably "be incurred by the members generally. The charges embodied in the scheme under this head in no case exceed the following scale : — Where absence from home is not less than 4 hours but less than 8 hours . . .2s. 6d. Where absence from home is not less than 8 hours but does not include a night . . , . 3s. 6d. Where absence from home includes a night, for each night .... 10s. Od. The allowance for a night covers any period up to 24 hours, commencing from the time of leaving home. Where a member claims compensation for loss of time in addition to subsistence allowance, the allowance for a night does not exceed 8s. (485) Compensation for loss of remunerative time is paid only in those cases in which a member has actually lost wages through attendance at meetings of Committees or Sub- Committees. This includes the case of a person who had to incur expense in providing a substitute, but excludes persons on fixed weekly or yearly salaries who incur no pecuniary loss, and persons working on their own account or not in employment. Actual loss of wages incurred by members who make claims under this head need not be investigated, provided the member has certified his loss and a fixed scale of payment has been laid down by the Committee. The maximum allowance which may be embodied in a Committee's scheme cannot exceed 3s. 6d. for each half-day on account of which the member suffers loss of wages. A scale of payment for periods of less than a half-day may, however, be allowed. (486) Allowances out of the grant are made from time to time to Committees to enable them to repay members the cost of these expenses. 4. GENERAL PURPOSES miJOME. (487) The income to be credited to the General Purposes Fund Account is obtained from the following sources : — (a) Sickness benefit payable in respect of insured persons who have no dependants and who are in receipt of sanatorium benefit. (b) Subscriptions and donations received from Local Authorities in terms of Sec. 61 (3) of the 1911 Act. (c) Fines payable by virtue of any rules made under Sub- section (3) of Section 14 of the 1911 Act. (d) Excess of any interest credited to the Committee in respect of sums in the hands of its bankers over bank charges debited to or paid by or on behalf of the Committee. (e) Incidental receipts. 143 5. TRANSFER BETWEEN FUNDS. (488) The whole available income of Committees, ordinary or special, for all purposes of benefit or administration, has been contributed and voted for specific purposes, and the Regulations and Schemes framed by the Commissioners with the approval where required of the Treasury have proceeded on the basis of allowing to Committees wide discretion within the ambit of their purposes. The contracts and commitments which Committees required to enter into have in general had the efEect of ear- marking all available monies. Under the Accounts of Insurance Committees Regulations, 1915, a Committee has, however, the power to transfer, subject to the express approval of the Com- missioners in each case, any monies available in the General Purposes Fund to the Administration Fund, the Sanatorium Benefit Fund, or the Medical Benefit Fund as the case may be ; provision is also made in these Regulations for a transfer from the Sanatorium Benefit Fund Account to the Administration Fund Account of a sum not exceeding the expenditure charged against the latter account in respect of the administration of Sanatorium Benefit. The purpose for which the money trans- ferred is to be applied must be one within the powers of the Committee, the terms of the Acts, and the conditions of the Grants (Accounts Regs. 4 (1) (iii.), 5 (2) (c), 6 (1) (ii.), and (7) (1) ("•))• SECTION (II.)— EXPENDITURE AND ACCOUNTING. (489) The income of Insurance Committees derived as indicated in the previous Section is expended in the following ways : — (a) Payments to Doctors for treatment. (b) Do. supply of drugs, etc. (c) Payments to Chemists. (d) Sanatorium Expenditure. (e) Administration Expenses. (/) General Purposes Expenditure. The further classification of expenditure is referred to in connection with the separate accounts into which the income and expenditure are carried, which are dealt with in the following paragraphs. 1. GENERAL. (490) In order that a proper record of all income and expendi- ture may be kept. Insurance Committees, in addition to the register of persons entitled to benefits administered by the Committee provided for in the Paragraph (F) and Medical Benefit Regulations, are required to keep certain registers, records, and accounts presciibed by the National Health Insurance (Accounts of Insurance Committees) Regulations, 1915, as follows : — 144 1. Sanatorium Benefit Register in a form approved by the Commissioners. 2. General Cash Book in a form approved by the Com- missioners. ' 3. Minate Book showing, inter alia, the payments authorised by the Committee. 4. Inventory of the property of the Committee not being moneys or securities. 5. Register of instruments, agreements, and contracts entered into by or on behalf of the Committee. 6. Ledger, containing the following accounts, together with, as respects each particular account, such sub- sidiary accounts as the Commissioners may from time to time require : — (a) Current Account with the Commissioners. (&) Administration Fund. (c) General Purposes Fund. (d) Sanatorium Benefit Fund. (e) Medical Benefit Fund. (/) Panel Service Fund. Ig) Institutions Fund. (h) Special Arrangements Fund. (i) Temporary Residents Fund, (j) Deposit Contributors Benefits Account. (Jc) Such other accounts as may be found necessary or desirable. 7. Register of sums due and paid to medical practitioners in a form approved by the Commissioners. 8. Register of sums due and contributed towards the ex- penses of systems or institutions approved under Sub- section (4) of Section 15 of the Act in a form approved by the Commissioners. 9. Register of sums duei and paid in respect of the supply of drugs, medicities, and appliances in a form approved by the Commissioners. 10. Register of claims received from and payments made to insured persons required or allowed to make their own arrangements in respect of medical benefit, in a form approved by the Commissioners. 11. Register of payments made in respect of benefits of Deposit Contributors in a form approved by the Commissioners. (491) The explanations in the following paragraphs of this Section will be more easily understood if the following principles are kept in view : — (a) Advances to the Committee on requisition prior to advice of the income for the year are to be entered in the Current Account with the Commissioners as a credit, 145 but no entry, thereof should be made in the ledger under any of the benefit fund or administration accounts. (&) When the Committee receives the advices of its income for medical and sanatorium benefits and administration the amount of the advice should be entered in the appropriate Ledger Account as a credit, and a corresponding debit entered in the Current Account with the Commissioners. (c) When payments are made by the Commissioners to the Committee's Bank Account in respect of income already advised, the Current Account with the Commissioners should be credited with the amount thereof, and the Bank Account debited. No entry should be made in the Ledger under any of the appropriate fund accounts. (d) All actual payments for medical and sanatorium benefits and administration should be entered in the Greneral Cash Book and posted to the appropriate Fund Account in the Ledger as a debit. (e) The amount available to the Committee on each Fund for the remainder of the year is, subject to any further credits which may be receivable at any time, shown in the appropriate Ledger Fund Account as the difierence between the advice credited and the actual payments debited plus expenditure incurred, but not yet paid. 2. GENERAL CASH BOOK. (492) A form of General Cash Book has been circulated for use by Committees, and has been generally adopted.. All cash transactions without exception must be entered in the Cash Book and subsequently posted to the appropriate account in ihe Ledger. (493) The receipts side of the General Cash Book should be posted in the Ledger as follows : — (a) the advances received from the Commissioners should be credited to the " Insurance Com- missioners Current Account " ; (6) receipts from any other sources should be credited to the appropriate accounts in the Ledger. (494) Any sums received direct by the Committee should be paid, without any deduction, into the account of the Committee at its bankers on the day of receipt, and a hue should be drawn under the last item, in column 6 of Cash Book, so paid into bank, and the total of the amount paid into bank entered on the same line in column 7a. (495) As regards payments, the entries in the " sundries " column of the General Cash Book should be posted separately to the debit of the proper Ledger Accounts, and the total of each of the other classification columns as a debit to the corresponding Ledger Account. 146 (496) In cases where postal orders are issued hj the Commis- sioners payable to the Insurance Committee for benefits of Deposit Contributors, the value of the postal orders should be entered in column (6) of the General Cash Book, and any pay- ments made in respect of the benefit should be recorded in column (14) of the General Cash Book. A subsidiary record of the receipts and payments in respect of each contributor's benefit so administered must be kept in the " Register of Payments made in respect of benefits of Deposit Contributors." (497) The other payments falhng to be recorded in the Cash Book are analysed under the headings given and should be posted to the respective accounts in the Ledger. These are referred to later under Ledger Accounts. 3. LEDGER ACCOUNTS. (498) It is of the utmost importance that after the initial entries of transactions are made in the Cash Book, these should be posted forthwith to Ledger Accounts in order that the position of the different funds may be ascertained at any date. The transactions of Insurance Committees are mainly in cash, and are entered in the Cash Book and posted to the Ledger. The income of Committees is advised to them by tha Commissioners, and an advice note thereof is issued. On receipt of the advice the amounts may be posted direct to the appropriate Ledger Accounts, or if preferred may be recorded in a Journal before being ported. A Journal, however, has not been regarded as necessary and has not been prescribed. (499) A trial balance should be made periodically to prove the Ledger. The entries in the Cash Book and the Journal, if kept, are posted to the debit and credit of Ledger Accounts, and if the cash and bank balances are taken into account, the debits in the Ledger should agree with the credits. (500) The main transactions falling to be recorded in the prin- cipal Ledger Accounts are as follows : . Current Account with the Commissioners. (501) The advice notes issued by the Commissioners show the income of the Committee under the following heads : — (a) Medical Benefit. (6) Sanatorium Benefit. (c) Administration. On receipt of the advice, which shows what is due to- the Committee, the Commissioners' Current Account should be debited and the appropriate Medical Benefit, Sanatorium Benefit, or Administration Fund credited. (502) Committees from time to time apply to the Commissioners for advances, and the amount advanced is paid by, them to the Committee's bank account. The Commissioners apportion 147 advances between the funds to enable Committees to decide as to what may be spent. Such, apportioned amounts should not be credited to the particular funds, but the advance shoidd be recorded in the Cash Book and from there posted to the credit of the Insurance Commissioners' Current Account. The actual income as distinct from an advance to account of that income should be posted to the appropriate Fund when the advice is received. (503) The Insurance Commissioners' Current Account should show therefore what is due by the Commissioners to the Com- mittee. As will be seen from the sample account given below, income advised is charged or debited to the account, whereas cash received to account is credited, any excess of the debit represent- ing the indebtedness of the Commissioners to the Committee. Examfle. Current Account with the Commissioners. Dr. Cr. To Medical Benefit Fund, per By Cash, being advance from Advice Form 156. Commissioners. ,, Sanatorium BenefitFund, per advice. „ Administration Fund, per advice. Medical Benefit Fund. (504) The amount of the Medical Benefit Fund as advised should be credited in the Ledger Account headed " Medical Benefit Fund," and transfers to the subsidiary medical funds be then made. Such transfers may be journalised. Examfle. Medical Benefit Fund. Dr. ' Cr. To Panel Service Fund. By General Medical Benefit „ Institutions Fund. Fund as advised by Com- „ Special Arrangements Fund. missioners. „ Practitioners Fund, amount of ,, Sanatorium Benefi.t Fund, Domiciliary 6d. amount of Domiciliary 6d. ,, Institutions Fund, do. „ Special Arrangements Fund, do. (Med. Benefit Regs. 33 (3) and 43.) The income credited in this account being wholly apportioned to other funds, there will, in ordinary circumstances, be no balance to carry forward. (505) The amount of income applicable to temporary residents obtained from the Central Medical Benefit Fund should be recorded separately from the ordinary medical benefit in- come (see paragraph (490) and Article 3 and First Sch. Accounts Regulations). 148 Panel Service Fund. (506) Under Article 33 (3) of the Medical Benefit Kegulations there is carried to the credit of the Panel Service Fund from the Medical Benefit Fund Account a sum calculated with reference to the number of persons on panel lists. (507) Article 33 (3) further provides that the Panel Service Fund shall be apportioned as to thirteen-seventeenths to the Practi- tioners Fimd, and as to four-seventeenths to the Drug Fund. The Regulations do not deal with the domiciliary sixpence, but this amoxmt should appear to the credit of the Panel Service Fund and be apportioned to the Practitioners Fund. (508) The Panel Service Fund will appear as follows in the Ledger : — Example. Pand Service Fund. Dr. Cr. To Practitioners Fund 13/] 7ths By Medical Benefit Fund, (Arts. 33 (3)). being amount apportioned „ Drug Fund 4:/17ths (33 (3)). as apphcable to this Fund (Art. 33 (3)). The references are to the Medical Benefit Eegulations. This account should always be square, no balance appearing thereon. Practitioners Fund. (509) The 13/17ths referred to above as coming from the Panel Service Fund should, be credited in this account, and to the debit be posted the cash paid to doctors as appearing in column in Cash Book headed " Practitioners Fund." There may also fall to be credited to this fund a transfer from the Drug Fund, viz., any balance on the Drug Fund remaining after meeting chemists' accounts which does not exceed one-fourth of the amount carried to the credit of the Drug Fund from the Panel Service Fund for the year. Any balance on the Drug Fund in excess of one-fourth of the amount credited for the year from the Panel Service Fund, i.e. excluding any balance brought forward from the preceding year, is carried forward to the credit of the Drug Fund for the next j^ear. The account in the Ledger would be — Example. Practitioners Fund. Dt. Cr. To Cash per monthly totals in By Panel Service Fund, amount Cash Book. transferred (Art. 33 (3)). ,, Drug Fund, amount trans- ferred (Art. 39 (7)). ,, Medical Benefit Fund, amount of Domiciliary 6d. The references are to the Medical Benefit Regulations. 149 Dbuq Fund (510) The Drug Fund is to meet chemists' and doctors' accounts for drugs, medicines, and prescribed appliances, and amounts due to doctors for dispensing on a capitation basis. The pay- ments to chemists and doctors should be posted from the Cash Book to the debit of the Drug Fund, and any credit balance on the Drug Fund after making these payments, not exceeding one- fourth of the initial credit to the fund for the year, i.e. excluding any balance from previous year, falls to be credited to the Prac- titioners' Fund Account, any further balance in excess of that amount being carried forward. The account summarised in ledger form is as follows : — Example. Drug Fund. Dr. Cr. To Cash per Cash Book (e). By balances brought forward (a). „ Practitioners Fund, being „ Panel Service Fund, amount one-fourth of amount of 4/17th8 transferred (6). credited at (b) {see Art. 39 (7)) {d). „ Balance carried forward (/). „ Bonus to Chemists (e). (/) must amount to -^ of ((a) + (6)) - ((i) if the balance so permits. The references to Articles are to those of the Medical Benefit Regulations. The transfer {d) must not exceed one-fourth of (6), but it may in certain circumstances exhaust the Fund. (e) is a special arrangement for the years 1913, 1914, and 1915. If, after the retransfer [d) there is a balance it is to be treated as follows : — (1) The difference, if any, between (c) and ^ of (a) plus (6), is paid to the Chemists as a bonus rateably, accord- ing to the total amount of their bills for the year. (2) The balance, if any, is carried forward. Institutions Fund. (511) To this fund is carried the amount available for meeting the cost of medical attendance and drugs of insured persons who are receiving treatment through an approved system or institu- tion. The only " institution " approved in Scotland is the Post Office Medical System. (512) From the Medical Benefit Fund there is transferre'd the equivalent of what is transferred to the Panel Service Fund for ordinary cases of insured persons. (513) Under the Medical Benefit- Regulations, returns are to be 150 furnislied by institutions at the commencement of each quarter, showing the number of insured persons who are members of the institution as also certificates as to the amount of expenditure. The Insurance Committees then disburse the income in this fund in repa3mig the institution (a) the amount of its certified expenditure, or (6) a sum bearing the same proportion to the sum standing to the credit of the Institutions Fund as the number of insured persons of the institution bears to the total number of insured members of institutions, whichever he the less. ,.,, 160 CONSTITUTION OF INSURANCE COMMITTEES— (cou^mwerf). BtJKGHS. o . ll ^4 pre- ical O A.t>^'Q- H Committee. a s s Members Re senting Insu Persons. Members Appointed Town Coun Members Re senting Med Praotitione Medical Pra tioners A] pointed b Town Coun Aberdeen . 60 14 36 12 2 2 ■ 8 Arbroath . 30 8 18 6 2 3 Airdrie . . . 30 8 18 6 2 3 Ayr .... 40 9 24 S 2 5 Clydebank . . 40 9 24 8 2 5 Coatbridge . 40 10 24 8 2 5 Dumbarton 30 8 : 18 6 2 3 Dumfries and Maxwell town 30 8 18 6 2 3 Dundee 60 14 36 12 2 8 Dunfermline . 30 8 18 6 2 3 Edioburgh . 70 16 42 14 2 10 Falkirk . . . 40 9 24 8 2 5 Glasgow . . 80 19 48 16 2 11 Greenock . . 50 11 30 10 2 7 Hamilton . 40 9 21 11 2 5 Inverness . 30 8 18 6 2 3 Kilmarnock 40 9 24 8 2 5 Kirkcaldy . . 40 9 24 8 2 : 5 Leith ... . 50' 11 : 30 10 2 7 Motherwell 40 10 24 8 2 5 Paisley 50 11 30 10 2 7 Perth . . . 40 9 : 24 8 2 5 Rutherglen 30 8 18 6 2 3 Stirling . . . 30 8 18 6 2 3 Wishaw . . 30 8 : 18 6 2 3 (B.) ELECTORAL DIVISIONS AND VOTES FOR DRUG ACCOUNTS COMMITTEE. (See Clap. I., Section {I.) {ix.), paragraph (65).) Insurance Committees. Value of Votes. Insurance Committees. Votes' Elbotobai Division II. . LECTOKAL DIVISION I. Aberdeenshire . . .3 Aberdeen Burgh . . .4 Zetland . 1 Kincardine . . . .1 Orkney . 1 Forfar 3 Caithness . . . . 1 Arbroath . . . .1 Sutherland . . 1 Perthshire . . . . 3 Ross and Cromarty k> Perth Burgh. . . . 2 Inverness -shire . 2 Elbotobal Division III. Inverness Burgh . . 1 Dundee . . . .4 Argyll . . 2 Fife 4 Bute . . 1 Dunfermline . . .2 Elgin and Nairn . . 2 Kirkcaldy .... 2 Banff . . 2 Clackmannan and Kinross . 2 161 ELECTORAL DIVISIONS AND VOTES FOR DRUG ACCOUNTS COMMITTEE— (coniimted). Insurance Committees. Value of Votes. Insurance Committees. Value of Votes. Elbotoeai Division IV. Electoral Division VI. Airdrie. 1 Lanark . 4 Coatbridge . 2 Linlithgow . . 3 Hamilton 2 Dunbartonshire . 3 MotherweU . •} StirUngshire . . 3 Rutherglen . 1 Electoeal Division VII. Wishaw I Midlothian 3 Ayr Burgh . 2 Leith .... . 3 Kilmarnock . 2 Edinburgh . . 5 Dumbarton Burgh 1 Electoeal Division VIII. Clydebank . 2 Peebles . 1 Stirling Burgh 1 Selkirk. . I Falkirk . 2 Haddington . . 2 Berwick 1 Electoeal Division V. Roxburgh . . 2 Ayrshire 4 Dumfriesshire . 2 Renfrew- 3 Dumfries and Maxwelltown . 1 Greenock . 3 Kirkcudbright . 1 Paisley 3 Wigtown . 1 APPENDIX III. MODEL RULES FOR ADMINISTRATION OF MEDICAL BENEFIT. (See Cap. II., Section (I.), paragraph (83), aiid Cap. IV., Section (IV.), paragraph (247).) (Conduct op Peesons in Receipt oe Benefit, and Pboobdube of the Medical Service, Pharmaceutical Seevice, and Joint Services Sub-Committees. ) 1. Conduct op Peeson in eeceipt of Medical Benefit. An insured person in receipt of medical benefit shall comply with the following rules : — (a) He shall obey the instructions of the practitioner attending him : (ft) He shall not conduct himself in a manner which is likely to retard his recovery : (dc) He shall not make unreasonable demands upon the professional services of the practitioner attending him : (d) He shall, whenever his condition permits, attend at the surgery or place of residence of the practitioner attending him on such days and at such hours as may be appointed by the practitioner : (e) He shall not summon the practitioner to visit him between the hours of p.m. and a.m., except in cases of serious emergency : (/) He shall, when his condition requires a home visit, give notice to the practitioner, if the circumstances of the case permit, before a.m. on the day on which the visit is required. 162 2. Omencbs. (1) The Committee may in their discretion inflict a fine upon any insured person who is guilty of a breach of any of these rules, or of any of the pro- visions of the Act relating to medical benefit, or of the regulations, or of any imposition or attempted imposition in respect of medical benefit, of a sum not exceeding * shillings, or in the case of repeated breaches ♦ shillings, and may, in the case of repeated breaches, suspend his medical benefit for a period not exceeding f : Provided that (i.) no insured person shall be subject to any penalty, or suspended from benefit on account of refusal to submit to vaccination or inoculation of any kind, or to a surgical opera- tion, unless such refusal, in the case of a surgical operation of a minor character, is considered by the Committee, or, on appeal, by the Commis- sioners, unreasonable ; and (ii.) if any act or omission alleged to constitute a breach of these rules is of such a nature as to amount to a breach of any rule of a Society of which the insured .person is a member, the Committee shall refer the matter to the Society, and unless the Society has unreasonably refused to take action or the action taken by the Society appears to the Committee to be inadequate, shall not deal with the matter themselves except by way of transferring the insured person, in cases where after inquiry they think fit, to another practitioner on the panel. (2) An insured person who has failed to pay a fine imposed on him under these rules within weeks of the date on which it was so im- posed may be suspended from medical benefit for a period not exceed- ing .t 3. Infliction of Penalties. Before inflicting any penalty upon an insured person or transferring him to another practitioner the Committee shall give notice to that person of their intention, and if within seven days from the receipt of the notice he gives notice to the Clerk that he desires to be heard in explanation of his conduct, the Committee shall, except in cases where the facts have already been investigated by any one of the Sub-Committees appointed under the Regulations for that purpose, fix a date for the hearing by the Committee, or shall refer the matter to the appropriate one of those Sub-Committees, and when the matter is heard by the Committee not less than seven days* notice shall be given to the insured person of the date fixed for the hearing. 4. Meetings of Sub-Committees. (1) The Medical Service Sub-Committee shall meet at least once in every weeks, and the Pharmaceutical Service Sub-Committee shall meet at least once in every weeks. * Section 14 (2) (o) of the National Insurance Act, 1911, provides that " no fine imposed . . . shall exceed ten shillings, or. in the case of repeated breaches of rules, twenty shillings." t Section 14 (2) (6) provides that " no . . . rule shall provide for the suspension of an/y benefit for a period exceeding one year." Section 69 (1) of the Act provides that, " //, for the purpose of obtaining any benefit or payment . . . under this Part of this Act . . . any person knowingly makes any false statement or false representation, he shM be liable .... to imprisonment for a term not exceeding three months." Section 71 of the Act provides, " // it is found at any time that a person has been in receipt of any payment or benefit under this Part of this Act withovt being lawfully entitled thereto, he, or in the case of his death his personal re- presentatives, shall be liable to repay to the Insurance Commissioners the amorint of such payment or benefit, and any such amount may be recovered as a, debt due to the Croum ..." 163 (2) In a case of urgency the Chairman of either Sub-Committee may- summon a special meeting of the Sub-Committee by giving not less than seven days' notice to each member thereof. (3) The Clerk shall summon a meeting of the Joint Services Sub-Com- mittee as often as may be required by giving not leas than seven days' notice to each member of the Sub-Committee. » 5. Pkooedttre op Mbdioal Seevicb and Phakmaceutical Sbbvioe Sue 'OOMMITTEBS. Where under the provisions of the Regulations any question arising between a. practitioner on the panel or a person supplying drugs or ap- pliances and an insured person is referred to the Medical Service Sub- Committee or to the Pharmaceutical Service Sub-Committee the following procedure shall be adopted : — (a) The Clerk shall, within three days, send copies of the statement made by the complainant to the respondent and to the Chairman of the appropriate Sub-Committee, and shall upon receipt of any reply or further statement made by either party send copies thereof to the other party and the Chairman. (5) * Not less than seven days' notice of the meeting at which a ques- tion is to be considered shall be given to both parties. (c) The Clerk shall at the meeting of the Sub-Committee supply to each member of the Sub-Committee copies of the statement and the reply, if any, thereto, and of any further statement made by either party. {d) Either party shall be entitled to be present at the hearing and to give such evidence, either by himself or by witnesses, as the Sub-Committee may think relevant to the matters in issue, and may put such questions to the other party, or to any witness called by him, either directly, or, if the Sub-Committee so direct, through the Chairman of the Sub-Committee, but, subject as aforesaid, the procedure at the hearing shall be such as the Sub- Committee may determine. (e) The Sub-Committee may, before giving their decision, exclude from the proceedings the parties and other persons present at the hearing. * The following paragraphs may be substituted for Paragraph (6) if it is desired that the Sub-Committee should have an opportunity of considering the statements made by the complainant, and dismissing the matter if it appears to them that no prima facie case has been shown. It should be observed, however, that the adoption of this procedure necessitates the case coming before the Sub-Committee at least twice, and consequently involves some delay : — " (c) The Suh-Gommittce shall consider the statement or statements made by the complainant, and if in their opinion the allegations con- tained therein disclose no case for inquiry the Olerlc shall inform the complainant that unless, within seven days, the complaiTiant submits a further statement, which in the opinion of the Sub-Comr mittee discloses a case for enquiry, or gives notice to the Cleric tltat he desires to be heard in person by the Sub-Com,mittee, the matter wUl be dismissed, and, if the complainant fails to submit such statement or give such notice as aforesaid within seweji days, the matter shall stand dismissed. ' " (d) If in the opinion of the Sub-Oommittee a case for inquiry is dis- closed, or the complainant has given notice of his desire to be heard in person, the Sub-Committee shall, unless in the former case tjiey decide, with the consent of both parties, to dispense with a hearing, appoint a day for the hearing and shall give not less than seven days' notice to both parties of the lime and place at whi-ch the hearing will iahe place." 164 (/) If either party fails to appear at the hearing, and the_ Sub-Com- mittee are satisfied that his absence is due to illness, incapacity, or other reasonable cause, they may postpone the hearing for such time as they think fit. ig) In the case of the Medical Service Sub-Committee the Chairman, together with one representative of insured persons and one * of the persons appointed by the Local Medical Copamittee or Panel Committee, and in the case of the Pharmaceutical Service Sub-Committee the Chairman, together with one representative of insured persons and one registered pharmacist, shall form a 6. Pbocedure of Joint Services Stjb-Gommittbe. Where under the provisions of the Regulations any question is referred to the Joint Services Sub-Committee the following procedure shall be adopted : — (a) The Clerk shall, within three days, send copies of any statements or replies furnished to the Sub-Committee by which the matter is referred, to any third party to whom the question relates, and to the Chairman of the' Sub-Committee, and shall, upon the receipt of any statement made by the third party, send a copy thereof to the other parties and the Chairman. (6) The Chairman, together with one representative of insured persons, one practitioner, and one registered pharmacist shall form a quorum, (c) Subject as aforesaid, the procedure of the Joint Services Sub-Com- mittee shall be similar to that of the Medical Service Sub- Committee with such modifications as are rendered necessary by the inclusion of a third party. 7. Fbivolous OB Vexatious Questions. Any insured person raising a question which, after investigation by the Committee or the Medical or Pharmaceutical Service Sub-Committee, appears to the Committee to be frivolous or vexatious, shall be deemed to have committed a breach of these rules. 8. Intbkpketation. (1) Words and expressions used in these Rules have the same meaning as in the National Health Insurance (Medical Benefit) Regulations (Soot- land), 1913, which are in these Rules referred to as " the Regulations." (2) The expression " the Committee " means the Insurance Committee for the County [Burgh] of , and the expression " the Clerk " means the Clerk or the Acting Clerk of the Committee. (3) The expression " the complainant " means the person who raises any question within the meaning of Paragraph (1) of Article 45 of the Regulations, and the expression " the respondent " means the person in respect of whom the question is raised. * In cases where the Medical Service Sub-Committee has been enlarged, with the consent of the Commissioners, under Article 45 (2) (1) of the Medical Benefit Regulations, it will be desirable to modify this rule. It is suggested that if the enlarged Sub-Committee consists of 9 members, the word " two " should be substituted for the word " one " where it appears in the rule, and that the word " three " should be similarly substituted if the enlarged Sub-Committee consists of 11 members. 165 APPENDIX IV. LIST 03? LOCAL MEDICAL COMMITTEES RECOGNISED BY THE COMMISSIONERS. (Rerised to 1st June 1915.) {See Cap. III., Section {I.), paragraph (121).) Counties. Aberdeen. Argyll. Ayr. Berwick. Banff. Bute. Clackmannan and Kinross. Dumfries. Dunbarton. Elgin and Nairn. Fife. Forfar. Haddington. Kincardine. Kirkcudbright. Lanark. Linlithgow. Orkney (Panel Committee). Peebles. Perth. Renfrew. Ross and Cromarty. Roxburgh. Selkirk. Stirling. Sutherland. Wigtown. Zetland. Burghs. Aberdeen. Airdrie. Ayr. Arbroath. Clydebank. Coatbridge. Dumbarton. Dumfries and MaxweUtown. Dundee. Dunfermline. Edinburgh. Falkirk. ■ Glasgow. Greenock. Hamilton. Inverness. Kilmarnock. Leith. Motherwell. Paisley. Perth. Ruthergien. Stirling. Wishaw. APPENDIX V. LIST OF PANEL COMMITTEES WITH MEMBERSHIP, QUORUM, AND SECRETARIES. (-See Cap. III., Section (II.), paragraphs (131), (134), and (135).) COTJJTTIES. Aberdeen — Members, 14 ; Quorum, 3 — Dr. R. Bruce, Thoreaby, Cults (Dr. J. E. Skinner, Westhill House, Skene, acting). Argyll — Members, 12 ; Quorum, 3 — Dr. J. A. Clarke, Milton House, Dunoon. Ayr — ^Members, 15 ; Quorum, 5 — ^Dr. W. A. Paterson, Elmbank House, Irvine. Communications to Mr. W. D. M'Michael, 84 John Finnic Street, Kilmarnock. Banff — ^Members, 10 ; Quorum, 3 — ^Dr. J. Taylor, Ugie House, Keith. Berwick — Members, 8 ; Quorum, 3 — Dr. A. J. Campbell, 47 Market Square^ Duns. Bute — ^Members, 7 ; Quorum, 3 — Dr. J. S, Hall, 13 Battery Place, Rothesay. Caithness — ^Members, 7 ; Quorum, 3 — Dr. T. Wright, 13 Sinclair Terrace, Wick (Dr. Turnbull, 13 Sinclair Terrace, acting). ■Clackmannan and Kinross — Members, 10 ; Quorum, 3 — ^Dr. J. D. V. Wilson, Endrick, West Kellie Place, AUoa. Dumfries — ^Members, 11 ; Quorum, 3 — ^Dr. M. Bryson, ThornhiU, Dam- friesshire. 166 Bunbarton — Members, 12 ; Quorum, 3— Dr. A. W. Sutherland, Barbain, Cardrosa. Elgin and Nairn — Members, 10 ; Quorum, 3— Dr. J. A. Stephens, Murray- field, Elgin. Fife — Members, 15 ; Quorum, 5 — Dr. G. C. Anderson, Denbeath House, Denbeath, Methil (Dr. Craig, Cowdenbeath, acting). Porfar — Members, 12 ; Quorum, 3 — Dr. G. C. Burgess, New Road, Forfar. Haddington — Members, 10 ; Quorum, 3— Dr. T. P. Caverhill, The Hollies, Haddington. InTcrnesB — Members, 12 ; Quorum, 3 — Dr. J. W. M'Kenzie, 5 Castle Street, Inverness. Kincardine — Members, 8 ; Quorum, 3 — Dr. H. Grey Brown, 47 Evan Street, Stonehaven. Kirkcudbright — Members, 8 ; Quorum. 3 — Dr. R. B. Lorraine, Castle Douglas. Lanark — Members, 16 ; Quorum, 5 — Dr. R. Thompson, Hawthornlaw, TJddingston. Communications to Mr. W. S. Mackenzie, Solicitor, Larkhall. Linlithgow — Members, 12 ; Quorum, 3 — Dr. J. Hunter, 16 Traquair Park, Corstorphine (Dr. Alexander Scott, Broxburn, acting). Midlothian — Members, 13 ; Quorum, 3 — Dr. Thomson, c /o J. B. Maekie, Esq., 25 George Street, Edinburgh. Orloiey — Members, 7 ; Quorum, 3 — Dr. G. Sinclair, Queen Street, Kirkwall. Peebles — Members, 7 ; Quorum, 3 — Dr. T, D. Luke, St. Rbnan's, Venlaw Brae, Peebles. Perth — Members, 12 ; Quorum, 3 — Dr. A. Trotter, Tayview House, Perth ; Dr. J. H. Lyell, 15 Marshall Place, Perth. Correspondence to Dr. LyeU. Renfrew — Members, 15 ; Quorum, 5 — Dr. J. Barr Steven, Beechcroft, Renfrew. Ross and Cromarty — Members, 10 ; Quorum, 3 — Dr. 0. Pender Smith, The Croft, Dingwall. Roxburgh — Members, 11 ; Quorum, 3 — Dr. W. T. Barrie, 18 Bridge Street, Hawick. Correspondence to Mr. E. Watson Simpson, Solicitor, Bank of Scotland Chambers, Hawick. Selkirk — ^Members, 8 ; Quorum, 3 — Dr. J. M. Menzies, Ettrick Lodge, Selkirk. Stirling — Members, 13 ; Quorum, 3 — Dr. J. Young, Mora, Bonnybridge. Sutherland — Members, 7 ; Quorum, 3 — Dr. J. B. Simpson, The Hollies, Golspie. Wigtown — Members, 8; Quorum, 3 — Dr. Jas., Dawson, Public Health Office, Newton-Stewart. Zetland — Members, 7 ; Quorum, 3 — Dr. J. F. Robertson, Viewtorth, Ler- wick. BUKGHS. Aberdeen — Members, 15 ; Qiiorum, 5 — Dr. C. Forbes, 54 King Street, Aberdeen. Communications to Mr. J. Johnstone, 80 Union Street. Airdrie — Members, 6 ; Quorum, 3 — ^Dr. Jas. Monie, Westfield, Airdrie. Arbroath— Members, 5 ; Quorum, 3 — Dr. J. E. G. Thomson, 13 Hill Terrace, Arbroath. Ayr — Members, 7 ; Quorum, 3 — Dr. J. AUan Thom, 19 Dalblair Road, Ajt. •Clydebank — Members, 7 ; Quorum, 3 — Dr. T. M. Strang, 1 Drumry Road, Clydebank. ■Coatbridge — Members, 8 ; Quorum, 3 — Dr. Jas. Andrew, Arlington, Coatbridge. Dumbarton — Members, 5 ; Quorum, 3 — Dr, T. Miller, British Linen Bank Buildings, High Street, Dumbarton. Dumfries and Maxwelltown — Members, 6 ; Quorum, 3 — Dr. J. Dewar Robson, Dalston House, 1 Hope Place, Maxwelltown. Dundee — Members, 15 ; Quorum, 5 — Dr. G. F. Whyte, 12 Airlie Plaoe, Dundee. JDunfermline— Members, 7 ; Quorum, 3 — Dr. .1. Dalgleish, 12 Comely Park, Dunfermline. 167 Edinburgh — Members, 16 ; Quorum, 5— Dr. J. Craig, 216 Bruntsiield Place, Edinburgh. Falkirk — Members, 7 ; Quorum, 3— Dr. G. Gardner, 2a Georre Street, Falkirk. Glasgow — Members, 20 ; Quorum, 7 — Dr. Jas. R. Drever, Linoluden, Clarkston Eoad, Cathoart, Glasgow. Greenock — Members, 12 ; Quorum, 3 — Dr. J. Miller, 35 Regent Street, Greenocli. Hamilton — Members, 8 ; Quorum, 3 — Dr. H. MiUer, Marie Lodge, Auohen- gramont Road, Hamilton. Inverness — ^Members, 6; Quorum, 3 — Dr. J. Munro Moir, 4 Ardross Terrace, Inverness. Kilmarnock — Members, 7 ; Quorum, 3 — Dr. J. Aitken, Allanhill, London Road, Kjlmam'ook. Kirkcaldy — Members, 7 ; Quorum, 3 — Dr. J. Isedale Greig, 23 Townsend Place, Kirkcaldy. Leith— Members, 12 ; Quorum, 3— Dr. J. Mill, 188 Ferry Road, Leith. Motherwell — Members, 8 ; Quorum, 3 — Dr. R. Robertson, " Stronbuie," Motherwell. Paisley — Members, 12 ; Quorum, 3 — Dr. J. D. Holmes, 12 Neilston Road, Paisley. Perth — Members, 7 ; Quorum, 3 — Dr. A. Trotter, Tayview House, Perth; Dr. .1. H. Lyell, 15 Marshall Place, Perth. Correspondence to Dr. Lyell. Rutheiglen — Members, 7 ; Quorum, 3 — Dr. A. D. Buchanan, Mossgiel, Rutherglen. Stirling — ^Members, 6; Quorum, 3. — ^Dr. A. Vest, 11 Pitt Terrace. Stirling. Wishaw — ^Members, 6 ; Qu.orum, 3 — Dr. T. Scott Brodie, 21 Belhaven Terrace, Wishaw. Note. — The membership and quorum of certain Highland and Island ■Committees where difficulty has been experienced in holding meetings is under consideration. APPENDIX VI. LIST OF PHARMACEUTICAL COMMITTEES WITH MEMBERSHIP, QUORUM, AND SECRETARIES. (See Cap. III., Section [III.), paragraphs (149), (152), and (153).) COXJNTIBS. Aberdeen — Members, 9 ; Quorum, 3 — J. E. Reith, St. Deveniok's Pharmacy, Cults. Jiigyll — Members, 7 ; Quorum, 3 — J. R. Thomson, 9 Main Street, Campbel- town. Ayr — Members, 9 ; Quorum, 3— W. G. Boyd, 68 Portland Street, Kilmar- nock. Banff— Members, 5 ; Quorum, 3— R. W. Garrow, CheJnist, Mid Street, Keith. Berwick — Members, 5 ; Quorum, 3— Wm. Elliot, Chemist, Coldstream. : Bute — Members, 5 ; Quorum, 3 — G. 0. Hill, 64 Montague Street, Rothesay. •Caithness — Members, 5 ; <3uorum, 3— G. Banks, 26 Bridge Street, Wick. ■Clackmannan and Kinross — Members, 5 ; Quorum, 3 — T. Hetherington, Chemist, Tillicoultry. Dumfries — Members, 5 ; Quorum, 3— A. G. Laidlaw, 84 High Street, Lockerbie. Dunbarton— Members, 7 ; Quorum, 3— A. T. Campbell, 71 Bank Street, Alexandria. JElgin and Nairn— Members, 5 ; Quorum, 3— A. Robertson, 94 High Street, Elgin. 168 Fife— Members, 7 ; Quorum, 3— C. Stewart, 231 High Street, Kirkcaldy. Forfar — Members, 7 ; Quorum, 3 — G. Forbes Johnston, 154 Brook Street, Broughty-Ferry. Haddington — Members, 5 ; Quorum, 3 — W. P. Wilson, 36 High Street, Haddington. Inverness — Members, 7 ; Quorum, 3 — E. Macdonald, 18 Church Street, Inverness. Kincardine — Members, 5 ; Quo;:um, 3 — A. Lyon Wood, 9 Market Square, Stonehaven. Kirkcudbright — Members, 5 ; Quorum, 3 — John Barr, 187 King Street, Castle-Douglas. Lanark — Members, 11 ; Quorum, 5 — J. A. Walls, The Pharmacy, 59 Main Street, Bothwell. Linlithgow — Members, 5 ; Quorum, 3 — F. Stuart, Chemist, Broxburn. Midlothian — Members, 7 ; Quorum, 3 — H. Dryerre, The Pharmacy, Bonny- rigg. Orkney — Members, 5 ; Quorum, 3 — B. Heddle, Albert Street, Kirkwall. Peebles — Members, 5 ; Quorum, 3 — W. J. Sanderson, 43 High Street, Peebles. Perth— Members, 7 ; Quorum, 3— T. Harley, 29 High Street, Perth. Keufrew — Members, 9 ; Quorum, 3 — D. Penman, 28 High Street, Johnstone. Ross and Cromarty — Members, 5 ; Quorum, 3 — J. F. Hunter, 8 High Street, Dingwall. Roxburgh — Members, 5 ; Quorum, 3 — G. Cairns, 12 Sandbed, Hawick. Selkirk — Members, ? ; Quorum, 3 — J. Henry, 24 Bank Street, Galashiels. Stirling — Members, 7 ; Quorum, 3 — R. Marshall, Chemist, South Bridge Street, Grangemouth. Sutherland — Members, 5 ; Quorum, 3 — J. Mennie, Chemist, Golspie. Wigtown — Members, 5 ; Quorum, 3t-J. Dunn, 64 Victoria Street, Newton- Stewart. * Zetland — Members, 2 to 5 ; Quorum, 2 — A. A. Porteous, Union Bank Buildings, Lerwick. Btteohs, Aberdeen — Members, 7 ; Quorum, 3 — W. F. Hay, 476 Union Street, Aber- deen. Airdrie — ^Members, 5 ; Quorum, 3 — W. S. Culbert, 39 Stirling Street, Airdrie. Arbroath — Members, 5 ; Quorum, 3— F. W. M. Bennett, 238 High Street, Arbroath. Ayr — Members, 5 ; Quorum, 3 — Martin Meldrum, 7 Burns Statue Square, Ayr. Clydebank — Members, 5 ; Quorum, 3 — John Weir, 3 Glasgow Road, Clydebank. Coatbridge — Members, 5 ; Quorum, 3 — G. Clark Wilson, 1 10 Bank Street, Coatbridge. Dumbarton — Members, 5 ; Quorum, 3 — P. Mitchell, 8 Church Street, Dumbarton. Dumfries and Maxwelltown — Members, 5 ; Quorum, 3 — J. Fraser, The City Pharmacy, 84 High Street, Dumfries. Dundee — Members, 7 ; Quorum, 3 — G. J. Lindsay, HI Nethergate, Dundee. Dunfermline — Members, 5 ; Quorum, 3 — R. Robertson, Abbey Pharmacy, 55 Moodie Street, Dunfermline. Edinburgh^Members, 9 ; Quorum, 5 — J. Muir, 7 Crichton Place, Leith Walk, Edinburgh. Falkirk — -Members, 5 ; Quorum, 3 — D. Dunnet, 82 Main Street, Bainsford, Falkirk. Glasgow—Members, 15; Quorum, 5 — G. S. Kitchin, U6 Nithsdale Road, Pollokshields, Glasgow. Greenock — Members, 5 ; Quorum, 3 — T. L. Sinclair, 86 Roxburgh Street, Greenock. Hamilton^Members, 5 ; Quorum, 3 — B. Reekie, 18 Brandon Street, Hamilton. 169 Inverness— Members, 5; Quorum, 3— B. Maodonald, 18 Church Street, Inverness. KUmarnoek— Members, 5 ; Quorum, 3— W. G. Boyd, 68 Portland Street, Kumamook. Kirkcaldy— Members, 5 ; Quorum, 3— A. G. Adamsou, High Street, West End, Kirkcaldy. Leith— Members, 5 ; Quorum, 3— P. Nisbet, 3 Duke Street, Leith. Motherwell— Members, 6 ; Quorum, 3— W. Morrison, 28 Brandon Stjreet, MotherweU. Paisley— Members, 5 ; Quorum, 3— H. Stewart, 81 High Street, Paisley. Perth— Members, 5 ; Quorum, 3— T. Harley, 29 High Street, Perth. Rutherglen— Members, 5; Quorum, 3— A. M'Haig, 198 Main Street, Eutherglen. Stirling— Members, 5 ; Quorum, 3— J. Walker, 67 King Street, Stirling. Wishaw— Members, 5 ; Quorum, 3— H. B. M'Minn, 17 Main Street, Wishaw. APPENDIX Vn, AGREEMENT BETWEEN MEDICAL PRACTITIONER AND INSURANCE COMMITTEE. Form Med. 18 (Bemsed). {Scotland.) ' {January 1915.) {See Gap. IV., Section (/.), paragraph (167).) Payment by Capitation. AGREEMENT between the Insurance Committee for the (hereinafter called the " Committee ") of the one part and* of , a duly qualified Medical Practitioner registered in the Medical Register in that name (hereinafter called the " Practitioner ") of the other part, whereby it is agreed as follows : — 1. The National Insurance Acts, 1911 to 1913, and the National Health Insurance (Medical Benefit) Regulations (Scotland), 1913 (hereinafter called " the Regulations "), and the National Health Insurance (Medical Benefit) Regulations (Scotland), 1914, or other Regulations for the adminis- tration of Medical Benefit in force for the time being in the area of the Committee are incorporated in and form part of this Agreement. 2. (i.) The Practitioner shall as from the date of the commencement of this agreement give to all persons who are for the time being entitled to obtain treatment from him such treatment as is of a kind which can con siatently with the best interests of the patient be properly undertaken by general practitioner of ordinary professional competence and skill : Pro vided that the Practitioner shall not by virtue of this agreement be required to give, nor entitled under this agreement to make, any charge fpr treatment to any person in respect of a confinement, that is to say, labour resulting in the issue of a living child, or labour after 28 weeks of pregnancy resulting in the issue of a child whether aUve or dead. (ii.) The Practitioner shall not accept any fee or other remuneration in respect of treatment which he is required to give under this agreement, except as provided in this agreement. 3. The persons entitled to obtain treatment from the Practitioner under this agreement (hereinafter called ttie " patients ") are those persons who have been or may be accepted by him under the provisions of the * The Practitioner should enter his name in the exact style in which ho is registered in the Medical Register. 12 170 Eegulations and such other persons as have been or may be assigned to him under any scheme or arrangements made in accordance with the Regula- ■tions by the Committee and the Panel Committee. 4. Where the condition of the patient is such as to require services beyond the competence of an ordinary practitioner, the Practitioner shall advise the patient as to the steps which should be taken in order to obtain such treatment as his condition may require. 5. (i.) The Practitioner shall attend and treat at the places, on the days and at the hours mentioned in the Third Schedule hereto, any patient who attends there for that purpose. (ii. ) The Practitioner may with the consent of the Committee, which shall not be unreasonably withheld, alter the places, days, and hours of his attendance, or any of them, and shall in that event take such steps as the Committee may consider necessary to bring the alteration to the notice of his patients. 6. (i. ) The Practitioner shall visit at the place of residence of the patient any patient whose condition so requires. (ii. ) Where a patient is at any place other than his place of residence, the Practitioner shall visit him if his condition so requires, provided that he is within a distance of miles by road from the place of residence of the Practitioner. (iii.) For the purposes of this clause the place of residence of the patient means the place where he resided at the date on which he was accepted by or assigned to the Practitioner. 7. The Practitioner shaU keep, and furnish to the Committee and Commissioners within 14 days of the expiration of the period to which such are applicable, records of the diseases of the patients attended by him, a,nd of his treatment of them, in such one of the two forms set out in the Pourth Schedule hereto, as shall be agreed on between the Committee and the Panel Committee, and such further records as may at any time here- after be agreed between the Committee and the Panel Committee, and shall, at the request- of any patient, furnish such certificates as are referred to in the First Schedule hereto, and the services rendered by the Practitioner shall be of such s, kind as to comply with the conditions set out in the First Schedule hereto (or any such modifications of those conditions as do not impose an additional burden on the Practitioner) being conditions respecting the nature and quality of treatment which must be complied with by reason of any scheme for the distribution of a Parliamentary Grant. 8. All treatment shall be given by the Practitioner personally, except where he is prevented by urgency of other professional duties, temporary absence from home, or other reasonable cause, and the Practitioner shall to the best of his ability provide that when he is so prevented some other practitioner will give attendance as his deputy on his behalf : Provided that where treatment is given by a deputy, tbe deputy shall be entitled to treat patients at places other than those mentioned in the Third Schedule hereto, due regard being had to the convenience of the patients. 9. The Practitioner shall, as soon as may be after the commencement of each quarter, furnish to the Committee on a form to be provided by the Committee a statement of the number of his patients, other than temporary residents, for that quarter, and shall as soon as may be after the expiration of each quarter furnish on a form to be provided by the Committee an account in respect of the treatment during that quarter of patients who are temporary residents. 10. The remuneration of the Practitioner in respect of patients other than temporary residents shall be calculated in accordance with the pro- visions of Part IV. of, and the First Schedule to, the Regulations on the basis of the rate contained in the Second Schedule hereto, and in respect of patients who are temporary residents shaU be calculated in accordance with the provisions of Part IV. of the Regulations and on the basis of the scale contained in the Fifth Schedule to the Regulations. 11. The Practitioner shall order on a form provided by the Committee ior the purpose such drugs and prescribed appliances as are requisite for 171 the treatment of any patient other than those which the Practitioner may iinder this agreement or any agreement hereafter to be made with the Committee himself supply, and if the Practitioner orders any drug not included in the list from time to time supplied to him by the Committee •or orders any drug or appliance for a patient who is a temporary resident, he shall distinguish the order so given in such manner as the Committee •may require. 12. (i.) The Practitioner shall himself supply to a patient where requisite •drugs which are necessarily or ordinarily administered by a practitioner in person, and drugs and appliances required for immediate administration or appUoation, or required for use before a supply can conveniently be obtained otherwise under the Regulations. (ii.) The Practitioner shall furnish, together with the accounts for ■treatment of temporary residents, accounts for the drugs and appliances so supplied by him, and payment shall be made therefor at such rate or rates as may be agreed, or in default of agreement at the same rate or rates as agreed to be paid by the Committee to chemists and other persons -supplying drugs or appliances. 13. (i.) If, owing to any breach on the part of the Practitioner of this agreement, any expenses have been reasonably and necessarily incurred by the Committee or by any patient, or the Committee are deprived of any sum which would otherwise have been payable towards the cost of providing medical benefit, the Committee shall be entitled to recover from the Practitioner or his legal personal representative, either by deduction from any moneys payable under this agreement or otherwise, the amount of the expenses so incurred and of the sum of which the Committee have been so •deprived. (ii.) Before taking action on any matter under the provisions of this ■clause, the Committee shall, unless the matter has previously been dealt with by the Medical Service Sub-Committee or Joint Services Sub-Com- mittee, refer it to the Medical Service Sub-Committee, which shaE deal with the matter in accordance with the Regulations relating to the powers and duties of that Sub-Committee. (iii.) The Practitioner or his legal personal representative shall be entitled to appeal to the Commissioners against any decision of the Com- mittee under this clause within fourteen days after receiving notice of the decision. 14. Any dispute or question (other than a question which under the provisions of the Regulations or of the last preceding clause hereof is referred to the Medical Service Sub-Committee, or is to be submitted for decision to referees appointed under the Regulations) arising between the Com- mittee and the Practitioner or his legal personal representative relating to ■the construction of this agreement or the rights and liabilities of the Com- mittee or the Practitioner or his legal personal representative hereunder flhall be referred to the Commissioners. 15. In the event of the Commissioners exercising any of the powers conferred on them by the proviso to sub-section (2) of section 15 of the principal Act, or by the proviso (i.) to sub-section (5) of that section, or by section 11 of the amending Act, in respect of the area within which the Practitioner is under this agreement required to give treatment, this agree- ment shall be determined forthwith, but save as aforesaid, this agreement shall not be varied or determined otherwise than in accordance with the provisions of Part II. of the Regulations as amended by the said National Health Insurance (Medical Benefit) Regulations (Scotland), 1914, or in the special circumstances to which Regulation 83 (2) applies, in accordance with said Regulation.* * Under Regulation 17 (2) a Practitioner who desires to withdraw from the panel may do so at the end of a year, as fixed by the Commissioners, by giving notice to the Committee not less than four weeks before the ■commencement of the succeeding year, and may with the consent of the 'Committee withdraw from the panel at any other time. 172 16. This agreement shall come into force on the Ist^day of January 1915, or on the date of the agreement, whichever date is the later. 17. Except where the context otherwise requires, words and expressions used herein shall have the same meaning as in the Regulations. In Witness whereof the parties hereto have executed this agreement, together with the said Schedules hereto, as follows : — Sealed with the Common Seal of the Committee, and subscribed on their behalf at , the . -day of , One thousand nine hundred and , in presence of Name — Address DeaignatioTir- Naym- Witness. Address nation- Signatures f on behalf I < 1 Committee. I Witness. Name- Signed and Delivered by the Practitioner at , the day of , One thousand niue himdred and , in presence of ■Address ■Designation- Witness. Name- Address -Designation^ Witness. THE FIRST SCHEDULE. The conditions of a grant to the. Committee will require that records shall be kept of the diseases of the insured. persons in the area and of their treatment in such form as is required by the Commi33ioner.s,* and that certificates shall be furnished to every insured person, where he so desires, and requests, in such form, on such occasions, and generally in such manner as the Commissioners may determine, for the purposes of any claim made by him for si'^kness or disablement benefit or for the purpose of determining or calculating the period during whiah sickness benefit is or would, but for any section of the principal Act disentitlmg him, have been payable, or of calculating arrears, and that unless and until the Commissioners so deter- * Note. — The form is that set out in the Fourth Schedule to this Agreement. 173 mine such certificates shall be fumisted for the purposes aforesaid as are required to be furnished in pursuance of the rules of the Society of which the insured person is a member or of the Committee, as the case may be, and that the general arrangements made by the Committee shall be such as to secure to insured persons a standard of treatment satisfactory to the Com- missioners, and that the domiciliary treatment of persons on panel-lists recommended for sanatorium benefit shall be undertaken by the practi- tioners by whom they are attended and that a sum of 6d. per annum in respect of each such person eligible for sanatorium benefit shall be provided for the remuneration of those practitioners in respect of their obligation to afford such treatment. THE SECOND SCHEDULE. Rate foe Oaloulati]S"o Rbmunbeation. The Practitioner shall be credited with a rate of a quarter in respect of persons included in his list at the commencement of the quarter who are entitled to medical benefit and a further rate of a quarter in respect of persons so included who are eligible for sanatorium benefit. THE THIRD SCHEDULE. PLACES OP ATTENDANCE. DAYS AND HOURS OF ATTENDANCE AT EACH PLACE. THE FOURTH SCHEDULE. Form No. 1. Day Book Rbooed. Form No. 2. Medical Rbooed Card {See Appendix IX.). APPENDIX VIII. PROCEDURE IN INQUIRIES AS TO RANGE OF MEDICAL SERVICE. {See Cap. IV., Section {I.), paragraph (178).) RULES MADE BY THE SCOTTISH InSTJEAIIOE CoMMISSIONEES T7NDEE Akticlb 50 OE THE Natiokal Health Insitbance (Medical Benefit) Regulations (Scotland), 1913. 1. In these Rules unless the context otherwise requires— " The Commissioners " means the Scottish Insurance Commissioners : " Question " means a question as to whether an operation or other service is of a kind which can consistently with the best interests of the patienf be properly undertaken by a general practitioner of ordinary pro- fessional competence and skill. , ,r ,. , ,-, •j.i ' 2. Where an Insurance Committee and a Local Medical Committee fail to agree as to the decision of any question, the Insurance Committee shall prepare and submit to the Local Medical Committee— {a) a written statement of the facts in connection with which the question has arisen : and (6) a written statement of the decision given by it and the grounds on which the decision is based. , „, 3. The Local Medical Committee shall,, as soon as may be after receipt 174: of the said statements, furnish to the Insurance Committee a written state- ment of the decision given by it and the grounds on which the decision is based, and shall inform the Insurance Committee whether it concurs in the statement of facts prepared by the Insurance Committee, and, if not, in what respects it does not concur in that statement. 4. The Insurance Committee shall send the statements prepared by both Committees to the Commissioners, and the Commissioners may, if they think fit, reqiiire both or either of the said Committees to furnish further particulars either with regard to the facts of the case or to the decision or the grounds of the decision. 5. The Commissioners shall furnish copies of all such statements or further statements to each of the Referees appointed by them for the purpose of deciding the question. 6. After consideration of the said statements the Referees shall inform the Commissioners whether in their opinion a hearing is desirable, and in the event of a hearing being required, the Commissioners shall fix the time and place of the hearing and shall give not less than seven days' notice thereof to the Insmance Committee and the Local Medical Committee. 7. Each Committee shall be entitled to appear at the hearing by the chairman, clerk, or secretary of the Committee, or by any other member thereof duly appointed for the purpose, or with the written approval of the Commissioners previously obtained by counsel or solicitor, and produce such evidence, whether orally or in writing, as in the opinion of the Referees may be relevant to the matters at issue. 8. The Referees shall as soon as may be after the hearing report to the Commissioners the decision at which they have arrived. 9. Where in the opinion of the Referees a hearing is not required, the Referees shall, as soon as may be after the matter has been referred to them, meet and consider the question and report to the Commissioners the decision at which they have arrived. 10. — -(1) Where the Commissioners think fit to refer for decision to Referees any question on which the Insurance Committee and the Local Medical Committee are agreed, the Commissioners may require either or both of the said Committees to furnish written statements of the facts in connection with which the question has arisen and of their decision and the groimds on which the decision was based, and the Commissioners shall thereupon request the Referees appointed by them for the purpose to fix a day for the hearing. (2) The statement or statements furnished in accordance with the provisions of the last preceding paragraph shall, for the piirposes of the hearing, be evidence of the facts therein alleged. (3) The Insurance Committee and the Local Medical Committee shall be given by the Commissioners not less than seven days' notice of a hearing held under this Rule, and shall be entitled to appear at the hearing by any of the persons mentioned in Rule 7. 11. At any hearing held under these Rules the Commissioners may produce such evidence, whether orally or in writing, as in the opinion of the Referees may be relevant to the matters at issue, and may appear by any one of themselves or of their officers or by counsel or solicitor. 12. The Commissioners may, if they think fit, dispense with any require- ment of these Rules in any case where, regard being had to all the circum- stances, it appears just or convenient to do so. 13. These Rules shall apply with the necessary modifications in the case of any question arising under Article 56 of the National Health Insurance (Administration of Medical Benefit) Regulations (No. 2) (Scotland), 1912. Dated this third day of September in the year one thousand nine hundred and fourteen. (Signed) H. L. F. FRASER, Assistant Seoretary to the Scottish Insurance Commissioners, and a person author- ised to sign on behalf of the Secretary. 175 oa I- I p ^-^ o w .fl rf* ■A Si( 'H N^ 1 g' N o 1 1 X =5 o 6 O H ^ 1 EC CO o 1-5 &■ l>5 >-5 C/2 1 o J2i s 5 'uoiq'BJO|jad arnqo'Ej^ a 1 1 1 1 1 1 1 1 1 l;^l 1 1 1 1 1 1 1 ) o 1 CQ 1 1 1 1 1 OS 1 (M 1 1 1 1 1 1 o s - 176 ^ S o cr n rt ^ tfl <-l n n a 2; D c M (A ro P rh G Q P JO a X B H s 3 B* H rt b; B 0. Z 3 a ■o •-t 5' B 3 s- cr rr fT> B B- CO o o Machine perforation. 0*

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NOTICE. The Committee require an insured person in receipt of Medical Benefit to comply with the following Eules as to Conduct :— (a) He shall obey the instructions of the practitioner attending him : (6) He shall not conduct himself in a manner which is likely to retard his recovery : (c) He shall not make unreasonable demands upon the professional services of the practitioner attending him : (d) He shall, whenever his condition permits, attend at the surgery or place of residence of the practitioner attending him on such days and at such hours as may be appointed by the practitioner : (e) He shall not summon the practitioner to visit him between the hours of 8 p.m. and 8 a.m., except in cases of serious emergency : (/) He shall, when his condition requffes a home visit, give notice to the practitioner, if the ckourastances of the case permit, before 9.30 a.m. on the day on which the visit is required, except in cases of accident or emergency : to) He shall not attend at the surgery nor summon the practitioner to visit him on Sundays, except in cases of accident or emergency. The Kules of the Committee also provide that any complaint by an insured person which is adjudged by them to be frivolous or vexatious, shall be regarded as a breach of their Bules. Failure to observe the Hules may entail penalties of a fine (not exceeding 10s. or in the case of repeated failure 20s.) or of suspension from benefit for a period not exceeding one year. ■ These Rules are liable to alteration, due notice of which will be given in the public Press. Part C. FOR USE in temporary residence. I hereby declare that I am only temporarily residing in the locality of the address which I have given below and that I do not intend or expect to remain in the locality for as long as 3 months from the date of my arrival. (Signature)^ (Temporary Address)^ -(Bate). Signature of doctor accepting : This Card can only be used for obtaining treatment during one period of absence from home not exceeding 3 months. When the above space has been used another Card mast be applied for from the Insurance Committee at the address shown on the first page, 4 Committee's Stamp. 204 APPENDIX XIV. List of Sajtatoeia, etc., in Scotland, Approved by the Local Govebn- MBNT Board for Scotland fob the Institdtional Treatment of TtTBEBCULOSIS UNDER THE NATIONAL INSURANCE ACTS. (See Cap. V., Section (I.) {ii.), paragraph (286).) Addresses of Secretaries. Aberdeen County — Aberdeen City Fever Hospital (Tuber- culosis Wards) .... Aberdeen City Tuberculosis Dis- pensary (at City Hospital) . Mrs. Smith's Convalescent Home and Sanatorium, Newhills Thos. Walker Hospital, Fraserburgh ■ Royal Aberdeen Hospital for Sick Children — Temporary premises at Kepplestone Aberdeen County Tuberculosis Dis- pensary, 16 Golden Square, Aber- deen . ... Peterhead Burgh Infectious Diseases Hospital (Observation Block) Argyll County — Argyll County Sanatorium, Oban . Campbeltown and Kintyre District Combination Hospital West Highland Cottage Hospital, Oban (non-pulmonary) Ayr County — Ayrshire Sanatorium (Glenaftou) Heathfield Hospital; Ayr (Tuber- culosis Pavilions) Ayr Burgh Tuberculosis Dispensary, 70 High Street Kaimshill Cholera and Smallpox Hospital, Kilmarnock. Kilmarnock Burgh Dispensary Kilmarnock Royal Infirmary (non- pulmonary) Biggart MemorialJ Hospital Home for Children,^ Prestwick (non- pulmonary) Ayr County Hospital No. of Beds. 122 The Town aerk, Aberdeen. — Do. do. 24 S. M. Chrystall, 21 Bridge Street, Aberdeen. 24 J. D. M'Intosh, Secretary, Fraserburgh. — D. M. M. Milligan, 12 Dee Street, Aberdeen. The County Clerk, Aberdeen. The Town Clerk, Peterhead. 30 The County Derk, Lochgilp- head. 7 The Town Clerk, Campbel- town. — The Clerk, Oban. R. Welsh, aerk, 42 Sandgate, Ayr. 10 The Town Qerk, Ayr. — Do. do. 12 The Town Qerk, Kilmarnock. 9 Do. do; — W. Austin, Secretary. KU- marnock. — A. M'Cracken, 81 Mitchell Street, Glasgow. — J. H. Goudie, Wellington Chambers, Ayr. Banff County — Chalmers Hospital, Banff (pulmonary) 8 G. L. Gumming, Secretary to (Non-pulmonary) . . .48 Chalmers Hospital, Banff. Turner Memorial Hospital, Keith . — John Pine, 63 Moss Street, Keith. Berwick County — Gordon Hospital (2 wards) . . 4 G. Rankin, W.S., Lauder. 205 Bute County — Victoria Hospital, pulmonary) No. of Beds. Rothesay (non- Addresses of Secretaries. A. D. MaoBeth, 28 Castle Street, Rothesav. Caithness County — Wick Joint Fever Hospital (Tuber- culosis Shelter) .... Olackmannan County — Clackmannan County Hospital (non- pulmonary) .... Dunba/rton County — Helensburgh Burgh Smallpox Hos- pital 10 Lanfine Home, Kirkintilloch . . 44 Helensburgh Burgh Infectious Dis- eases Hospital (Tuberculosis Wards) 5 BroomhiU Home, Kirkintilloch (non- — pulmonary) Dumbarton Joint Hospital . . 18 1 The County Clerk, Thurso. C. Thomson, Royal Bank Buildings, AUoa. The Town Clerk, Helensburgh H. M'Leod, 101 St. Vincent Street, Glasgow. The Town Clerk,Helensburgh. H. M'Leod, 101 St. Vincent Street, Glasgow. The Town Clerk, Dumbarton. Dumfries County — Dumfries Burgh Smallpox Hospital . Lochmaben Joint Hospital (Tuber- culosis Wards) 12 ThornhUl Infectious Diseases Hos- 4 pital (Tuberculosis Wards) Dumfries and Galloway Royal In- — firmary (non-pulmonary) Westmoreland Consumption Hos- — pital, Grange-over-Sands The Town Clerk, Dumfries. D. Cormaok, Clerk to Loch- maben Joint Hospital, Lockerbie. R. Wilson, Thornhill, District Clerk, Sanquhar. J. Symons, 84 Irish Street, Dumfries., W. R. Parker, M.D., Strick- landgate, Kendal. Elgin County — Elgin Sanatorium . Dr. Gray's Hospital, pulmonary) 8 The County Clerk, Elgin. Elgin (non- ' — Stewart & M'Isaac, Royal Bank Buildings, Elgin. Fife County — Kirkcaldy Burgh Sanatorium St. Michael's Hospital, near Leuchars (Tuberculosis Wards) Ovenstone Infectious Diseases Hos- pital, Pittenweem (Shelter) Thornton Smallpox Hospital . Cameron Infectious Diseases Hos- pital, Buokhayen (1 Pavilion) 12 18 The Town Clerk, Kirkcaldy. J. L. Macpherson, Clerk to St. Michael's Joint Hospital, St. Andrews. J. L. Macpherson, District Clerk, St. Andrews. A. & D. Beveridge, 220 High Street, Kirkcaldy. 4 The Town Clerk, Buckhaven. Forfar County — Dundee Municipal Tuberculosis Dis- pensary . . . . Sidlaw Sanatorium, Auchterhouse . — The Town Clerk, Dundee. 44 G. B. Brough, Royal Infirm- ary, Dundee. 206 Forfar County — (continued). Forfar Infirmary (non-pulmonary) , King's Cross Hospital, Dundee Montrose Royal Infirmary (non- pulmonary) .... Arbroath Joint Infectious Diseases Hospital (1 pavilion) Arbroath Infirmary, Greenbank House (non-pulmonary) Arbroath Infirmary Convalescent House (non-pulmonary) Noranside Sanatorium . No. of Beds. Addresses of Secretaries. — A. MacHardy, Secretary, Forfar. 90 The Town Clerk, City Chambers, Dundee. — A. Lyell, Secretary, Montrose. 8 W. K. MacDonald, Clerk to Joint Hospital Committee, Arbroath. 11 W. K. MacDonald, Hon. Sec- retary, Arbroath. — Do. do. 60 The County Clerk, Forfar. Hiddington County — Haddington County Combination Smallpox Hospital . . .16 Inverness County — Grampian Sanatorium, Kingussie Inverness Burgh Tuberculosis Dis- — pensary ..... Northern Infirmary, Inverness 8 (Tuberculosis Wards) . Do. do. (General Wards) — Inverness -shire Sanatorium, Bridge 28 of Oich The County Clerk, Hadding- ton. 18 Dr. de Watteville, Medical Superintendent, Kingussie. The Town Clerk, Inverness. 8 D. Shaw, The Northern In- firmary, Inverness. Mrs. Angelo, CuUachy, Fort- Augustus. Kinross County — Coppins Green Sanatorium, Milna- 47 thort Ochil Hills Sanatorium . . .40 Thomas Hart, Jun., C.A., 144 St. Vincent Street, Glasgow. Do. do. Lanark County — Dispensary at Blantyre Fever Hos- pital Tuberculosis Hospital, Uppertown, Longriggend .... Hairmyres Sanatorium . Hairmyres Sanatorium Open Air School PaviHon (Children) . Tuberculosis Hospital, Stonehouse . Tuberculosis Hospital, Shotts Tuberculosis Dispensary, Cambus- — W. E. Whyte, Hamilton. , District Offices, 38 10 Do. Do. do. do. 24 52 48 Do. Do. Do. do. do. do. County Infectious Diseases Hospital, near Motherwell County Infectious Tuberculosis Dis- pensary ..... Dalserf Infectious Diseases Hospital Lightbum Joint Infectious Diseases Hospital (Tuberculosis Wards) 32 30 Do. Do. do. do. Do. do. Do. do. Jas. A. M'CaUum, 15 West George Street, Glasgow. 207 No. of Lnntrk County — (continued). Beds. Upper Ward District Hospital, 12 Carluke BeUefield Sanatorium, Lanark . 52 Glasgow Corporation Dispensaries — Granville Street ; Govan Cham- bers ; Black Street ; 128 Adelphi Street ; Brown Street ; 37 Elm- bank Crescent, Glasgow Knightswood Infectious Diseases Hospital, Amiiesland (Tuber- culosis PaviUon) Shieldhall Infectious Diseases Hos- pital, Govan (Tuberculosis Pavilion) ..... Ruchill Infectious Diseases Hospital, Glasgow (five Pavilions) Airdrie Burgh Reception House Coathill Infectious Diseases Hospital, Coatbridge — Tuberculosis Block South Pavilion .... Tuberculosis Dispensary Hamilton Burgh Tuberculosis Dis- pensary, Oak Lodge . Motherwell Burgh Infectious Dis- eases Hospital (Tuberculosis Ward Block) .... Wishaw Burgh Infectious Diseases Hospital (Tuberculosis Pavilion) . 14 Wishaw Tuberculosis Dispensary . — Douglas Cottage Hospital (Non- — ■ Pulmonary) Linlithgow County — Tippethill Smallpox Hospital, near 12 Armadale Addresses of Secretaries. A. W. Paterson, District Offices, Lanark. The Town Clerk, Glasgow. — Do. do. 20 Do. do. 24 Do. do. 170 7 Do. The Town Clerk, The Town Clerk do. , Airdrie. , Coatbridge. 28 20 — The Town Clerk, Hamilton. 18 The Town Clerk, Motherwell. The Town Clerk, Wishaw. Do. do. Mrs. J. P. Baird, Castle Mains, Douglas, Lanarkshire. W. Allan, Town Clerk's Office, Bathgate. Midlothian County — Edinburgh City Tever Hospital (Tuberculosis Pavilions) Royal Victoria Dispensary, Edin- . burgh ..... Royal Victoria Hospital Farm Colony, Lasswade ..... Leith Dispensary (South Fort Street) Leith, East Pilton Hospital (Tuber- culosis Pavilions) Edinburgh Hospital for Women and Children (non-pulmonary) Woodburn Sanatorium, Edinburgh Peebles County — Manor Valley Sanatorium, Peebles . Perth County — Dunblane Consumption Hospital . 231 The Town Clerk, Edinburgh. _ Do. do. 23 Do. do. — The Town Clerk, Leith. 75 Do. do. — Miss E. M'Lareu, LL.B., 62 FrederickStreet.Edinburgh. 43 Dr. Isabella Mears, Woodburn, Morningside, Edinburgh. 30 A. J. Simpson, 8 Commercial Street, Leith. Dr. T. W. Dewar, Kinoaim, Dunblane. 208 No. of Perth County — (continued). Hillside Homes (and 2 cottages) . 49 Perth Burgh Isolation Hospital (Tuberculosis Pavilion) . . 8 Perth Royal Infirmary (non-pul- — monary CriefE and District Cottage Hospital — (non-pulmonary) Renfrew County — ■ Bridge of Weir Sanatorium . . 147 Gockston Smallpox Hospital, Paisley 30 Paisley Burgh Fever Hospital (Tuber- culosis Pavilion) ... 8 Paisley Municipal Dispensary . — Greenock and District Combination 15 Hospital (Gateside) (Tuberculosis Pavilion) Greenock Corporation Tuberculosis Dispensary . . . . — ■ Johnstone Combination Hospital 54 KUbajchan (Tuberculosis Pavilion and Chalets) .... Tuberculosis Dispensary, King Street, Port-Glasgow. .... West Renfrewshire Combination Smallpox Hospital . . .17 BlawarthiU Fever Hospital (2 Tuber- 16 culosis Wards) DarnleyJoint Fever Hospital (Tuber- 36 culosis Pavilion) Addresses of Secretaries. S. T. EUison, Clerk to Hillside Homes, Perth. The Town Clerk, Perth. R. M. Bates, Secretary, 44 Tay Street, Perth. C. E. Colville, Hon. Secretary, CriefE. Miss Quarrier, Orphan Homes, Bridge of Weir. The Town Clerk, Paisley. Do. do. Do. do. The Town Clerk, Greenock. Do. do. H. W. MacGregor, Clydesdale Bank, Johnstone. — The Town Clerk,Port-GlaBgow. The County Clerk, Paisley. J. Hepburn, Burgh Chambers, Clydebank. Jas. A. MaoCallum, 15 West George Street, Glasgow. Boxburgh County — Anderson Sanatorium, Hawick Hawick Cottage Hospital (non-pul- monary) ' Selkirk County — Meigle Sanatorium, Galashiels Stirling County — ■ Falkirk Infirmary (non-pulmonary) Stirling Royal Infirmary (non-pul- monary) Stirling Royal Infirmary Convales- cent Home (non-pulmonary) Tuberculosis Dispensary, Melville Street, Falkirk .... Temporary Dspensary, 1 Viewfield Place, Stirling .... Zetland County — Gilbert Bain Memorial Hospital, Lerwick (non-pulmonary) 10 J. R. Purdom, Solicitor, Hawick. — R. Purdom, Hawick Cottage Hospital. 10 D. G. StaUcer, Hon. Secy., Galashiels. — T. C. Wade, King's Court, Falkirk. — J. Dobbie, 3 Port Street, Stirling. — Do. do. — The Town Clerk, Falkirk. — The Town Clerk, Stirling. G. W. RusseU, Burgh Chambers, Lerwick. 209 APPENDIX XV. MODEL SCHEME OF ARRANGEMENTS FOR THE DOMICILIARY TREATMENT OF TUBERCULOSIS, WITH RELATIVE CIRCULAR. (See Cap. V., Section (I.) (»«.), paragraph (300).) (1) ClRCTJLAR. Memo. No. 602. Under the provisions of Section 16 (1) of the National Insurance Act, 1911, one of the duties of an Insurance Committee is the making of arrange- ments for the treatment of tuberculoRis otherwise than in sanatoria or other institutions — which treatment has come to be known as Domiciliary Treatment. Such arrangements are to be made with persons and Local Authorities (other than Poor Law Authorities) undertaking treatment ia a manner approved by the Local Government Board. The manner approved by the Board has been laid down by them in their Circular Public Health No. VI., 1913, in which it is made known that Insurance Committees who have made arrangements for the treatment of cases ia conformity with the general lines approval of which is expressed by the Circular are relieved of the obligation to apply to the Board for approval of individual oases. The arrangements are also to be to the satisfaction of the Insurance Commissioners. Arrangements hitherto considered by the Commissioners have been those put forward by Committees for, and with special reference to the needs of, individual cases ; and the Commissioners have not been disposed to raise with Committees the question of general lines of pro- cedure u^tU sufficient time had elapsed to enable experience to be gained of the workmg of Sanatorium Benefit. The Commissioners, however, consider that Committees are now in a position to adopt and give effect to a General Scheme of arrangements. A model form of such General Scheme — Form No. 603 — accompanies this circular. It is suggested that Committees should obtain the advice of their Medical Adviser as to the medical comforts which should be made available for supply to patients in receipts of domiciliary treatment, should adopt the Scheme with the names of these substances entered in Section (4) thereof, other blanks, where necessary, duly filled in, and such modifications, if any, made as local or other circumstances may require, and should submit the Scheme, so completed, for the approval of the Commissioners. In submitting Schemes, it is requested that Committees will employ the model print herewith. After adoption and approval of the general arrangements individual cases will require to be reported to the Commissioners as indicated in Section 22 of \ the Scheme, in order to enable the Commissioners to transmit to the Local Government Board the information required by the Board's Circular already referred to. While all cases must be reported by Committees to the Commissioners, approval need not be asked if the arrangements made are in accordance with the General Scheme. If, however, in any case for special reasons it is desired to depart from or modify the General Scheme special sanction must be secured by the Committee from the Commissioners in order to conform with the terms of the Act. The Scheme will in general apply to arrangements proposed to be made in terms of Section 16 (1) (6) of the National Insurance Act, 1911, whether with persons or Local Authorities. The medicines and appliances which may be ordered under the Scheme are dealt with in Section (4), of Form No. 603. Any medicines or appliances as .defined in Section 8 (1) (o) of the National Insurance Act, 1911, and the Medical Benefit Regulations, as part of Medical Benefit may, when appropriate to the treatment of tuberculosis, be ordered for domiciliary treatment under the Scheme. When so ordered, however. 210 they must be charged to the Sanatorium Benefit Fund, not to the Drug Fund. It should be noted that where -■ patient who is receiving domiciliary treatment for tuberculosis under the Scheme suffers concurrently from a disease or injury not arising out of his tuberculosis, any medicines or appli- ances ordered by his panel doctor for the treatment of the concurrent disease or injury should be charged to the Drug Fund, since the patient, in respect of the concurrent disease or injury, would be under Medical Benefit. The expression " medical comforts " as employed under the Scheme is intended to refer to substances other than medicines which may be regarded as essential to treatment. Where the substance is one which is often or habitually used for the purpose of subsistence or for a purpose other than the treatment of disease, the quantity allowed as part of treatment ought to be only the excess beyond the amount needed for ordinary use. It is impracticable owing to individual differences to define by rule the amount required for ordinary use ; but so as to give effect to the principle, the total amount allowed as part of treatment, including medicines, appliances, and medical comforts, should be so limited that the inclusive cost shall not exceed 5s. weekly. It should, however, be borne in mind that none of these articles should be ordered as a matter of routine ; they should be given if and so far as required for the individual needs of separate cases. Medical comforts must always be charged to the Sanatorium Benefit Fund. National Health Insurance Commission (Scotland), 83 Peincbs Stkebt, EoiNEuiiaH, 31si July 1915. (2) Scheme. Form No. 603. I. Conditions. (1) The general arrangements made by the Committee for the purpose of administering Sanatorium Benefit shall be such as to secure that adequate medical treatment and supervision shall be provided for each case of domiciliary treatment (that is to say, treatment otherwise than in a sanatorium or other institution). (2) In the case of an insured person, such treatment shall be under- taken by the medical practitioner by whom he is attended under Medical Benefit. (3) In the case of a dependant of an insured person, the rate of remuneration for such treatment to the practitioner in attendance under arrangements made by the Committee for affording domiciliary treatment to dependants shall not exceed per week. (4) Subject as hereinafter provided, an insured person, or the dependant of an insured person, recommended for Sanatorium Benefit and in receipt of domiciliary treatment (hereinafter called a " patient ") may be supplied under arrangements made by the Committee with the following articles : — (o) Medicines and Appliances " as defined in Section 8 (1) (a) of the National Insurance Act, 1911. (6) Medical Comforts : f viz. provided always that a patient shall not be supplied, under arrangements made by the Committee, with any medicines, appliances, or medical com- forts other than those specified in this Section. * Any medicines or appliances which are allowed under Medical Benefit may, when appropriate to the treatment of tuberculosis, be ordered for domiciliary treatment under the Scheme. When so ordered, they must be charged to the Sanatorium Benefit Fund, not to the Drug JTund. ■f Medical comforts are substances other than medicines which may be regarded as essential to treatment. They must always be charged to the Sanatorium Benefit Fund. 211 (6) Subject as hereinafter provided, no medicines, appliances, or medical oomfortB specified in the foregoing Section shall be supplied under arrangements made by the Committee unless certified by the medical practitioner in attendance as required for the treatment of the tuberculosis from which the patient is suffering, and approved by the Medical Adviser of the Committee. (6) The total inclusive cost of medicines, appliances, and medical com- forts shall not exceed 5s. weekly. (7) Save as hereinbefore provided, a patient shaU not be supplied under arrangements made by the Committee with any food or other article of diet. (8) Subject as hereinafter provided, arrangements may be made by the Committee with a person or Local Authority (other than a Poor Law Authority) undertaking treatment in » manner approved by the Local Government Board with a view to the carr3Tng out of the treatment of the patient, including the supervision or control thereof (excepting in so far as any part of such treatment may be otherwise arranged for under this Scheme), and the provision, if considered by the Medical Adviser of the Committee to be required for the proper treatment of the patient, of a shelter, provided always that where the patient is unable himself to provide bed, bedding, or bedclothes, other than body clothes, for the due equipment of the shelter, such bed, bedding, or bedclothes, other than body clothes, may be provided as part of the arrangements made by the Committee. (9) The charges payable by the Committee in respect of arrangements made under the foregoing section, in so far as including the provision of a shelter, shall not exceed Is. 6d. per week ; in so far as including the pro- vision of a shelter with bed and mattress, shall not exceed 2s. per week ; and in so far as including the provision of a shelter with bed, bedding (including mattress), and bedclothes, shall not exceed 2s. 6d. per week, provided that these charges in each case shall be held to include the cost of transport and erection. (10) Save as hereinbefore provided, a patient shall not be supplied under arrangements made by the Committee with bed, bedding, or bed-clothes. (11) A patient shall not be supplied under arrangements made by the Committee with foot-gear, under-clothing, or other wearing apparel. (12) Save as hereinbefore provided, the rent, or any part of the rent, of premises occupied by a patient or of any part of such premises, shall not be defrayed under arrangements made by the Committee. (13) The Medical Adviser of the Committee shall once in each inform the Committee as to the progress of the patient. (14) A patient, either himself or through his representative, shall not be supplied by the Committee with any money to be disbursed on his behalf, but the Committee shall make arrangements with a view to the supply by purveyors to the patient of medicines, appliances, and medical comforts. (15) Orders for medicines and appliances to be provided under arrange- ments made by the Committee shall, if given on the Medical Benefit Order Porm of the Committee, be distinguished by an Index Mark appropriate to Domiciliary Treatment under Sanatorium Benefit. (16) Orders for medical comforts to be provided under arrangements made liy the Committee shall be given to purveyors in the Form D (o) (herewith), which shall be supplied by the Committee for this purpose to the practitioner in attendance on the patient. (17) The general conditions for the domiciliary treatment of tuber- culosis set forth in the Circular Public Health No. VI., 1913, of the Local Government Board shall be observed.* * The general conditions of the Local Government Board are as follows : — " (1) That the name of every case recommended for domiciliary treatment, together with the address at which such treatment is to ie carried out, shall be intimated by the Insurance Committee, through their Medical Adviser or other- wise to the Medical Officer of Health of the district where the patient is to be 212 II. Pkoobdueb. (18) Domiciliary treatment shall be for a specified period, but Such geriod shall not in any case exceed three months, provided that the ommittee may at the close of any period, if they think fit, extend such treatment for a further period not exceeding three months. (19) As soon as may be after the Committee has decided to grant domiciliary treatment, including any extension thereof, the CHerk to the ■Committee, in the case of an insured person, shall inform the practitioner on the panel from whom the insured person is entitled to obtain treatment that he has been granted domiciliary treatment, and in the case of a de- pendant of an insured person shall make arrangements for his treatment by a practitioner. (20) As soon as may be after the Committee has decided to grant domiciliary treatment, including any extension thereof, if it is proposed that the patient shall be provided with any of the articles specified in Section (4) hereof, an estimate of the weekly cost of the articles shall be drawn up. (21) Such estimate shall be in the Form D (c) (herewith), which shall be supplied by the Committee to the practitioner in attendance. The practitioner shall, in giving treatment, adhere as far as practicable to the terms of the estimate ; but if during the currency of the treatment he considers it to he in the interest of the patient to depart from the terms of the estimate he shall be at liberty to do so, provided always that any articles ordered shall be among those specified iu Section (4) hereof, and that the total weekly cost, unless in any grave emergency, shall not exceed that stated in. the estimate. Any excess expenditure incurred in grave emergency shall without delay be intimated by the practitioner to the Committee, who shall, at such times and in such form as the Commissioners may require, report to the Commissioners regarding such excess expenditure. III. Intimation to Commission. (22) As soon as may be after the Committee has decided to grant domiciliary treatment, including any extension thereof, but not more than one week thereafter, the Clerk to the Committee shall transmit to the Com- missioners in duplicate one or other of the forms herewith — in the case of an insured person Form D (1), and in the case of a dependant of an insured person, Form D (2) — duly filled in. " (2) That regular medical attendance and supervision are provided. " (3) That the Medical Adviser of the Insurance Committee shall inform the Medical Officer of Health of any change either in the patient's condition or in Ms surroundings that may render the house or other place in which the treatment is being carried out unsatisfactory for the purpose, " (4) That the Medical Adviser of the Insurance Committee shaU inform the Medical' Officer of Health when in his opinion continued residence of a patient at home might endanger the health of others, and when a patient has been removed to an institution. " (5) That the treatment of the patient and the circumstances under which the treatment is conducted shall be in conformity with the provisions of the Public Health (ScoUand) Act, 1897." " The conditions above set forth apply to treatment undertaken by persons. Where a local authority propose to carry out such treatment, application should be made (1) for the Board's authority under Section 16 (1) (6) of the National Insurance Act, 1911, or (2) for their consent imder Section 66 (1) {d) of the Public Health (Scotland) Act, 1897, if a Local Authority under the latter Act — or a County Council by virtue of their powers under Section 41 (3) of the National Insurance Act, 1913 — prefer to proceed in terms of that Section. In such cases, the application for the Board's authority or consent as the case may be should be accompanied by a report by the Medical Officer of Health giving full details of the scheme of treatment proposed." [Circular Public Health No. VI., 1913, Local Government Board]. 213 Form D (I). Insurance Committee for the of . INSURED PERSON. * Recommendation ^ * Extension of Recommendation /*°r Sanatorium Benefit. BOMICILIARY TREATMENT. I hereby intimate the following arrangements t and appH- for approval. (i.) Name of Insured Person Address Age (ii.) Period of treatment is for ending on. . . (iii.) Eorm of Tuberculosis (iv.-) Name of practitioner on panel from whom insured person is to obtain treatment (v. ) Are arrangements fully conform to general condi- tions for domiciliary treatment of tuberculosis set forth in Circular PubUc Health No. VI., 1913, of Local Government Board ? If not, the facts should be stated ( vi. ) Have other conditions and the procedure laid down in General Scheme been adhered to ? If not, the facts and reasons should be stated (vii.) Is it proposed that a shelter should be provided ? If so, state name of person or Local Authority providing shelter, extent of equipment, and charge payable, if any (viii. ) Is it proposed that medicines, appliances, or medical comforts according to Form D (e) should be provided ? If so, enter hereunder. Name of Article. Estimated Quantity per week. Estimated Cost per week. Medical Comforts Medicines and Appliances .... Total estimated cost per week .... .OUrk. Date. * Delete word or words inapplicable. In the case of an extension of recommendation, answers (iii.) to (viii.) inclusive, if the same as before, may be left blank. j- Delete if answers to (v.) and vi.) are " Yes.'" 214 Form D (2). Insurance Committee for the of DEPENDANT. * Recommendation "i c r, . • t. />i * Extension of Recommendation T'"' Sanatorium Benefit. DOMICILIARY TREATMENT. I hereby intimate the following arrangements ■f and apply for approval. . (i.) Name of Dependant Address Age Relation to insured person Name of insured person Address of insured person (ii.) Period of treatment is for ending on. (iii. ) Form of Tuberculosis (iv.) Name of Practitioner with whom arrangements have been made for the medical attendance of the dependant, together with amount of fees proposed to be paid to such practitioner (v.) Are arrangements fully conform to general condi- tions for domiciliary treatment of tuberculosis set forth in Circular Public Health No. VI., 1913, of Local Government Board ? If not, the facts should be stated, (vi. ) Have other conditions and the procedure laid down in General Scheme been adhered to ? If not, the facts and reasons should be stated (vii. ) Is it proposed that a shelter should be provided ? If so, state name of person or Local Authority providing shelter, extent of equipment, and charge payable, if any (viii. ) Is it proposed that medicines, appUances, or medical comforts according to Form D (e) should be provided ? If so, enter hereunder. Name of Article. Estimated Quantity per week. Estimated Cost per week. Medical comforts • Medicines and Appliances Total estimated cost per week .... .Clerk. Date. * Delete word or words inapplicable. In the case of an extension of recommendation, answers (iii.) to (viii.) inclusive, if the same as before, may be left blank. f Delete if answers to (v.) and (vi.) a^-e " Yes." 215 Form (e) Insurance Committee for the of DOmCILIABY TREATMENT. ESTIMATE. Name of Patient I certify the following to be required for the treatment of the tuber- culosis from which the above patient is suffering : Name of Article. Estimated Quantity per week. Estimated Cost per week. Medical comforts Medicines and Appliances .... Total estimated cost per week .... Date Medical Pro ctitioner in attendance. Note.' — Medical comforts may only be ordered in so far as in excess of the amount required for ordinary maintenance. In the case of medical comforts, state name of article, estimated quantity per week, and estimated cost per week. The medicines and appliances which may be ordered are the same as in Medical Benefit. In the case of medicines and appliances, state only estimated cost per week. The total estimated cost per week must not exceed 5s. APPROVED. Date. Medical Adviser of the Committee. FormD{o.) Insurance Committee for the of , DOMICILIARY TREATMENT. Order for , MEDICAL COMFORTS. Name of Patient Address To Kindly supply for treatment of the above patient — Medical Practitioner in attendance. Date. 216 To the Clerk Insurance Committee for the of , I have supplied the above article .... as ordered, and enclose my account herewith. Furvsyor. Date APPENDIX XVI. COPY OF THE LETTER OP THE CHANCELLOR OP THE EXCHEQUER TO MR. HENRY HOBHOUSE. (See Introduction and Gap. V., Section (III.) (ii.), paragraph (34.5).) Deae Mr. Hobhouse, — The President of the Local Government Board and I have considered the representations which were submitted to us yesterday on behalf of the County Councils' Association with reference to the financial arrangements for defraying the cost of schemes for treatment of tuberculosis. As regards capital expenditure, the Government have provided a sum of £1,500,000 to aid the provision of sanatoria and other institutions, and in their circular letter of the 14th of May last * the Local Government Board announced that, subject to certain limitations, they would provide three-fifths of the outlay on sanatoria and four-fifths of the outlay on dis- pensaries out of this fund. We understand that local authorities are satis- fied with these arrangements, and that their main anxiety is in regard to the annual cost of maintenance. I gathered that local authorities are prepared to bear 26 per cent, of the annual cost of schemes, if the remainder were provided from other sources ; and that their request is that this should be paid to them direct by the Local Government Board. We have submitted your views to our colleagues, and the Government are prepared to go a long way towards meeting your requests. Before setting out what further arrangements the Government are prepared to make it may be well to recapitulate the present position. Under the Insurance Act an annual sum of about one million is provided for the treatment of insured persons. While the Bill was passing through Parliament provisions were inserted for extending sanatorium benefit to dependants of insured, and in view of this the Government consented to bear one half of any deficit in regard to sanatorium benefit where local authorities undertook the other half. It is now urged that schemes for the treatment of tuberculosis snould relate to the whole community, and that generally they should be organised and carried out by the councils of counties and county boroughs. This extension involves additional outlay, and in view of this the Government have decided to place at the disposal of the Local Government Boards of the three kingdoms annually a sum of money which will represent approximately half the total estimated cost of treating the non-insured persons as well as the dependants of insured persons. This money will be distributed by the Local Government Boards, in pursuance of regulations to be made by these Departments, to local authorities which undertake schemes, to be approved by the Departments, for the general treatment of tuberculosis in their areas : and provision will * This refers to the Circular of the English Local Government Board. The corresponding Circular of the Local Government Board for Scotland is that of 29th May 1912. 217 be made accordingly for these grants in tlie Estimates of tlie three Depart- ments. '■ As regards the cost of treating insured persons, the sum already provided under the Insurance Act, which, as I have aiready stated, is about one million pounds, can only pass to local authorities in pursuance of agree- ments made between them and Insurance Committoes. But I have no doubt that Insurance Committees generally will be anxious to deal with the LoDal Authority of their area, and the Association may rest assured that the Government wili do all in their power to secure this. I should lite to take this opportunity of expressing mv great apprecia- tion of the way in which county councils and county borough councils have taken up this important work, and I feel sure that, in view of the additional grants I have herem described, they wiU proceed without delay to formulate and carry out their schemes. Yours sincerely, „ . , , ,„,„ (Sg*^!-) D- Lloyd Gbobge. 31st July 1912. APPENDIX XVII. MODEL RULES FOR DEPOSIT CONTRIBUTbRS. (StjgCtEstbd j?or Adoption by Scottish iNStrnANOE Committees. ) (See Gap. VI., Section (III.), paragraph (365).) 1. General. In these rules, unless the context otherwise requires or admits — (1) " The Act " means Parts I. and III. of the Ivational Insurance Act,' 1911, and the National Insurance Act, 1913, and all regulations, orders, and special orders lawfully made thereunder and in force for the time being which shall be deemed to be incorporated in these rules, and anything in these rules inconsistent with any provision of the Act shall be void of and no effect. (2) " Deposit Contributor " means any person contributing for or entitled to benefits under the Act who has not joined an Approved Society within the prescribed time, or who, having been a member of an Approved Society, has been expelled or has resigned therefrom, and has not within the prescribed time joined another Approved Society. ■ (3) '" Committee " means the Insurance Committee for the County [Burgh] of (4) " The Clerk " means the Clerk or the Acting Clerk of the Com- mittee. 2. Residence. (1) Except as otherwise provided in these rules no deposit contributor shall apply to the Committee for the payment to him of sickness or maternity benefit by the Committee unless he is resident in the County [Burgh] of (2) Where a deposit contributor becomes temporarily resident in some place outside the area of the Committee but in the United Kingdom, or in the Isle of Man or the Channel Islands, the Committee, if satisfied that his residence outside the area of the Committee is temporary only, may take into consideration any application made by him for the payment of any sickness or maternity benefit. (3) A deposit contributor who changes his place of residence shall notify the full postal address of his new place of residence to the Scottish Insurance Commissioners, and shall state whether he intends to reside in that place permanently or not. 15 m 3. Sickness Benemt. (1) (a) A deposit contributor who desires to claim sickness benefit may do so by sending an application to the Committee at the end of the period during which he has been rendered incapable of work, or at the expiration of one week from the commencement of the disease or disable- ment whichever is the earlier. (6) The application must be made on a form supplied to him for the purpose and must be accompanied by a declaration that he has been ren- dered incapable of work and that he has not recovered, is not in receipt of, and is not entitled to receive or recover, any compensation or damages such as are mentioned in Section 11 of the Act, by a certificate signed by a medical practitioner stating the cause of his incapacity, and by his contribution card. The Committee may in special circumstances require or allow a deposit contributor to furnish other evidence of his incapacity and require him to furnish a statement in writing of such other particulars as the Committee may think fit : Provided that the Committee may take into consideration any application, notwithstanding that it is not made in accordance with the foregoing requirements. (2) Every application for sickness benefit shall be taken into considera- tion within days from the receipt of the application. (3) At the end of every week after the first during which the incapacity continues the deposit contributor shall, for the purpose of receiving sickness benefit, send to the Committee such evidence as the Committee may by standing orders or otherwise require of the continuance of the incapacity. (4) Any deposit contributor who — (a) makes any false declaration as to incapacity for work ; or (6) attempts by any means improperly to procure a payment to be made to him out of the Deposit Contributors' Fund ; shall be liable to be suspended from sickness benefit for a period not exceed- ing one month or to a fine not exceeding , or in the case of repeated breaches of this rule, (5) A deposit contributor in receipt of sickness benefit — (o) shall obey instructions of the doctor attending him ; (6) shall not in any case be absent from home between the hours of 9 p.m. and 7 a.m. from 1st April to 30th September, and 7 p.m. and 9 a.m. from 1st October to 31st March, and shall not, except with the consent of, and subject to such conditions as may be imposed by, the Committee, be absent from home at any time without leaving word where he may be found ; (c) shall not conduct himself in a, manner which is likely to retard his recovery. (6) The Committee may suspend payment of sickness benefit to a deposit contributor whose disease or disablement has been caused by his own misconduct. (7) Any sickness benefit payable to a deposit contributor shall be paid by means of a postal order payable at such Post Office, and to himself or such other person, as he may specify in the form of application. (8) Where a married woman who was at the date of her marriage a deposit contributor is by virtue of Section 44 of the Act suspended from ordinary benefits under Part I. of the Act, the following provisions shall have effect with respect to the payments to be made to her during any period of sickness or distress by way of benefits under Part III. of the Fourth Schedule to the Act : — Any such married woman who is sick or in distress may make applica- tion in writing to the Committee for the payment to her during the sick- ness or distress of benefits under Part III. of the said Fourth Schedule, and the Committee may during the sickness or distress make to her towards such benefits weekly pasonents of such amounts as having regard to the circumstances of the case the Committee think fit, not 219 exceeding in the whole two-thirds of the amount standing to her credit in the Deposit Contributors' Fund at the date of her suspension. (9) If any deposit contributor is entitled to receive or recover any such compensation or damages as are mentioned in Section 11 of the Act he shall, prior to entering into any agreement in respect thereof, give notice of his intention to the Insurance Committee, and shall furnish such particulars thereof, and such information in connection therewith as the Committee may require ; and any deposit contributor who has received or recovered or has made any agreement in respect of any such compensation or damages shall within three days after receiving or recovering the compensation or damages or after entering into the agreement, as the case may be, give notice in writing to the Committee setting out the amount of the compensa- tion or damages. (10) Any deposit contributor may make an application for sickness benefit by way of advance pending the settlement of a claim for any such compensation or damages as are mentioned In Section 11 of the Act, and the Committee, subject to the provisions of sub-section (3) of Section 11 of the Act, shall take the application into consideration and may pay benefit accordingly. 4. Matbbnity Benefit. (1) Where a claim for maternity benefit arises in respect of a deposit contributor, notice of the confinement shall be given by or on behalf of the deposit contributor, or in the case of his being the husband by or on behalf of his wife, and that within 7 days after the confinement, and there shall also be produced if required a certificate signed by the .doctor or piidwife by whom the mother of the child was attended during the confine- ment, or such other sufficient evidence of the confinement ; and where the claim for maternity benefit is in respect of the husband, a copy of his marriage certificate or such other evidence of the marriage as the Committee may think fit. (2) For the purposes of these rules, " confinement " means labour resulting in the issue of a living child, or labour after 28 weeks of pregnancy resulting in the issue of a child whether alive or dead. (3) The benefit shall be administered in the interests of the mother and child in cash or otherwise, at the discretion of the Committee, and any part thereof may, in the discretion of the Committee, be paid direct to the doctor or midwife attending at the confinement ; all payments shall be made by means of a postal order payable at such Post Office as the recipient may specify, or, failing Specification, as the Committee may determine. j (4) Maternity benefit being in every case the mother's benefit, the wife's receipt or the husband's receipt on her behalf, if authorised by her, shall be a sufficient discharge to the Committee, and where the benefit is paid to the husband he shall pay it to the wife. (5) A wofnan who is an employed contributor and in respect of whose husband's insurance no maternity benefit, or a sum less than the full maternity benefit, is payable, shall on her confinement be entitled to receive in respect of her own insurance such sum as, with the sum, if any, payable in respect of her husband's insurance, is equal to the sum she would have been entitled to receive if he had not been an insured person. (6) An insured woman in respect ofwhom a Maternity Benefit is payable in virtue of sub-section (3) of Section 14 of the National Insurance Act, 1913, shall abstain from remunerative work during a period of four weeks after her confinement, provided that any penalties imposed for breaches of this rule in the period of four weeks shall not exceed, in the aggregate, the sum payable in respect of ihe.Maternity Benefit.. 5. Payment to DEPENDAina. Where any sum is to be paid or applied under sub-section (2) (a) of Section 12 of the Act for the relief or maintenance of the dependants of a deposit contributor, the Committee may require the contributor to furnish 220 them with the names and addresses of the dependants and such other information or such evidence relating to them as the Committee may think fit, and payment shall be made by means of a postal order payable at such Post Office as may be specified by the contributor in his form of application, or by the dependants, as the case may be. 6. VlSITOBS. The Committee may appoint visitors to visit and report upon deposit contributors in receipt of sickness benefit and deposit contributors or wives of deposit contributors to or in respect of whom maternity benefit is or may be payable : Provided that no woman shall be visited otherwise than by a woman. 7. Offenobs. (1) In the case of the breach of any of these Rules for which no penalty is assigned, the Committee may in their discretion inflict a fine or suspension of benefits : Provided that : (a) a deposit contributor shall not be fined a sum exceeding or in the case of repeated breaches of Rules , and shall not be suspended from any of the benefits under Part I. of the Act for more than one month, and (6) maternity benefit shall not be suspended in respect of the con- finement of the wife of a deposit contributor where the wife has not herself been guilty of any breach of rules, imposition or attempted imposition. (2) A deposit contributor who has been fined and has failed to pay the fine withia four weeks, shall be suspended from benefit until the ex- piration of one month, or until the fine is paid, whichever first happens. (3) Before inflicting any penalty upon a deposit contributor the Com- mittee shall give notice to him of their intention, and if within seven days from the receipt of the notice he gives notice to the Clerk that he desires to be heard in explanation of his conduct, the Committee shall fix a date for the hearing by the Committee of his explanation, and not less than seven days' notice shall be given to the deposit contributor of the date so fixed. 8. Notices of Mabeiaqb, etc. (1) Where any depo^ contributor being a woman marries, she shall, within fourteen days after the date of marriage, give notice thereof to the Clerk, and shall also if she continues to be employed withia the meaning of the Act after her marriage state that she so continues. (2) A deposit contributor, whose husband dies or whose marriage has been dissolved or annulled, shall give notice of the death of her husband or of the decree dissolving or armmliug the marriage within fourteen days from the date of the death or decree, as the case may be. (3) A deposit contributor giving anv such notice or making any such statement as aforesaid shall, if and when required, produce satisfactory evidence of the facts appearing in the notice or statement. APPElSfPIX _XV-U L SEE Cap? VII. Section (I) I (e) paragraph (457). SRAM DISPLAYING GRAPH/CALLY Tft£ PASSAGE OF Af&DICAL j9£AI£P/r MONEYS THPOUGN THE ACCOUNTS OF /NSUPANCE COMMITTEES . AccouiUs C^p/ZsZ-wn /ies ■//> respec/' offie/'sons Maf/'/jp /r^ve/feps i/oi/c/itups Accounts Accoiaids to make app^npe/ne/fAs SiWpence //?st/ri//-/ons Wt 4505-358 4000 6/15 MT i E. 221 APPENDIX XIX. (See Gap. VII., Section (I.), paragraph (459).) Scheme eeambd by the Scottish Insurance Qommissionebs and APPROVED BY THE NATIONAL HEALTH INSURANCE JoiNT COMMITTEE AND BY THE LoKDS COMMISSIONBES OF HiS MaJESTY's TREASURY FOR THE Distribution oe the Parliamentary Grant in Aid or Mileage IN Sparsely-Populated Districts in Scotland, exclusive of the Highlands and Islands for the Year 1914. CONDITIONS. 1. The Grant for the year 1914 shall be diatributed in aid of mileage in sparsely populated districts of Scotland other than the Highlands and Islands as defined in the Highlands and Islands (Medical Service) Grant Act, 1913. 2. (1) The amount of the grant applicable to each County or portion of a County containing sparsely populated districts shall be determined by the Scottish Insurance Commissioners (hereinafter referred to as " the Commissioners ") having regard to, inter alia : — (a) the amounts of the Mileage Grants paid in respect of each County or portion of a County for the year 1913-14 ; (6) such adjustments as the Commissioners may consider necessary in consequence of any change of circumstances in the case of any County or portion of a County including any change in the area of the sparsely populated districts ; (c) any sum which the Commissioners may determine to be payable out of the funds for mileage in respect of members of the Sea- men's National Insurance Society resident in those districts of Scotland to which the grant applies — such sum, if any, being payable to the Society in instalments or otherwise as the Com- missioners think fit. (2) In making adjustments in consequence of change of circumstances, no account shall be taken by the Commissioners of insured persons resident within three miles by land of the residence of any medical practitioner on the Insurance Committee's List. 3. The sums determined as aforesaid shall be intimated by the Com- missioners to the respective Insurance Committees and shall be paid to them in instalments or otherwise, and subject to such conditions as the Com- missioners may think fit. 4. All sums so paid by the Commissioners shall be carried by the In- surance Committee to a special Mileage Fund which shall be audited by the Auditors appointed by the Treasury. 5. Subject, as hereinafter provided, the Insurance Committee shall distribute the Mileage Fund for the year 1914 among the practitioners on the panel who may be deemed by the Committee to be entitled to participate therein on the basis of one unit for every mile of " normal mileage," and two and a half units for every mile of " special mileage," and four units for every mile of " water mileage " respectively. 6. " Normal mileage " shall be the distance along a driving road between the residence of an insured person and that of the nearest practitioner on the Insurance Committee's List. " Special Mileage " shall be the like distance along a path or road not used for vehicular traffic or across moor- land. " Water mileage " shall be the whole distance by sea or loch measured between the points of embarkation and landing, having regard to the length of an average voyage. 7. In making such distribution and in determining the sum, if any, payable to each practitioner on the panel, the Insurance Committee may take into account any special circumstances of their area, or any repre- sentations made by any of such practitioners or by the Local Medical 222 Committee or by the Panel Committee in regard thereto, and may vary the scheme of distribution accordingly. 8. The scheme of distribution adopted by the Committee, including any allowance for special circumstances, shall be such as to secure that the cumulo sum to be distributed by the Committee to the practitioners on the panel as aforesaid shall not in any. area exceed the total sum payable to the Committee by the Commissioners in respect of mileage. 9. The Committee shall distribute the sum payable to each practitioner in such instalments as to secure that a practitioner who is on the panel for only part of the year shall not receive more than the share proportionate to the length of his service. APPENDIX XX. LIST OF OFFICIALS, Etc. (See Gap. VIII., paragraph (532).) (A.) COMMISSIONERS AND THEIR HEAD OFFICE STAFF. Principal Office . . . .83 Princes Street, Edinburgh (Tel. No. 8820-3 Central). Accounts Branch. . . .39 Buckingham Terrace, Edinburgh (Tel. No. 8920 Central). Approved Society and Exemption 42 Frederick Street, Edinburgh (Tel. No. 8924 Central). . Sir Jambs Lbishman. . Dr. J. C. M'Vail. /Mr. JoHH M'NiooL. \Miss Maby M. Pateeson. . Mr. John Jeffbdy. /Mr. H. L. ,F. Feaseb. {Mi. William Leitch. . Mr. JoHif M. Vallauoe. . Mr. J. Stewart Seogib. fDr. J. R. CuBEiE. \Dr. G. Matheson Cullbn. Actuarv (on Joint Committee Staff) . . .Mr. J. W. Thomson. For all above Offices . . . Telegrams : " Benefits," Edinburgh, Branches Chairman Deputy Chairman Commissioners Secretary Assistant Secretaries Legal Adviser Accountant . Medical Officers . (B.) SCOTTISH STAFF OF NATIONAL INSURANCE AUDIT DEPARTMENT. Inspector of Audit -Mr. W. G. Twoet, 50 Castle Street, Edinburgh (Tel. No. 7751 Central). Auditor. Address. District. 51 . (Aberdeen . . Mr. J. D. Gardiner 25 Union Terrace, Aberdeen. Sub-Office (Dundee) Mr. J. D. Gardiner 29 Bank Street, Dundee. 52. (Glasgow) . . Mr. J. Davies \ Wellington Street, Glasgow 53. Glasgow . . Mr. A. C. Aitken \ ,„ , '» „ .„„ p.„4.i> ^ 54. (Glasgow) . . Mr. W. M'Auslin J (^^^- ^°- °*^** t-entral). 55. (Edinburgh) . Mr. D, Drysdale . 56 Castle Street, Edinburgh (Tel. No. 7761 Central). 223 fn 'i> ■? 3 J2 3 m Kl riS ;^ 1 C6 9 a . ■as o . ,a 3 o 02 r-i q^ ^ J, 1 B ^ ,a ^ -ta c3 o o W [2; ^ ^' \6 s? 224 APPENDIX XXI. (1) INSURANCE COMMITTEES IN SCOTLAND, WITH NAMES AND ADDRESSES OP CLERKS AND TELEPHONE NUMBERS. (-See Gap. VIII., paragraph (533).) Counties. Aberdeen. — Alexander Clark, 183a Union Street, Aberdeen (288 Central). Argyll Malcolm Sinclair, County Offices, Loohgilphead (8 Lochgilphead). Ayr. — Jamea D. Wyllie, 37 Bank Street, KUmamock (251 Kilmarnock). Banff. — J. D. Paterson, Solicitor, 5 Back Path, Banff (5x5 Banff). Berwick. — Thomas Agnew, 25 Market Square, Duns. Bute. — A. W. Herbert, County Office, Rothesay (54 Rothesay). Caithness. — A. B. Campbell, British Linen Bank Building.s, 18 Bridge Street, Wick. Clackmannan and Kinross. — James W. Moir, County Buildings, Alloa (15 Alloa). Dttnbarton. — James Brown, 43 Church Street, Dumbarton (44 Dunbarton (office), 16 Alexandria (liouse)). DiTMFBiES. — John Robson, County Buildings, Dumfries (400 Dumfries). Elgin and Nairn. — E. D. Jameson, County Clerk's Office, Elgin (21 Elgin). Fife.— W. T. Duncan, Whytescauseway, Kirkcaldy (429 Kirkcaldy). Forfar. — Thomas Hani.k, Town House, Forfar (89 Forfar). Haddington. — W. B. Lawrie, Chambers, Bank of Scotland, Haddington (37 Haddington). Inverness. — Duncan Shaw, County Clerk's and Treasurer's Office, Inver- ness (2 Inverness). KiNCAKDiNB. — J. Falconer, County Clerk's Office, Stonehaven (19 Stone- haven). Kirkcudbright. — Adam Brown, Coimty Clerk's Office, Kirkcudbright (26 Kirkcudbright). Lanark.— W. M. Marshall, 3 Merry Street, Motherwell (82 Motherwell). Linlithgow. — J. G. B. Henderson, W.S., 61 High Street, Linlithgow (10b Linlithgow). Midlothian.— R. T. Wishart, 24 Hia Street, Edinburgh (6847 Central). Orkney. — Peter Brass, 3 East Road, Kirkwall. Peebles. — W. H. Williamson, High Street, Peebles (76 Peebles). Perth.— T. B. Marshall, Solicitor, 38 Tay Street, Perth (329 Perth). Renfrew. — D. A. Morrison, Writer, 23 Moss Street, Paisley (675 Paisley). Ross AND Cromarty. — W. J. Duncan, County Clerk's Office, Dingwall (14 Dingwall). ^ Roxburgh. — A. Douglas Haddon, Royal Bank Buildings, Hawick (69 Hawick). Selkirk. — D. Q-.' Stalker, Solicitor, Galashiels (92 Galashiels). Stirling. — James Learmonth, Coimty Offices, Stirling (115 Stirling). Sutherland. — A. Argo, Solicitor, Golspie. Wigtown. — Thomas M. Hunter, Union Bank Buildings, Stranraer (40 Stranraer). Zetland. — William Williamson, St. Olaf Street, Lerwick. Burghs. Aberdeen. — Alexander M. Craig, Crown Mansions, 41J Union Street, Aberdeen (67 Central). AlRDRiE. — John A. Chapman, 13 Bank Street, Airdrie (97 Airdrie (office), 67 Airdrie (house)). Arbroath. — Rollo S. Black, London House, 7 Hill Street, Arbroath (87 Arbroath). Ayr. — John Boyd, Winton BuUdinga, 79 High Street, Ayr (268 Ayr). Clybeeank. — George J. Miller, Solicitor, Municipal Buildings, Clydebank (11 Clydebank). Coatbridge. — Robert Deuholm, 17 Academy Street, Coatbridge (148 Coatbridge). 225 Btjeghs {Continued). DtTMBAETON.— Kenneth S. Mackenzie, 80 Church Street, Dumbarton. DtiMFKiBS AND Maxwelltown. — R. A. Grierson, Town Hall Buildings, Dumfries (287 Dumfries). Dttndbe.— D. Duncan, 2 Union Street, Dundee (637 Dundee). DtTNFERMLiNE. — Robert Irvine, 39 Bridge Street, Dunfermline (376 Dunfermline). EDiNBtTEOH. — Jas. Russell, 18 Melville Street, Edinburgh (7812 Central). Falkirk, — John Wilson, Solicitor, Manse Place, Falkirk (327 Falkirk). GLAsaow. — William Jones, 59 Bell Street, Glasgow (767 and 768 Bell). Gbbenook. — R. W. Robertson, 4 Brymner Street, Greenock (294 Greenock). Hamilton. — Francis Cassells, 47 Cadzow Street, Hamilton (194 Hamilton). Inverness. — William Michie, 28 High Street, Inverness (30 Inverness). Kilmarnock. — Thomas Johnstone, 1 St. Mamock Place, Kilmarnock. Kirkcaldy. — James M. Lumsden, Solicitor, 288 High Street, Kirkcaldy (121 Kirkcaldy). Lbith. — J. Kinghorn Miles, S.S.C, 46 Constitution Street, Leith (1031 Leith). Motherwell. — William Ballantyne, Commercial Bank, Motherwell (54 Motherwell). Paisley. — Thomas Hunter, 94 High Street, Paisley (480 Paisley). Perth.— Wm. C. Burt, 36 High Street, Perth (394 Perth). RtTTHEEOLEN. — John Henderson, 264 Main Street, Rutherglen. Stieling. — John Brown, Solicitor, 20 Barnton Street, Stirling (341 Stirling). WisHAW. — Thomas S. Haran, Writer, Clyde Chambers, Wishaw (101 Wishaw). (2) LIST OF ADDRESSES OF INSURANCE COMMITTEES IN ENGLAND, IRELAND, AND WALES. (Revised to March 1915.) (o) Englaitd. Counties. Committee. Address. Bedfordshire The Clerk, Bedfordshire Insurance Committee, 1, 2, 3, & 4 Association Buildings, Harpur Street, Bedford. Bbekshieb. — The Clerk, Berkshire Insurance Committee, 2 Abbot's Walk, Reading. Buckinghamshieb. — The Clerk, Buckinghamshire Insurance Committee, 65 Buckingham Street, Aylesbury. Cambridgeshire. — The Clerk, Cambridgeshire Insurance Committee, 24 St. Andrew's Street, Cambridge. Cheshire The Clerk, Cheshire fiisurance Committee, 28 Nicholas Street, Chester. Cornwall. — The Clerk, Cornwall Insurance Committee, Lloyds Bank Chambers, Boscawen Street, Truro. Cumberland. — The Clerk, Cumberland Insurance Committee, 1 Lonsdale Street, Carlisle. Dbrbyshiee. — The Clerk, Derbyshire Insurance Committee, 3 Market Place, Derby. Devonshire. — The Clerk, Devonshire Insurance Committee, 60 High Street, Exeter. Dorsetshire. — The Clerk, Dorsetshire Insurance Committee, 22 High East Street, Dorchester. DuEHAM. — The Clerk, Durham Insurance Committee, 20 New El vet, Durham. Essex The Clerk, Essex Insurance Committee, 58 FUlebrook Road, Leytonstone, N.E. GLOtrcESTERSHiRE. — The Clerk, Gloucestershire Insurance Committee, Shire Hall Chambers, Gloucester. Hampshieb. — The derk, Hampshire Insurance Committee, 39 Southgat? Street, Wiiiohester. 226 Committee. Address. Hebbfoedshibb. — The Clerk, Herefordshire Insurance Committee, St Peter's House, St. Peter's Street, Hereford. HEETFOEDSHmE. — The Clerk, Hertfordshire Insurance Committee, 12 Market Place, Hertford. HuiirTirraDONSHiEB.— The Clerk, Huntingdonshire Insurance Committee, 38 High Street, Huntingdon. Isle of Ely. — The Clerk, Isle of Ely Insurance Committee, Station Road, March. Isle of Wight. — The Clerk, Isle of Wight Insurance Committee, 113 Pyle Street, Newport, Isle of Wight. Isles of Soilly. — The Clerk, iSes of Scilly Insurance Committee, Council Oflces, St. Mary's, Isles of Scilly. Kent. — The Clerk, Kent Insurance Committee, Station Road, Ms-idstone. Lanoashiee. — The Clerk, Lancashire Insurance Committee, 1 Kshergate Hill, Preston. Lbioestbeshiee. — The Clerk, Leicestershire Insurance Committee, 144 London Road, Leicester. Linos. (Holland) The Clerk, Linos. (Holland) Insurance Committee, Spalding. Linos. (Kesteven). — The Clerk, Lines. (Kesteven) Insurance Committee, 16 Knkin Street, Grantham. Linos. (Lindsby). — j?he Joint Clerks, Lines. (Lindsey) Insurance Committee, Stonebow, Lincoln. London. — The Clerk, London Insurance Committee, 5 Chancery Lane, W.C. Middlesex The Clerk, Middlesex Insurande Committee, 13 Victoria Street, Westminster, S.W. NoEFOLK. — The Clerk, Norfolk Insurance Committee, 54 Prince of Wales Road, Norwich. Nobthamptonshieb. — The derk, Northamptonshire Insurance Committee, 30 Market Square, Northampton. NoETHtTMBBELAND. — The Clerk, Northumberland Insurance Committee, 3 Royal Arcade, Pilgrim Street, Newcastle-upon-Tyne. NOTTINQHAMSHIEE The Clerk, Nottinghamshire Insurance Committee, Clumber Buildings, Clumber Street, Nottingham. OxFOEDSHiBE. — The Clerk, Oxfordshire Insurance Committee (County Insurance Office), New Road, Oxford. RuTLANDSHiEE. — The Clerk, Rutlandshire Insurance Committee, Church Passage, Oakham. Salop. — The Clerk, Salop Insurance Committee, Talbot Chambers, Shrews- bury. Soke of PetebBobotjoh. — The Clerk, Soke of Peterborough Insurance Committee, 45 Priestgate, Peterborough. SoMEBSBT The Clerk, Somerset Insurance Committee, Frome, Somerset. STAPFOEDSHiEB.-^The Clerk, Staffordshire Insurance Committee, Market Square, Stafford. Suffolk, East. — The Clerk, Suffolk, East, Insurance Committee, 62 Carr Street, Ipswich. Sttffolk, West. — The Clerk, Suffolk, West, Insurance Committee, 4 Lower Baxter Street, Bury St. Edmunds. SuBBBY. — ^The Clerk, Surrey Insurance Committee, County Insurance Office, Penjhyn Road, Kingston-on-Thames. Sussex, Bast. — The Clerk, Sussex, East, Insurance Committee, 81 High Street, Lewes. Sussex, West. — The Clerk, Sussex, West, Insurance Committee, County Insurance Offices, Arundel. Waewiokshibe. — The Clerk, Warwickshire Insurance Committee, 15 Waterloo Place, Leamington. Wbstmobland. — The Clerk, Westmorland Insurance Committee, Central Chambers, Lowther Street, Kendal. WiLTSHiEE. — The Clerk, Wiltshire Insurance Committee, Clerk's Office, Trowbridge. 227 Committee. Address. WoECBSTEESHiBi;. — The Clerk, Worcestershire Insurance Committee, Bank House, Shaw Street, Worcester. YoBKSHiRB, East Riding. — The Clerk, East Riding Insurance Committee, County Hall, Beverley. Yorkshire, Nobth Riding — The Clerk, North Riding Insurance Com- mittee, White House, High Street, Northallerton. Yorkshire, West Riding. — The Clerk, West Riding Insurance Committee. County Hall, Wakefield. County Boroughs. Barnsley. — The Clerk, Barnsley Insurance Committee, Market Place, Bamsley. Barrow-in-Furness — The Clerk, Barrow-in-Furness Insurance Committee, 92 Duke Street, Barrow-in-Furness. Bath. — The Clerk, Bath Insurance Committee, 2 Quiet Street, Bath. Birkenhead. — The Clerk, Birkenhead Insurance Committee, Hamilton Chambers, Hamilton Street, Birkenhead. Birmingham. — The Clerk, Birmingham Insurance Committee, 191 Cor- poration Street, Birmingham. Blaokbubn. — The Clerk, Blackburn Insurance Committee, 44 Ainsworth Street, Blackburn. Blackpool The Clerk, Blackpool Insurance Committee, Town Hall, Blackpool. Bolton. — The Clerk, Bolton Insurance Committee, Central Hall, 9 Acres- field, Bolton. BooTLB The Clerk, Bootle Insurance Committee, Central Library, Oriel Road, Bootle. Bournemouth The Clerk, Bournemouth Insurance Committee, 200 Old Christohuroh Road, Bournemouth. Bradford. — The Clerk, Bradford Insurance Committee, 38 King's Arcade, Market Street, Bradford. Brighton. — The Clerk, Brighton Insurance Committee, 82 Grand Parade, Brighton. Bristol. — The Clerk, Bristol Insurance Committee, Sun Buildings, 1 Clare Street, Bristol. Burnley. — The Clerk, Burnley Insurance Committee, Old Technical School Elizabeth Street, Burnley. Burton-upon-Trbnt. — The .Clerk, Burton-upon-Trent Insurance Com- mittee, 31 Union Street, Burton-upon-Trent. Bury The Clerk, Bury Insurance Committee, 17 Manchester Road, Bury. Canterbury. — -The Clerk, Canterbury Insurance Committee, 30 Watling Street, Canterbury. Carlisle. — The Clerk, Carlisle Insurance Committee, Midland Bank Chambers, Carlisle. Chester. — The Clerk, Chester Insurance Committee, 21 Old Bank Buildings, Chester. Coventry. — The Clerk, Coventry Insurance Committee, Grey Friars Chambers, Hertford Street, Coventry. Croydon. — The Clerk, Croydon Insurance Committee, 14 Katharine Street, Croydon. Derby. — The Clerk, Derby Insurance Committee, Old Bank Chambers, Iron Gate, Derby. Dewsbuby. — The Qerk, Dewsbury Insurance Committee, Church Street, Dewsbury. Dudley. — The Clerk, Dudley Insurance Committee, Labour Exchange Room, 15 Hollo way Chambers, Priory Street, Dudley. Eastbourne The Clerk, Eastbourne Insurance Committee, 5 Pevensey Road, Eastbourne. ExETEB. — The Clerk, Exeter Insurance Committee, The Court House, Exeter. 228 Committee. Address. Gateshead. — The Clerk, Gateshead Insurance Committee, Savings Bank Buildings, West Street, Gateshead. Glotjoester. — The derk, Gloucester Insurance Committee, Westgate Chambers, Berkeley Street, Gloucester. Great Yarmouth The Clerk, Great Yarmouth Insurance Committee, Fastolff House, Regent Street, Great Yarmouth. Grimsby. — The Clerk, Grimsby Insurance Committee, Victoria Street, Great Grimsby. Hauitax. — The Clerk, Halifax Insurance Committee, 15 King Cross Street, Halifax. Hastings. — The Clerk, Hastings Insurance Committee, Queen's Chambers, Harold Place, Hastings. HUDDERSOTBLD.^ — The'Clerk, HuddersfLeld Insurance Committee, 4 Byram Street, Huddersfield. IpswiOH. — The Clerk, Ipswich Insurance Committee, Town Hall, Ipswich. KiNGSTON-trpON-Huii. — The Clerk, Kingstou-upou-HuU Insurance Com- mittee, 6 Wright Street, HuU. Leeds. — The Clerk, Leeds Insurance Committee, 74 New Briggate, Leeds. Leicester. — The Clerk, Leicester Insurance Committee, 58 London Road, Leicester. LiNCOLif.— The Clerk, Lincoln Insurance Committee, Silver Street, Lincoln. IjIVErp'ool. — The Clerk, Liverpool Insurance Committee, Alexandra Buildings, 55 Dale Street, Liverpool. Manchester. — The Clerk, Manchester Insurance Committee, Union Bank Buildings, Piccadilly, Manchester. MiDDLBSEROTTGH. — The Clerk, Middlesbrough Insurance Committee, 79 Grange Koad West, Middlesbrough. NEwoASTLB-tFPON-TYNB. — The Clerk, Newcastle-upon-Tyne Insurance Committee, 26 Ellison Place, Newcastle-upon-Tyne. North AMPTOif. — The Clerk, Northampton Insurance Committee, 31 Market Square, Northampton. NORVPIOH. — The Clerk, Norwich Insurance Committee, 17 Haymarket, Norwich. Nottingham. — The Clerk, Nottingham Insurance Committee, 12 Victoria Street, Nottingham. Oldham. — The Clerk, Oldham Insurance Committee, Union Bank C'hambers, Church Lane, Oldham. OxroRD. — The Clerk, Oxford Insurance Committee, 38 Queen Street, Oxford. Plymouth. — The Clerk, Plymouth Insurance Committee, 7 Sussex Terrace, Princess Square, Plymouth. Portsmouth. — ^The Clerk, Portsmouth Insurance Committee, Town Hall, Portsmouth. Preston. — The Clerk, Preston Insurance Committee, 11 Market Street, Preston. Reading. — The Clerk, Reading Insurance Committee, Broadway Buildins^s, Station Road, Reading. Rochdale. — The Clerk, Rochdale Insurance Committee, 33 Oldham Road, Rochdale. RoTHERHAM. — The Clerk, Rotherham Insurance Committee, Empire Chambers, High Street, Rotherham. St. Helens.- — The Clerk, St. Helens Insurance Committee, 11 Hardshaw Street, St. Helens. Saleord. — The Clerk, Salford Insurance Committee, 241 Chapel Street, Salford. Shbfiteld. — The Clerk, Sheffield Insurance Committee, Overend Chambers, 41 Church Street, Sheffield. Smethwick. — The Clerk, Smethwick Insurance Committee, 120 High Street, Smethwick. SotTTHAMPTON. — The Clcrk, Southampton Insurance Committee, 17 Panover Buildings, Southampton. 229 Committee? Addreas. Southend-on-Sea.— The Clerk, Southend-on-Sea Insurance Committee, Coronation Chambers, 51 High Street, Southeud-on-Sea. SouTHPOKT. — The Clerk, Southport Insurance Committee, Town Hall, Southport. South Shields.— The Clerk, South Shields Insurance Committee, Edinburgh Buildings, 34 King Street, South Shields. Stookpobt. — The Clerk, Stockport Insurance Committee, Central Buildings, St. Petersgate, Stockport. Stokb-on-Teent. — The Clerk, Stoke-on-Trent Insurance Committee, 6 Glebe Street, Stoke-on-Trent. SuNDEBLAND. — The Clerk, Sunderland Insurance Committee, Baliol Chambers, West Sunniside, Sunderland. Tynemouth. — The Clerk, Tynemouth Insurance Committee, 7 Northumber- land Square, North Shields. Waixasey. — The Clerk, Wallasey Insurance Committee, 4a Church Street, Egremont. , WiiSAJLL. — The Clerk, Walsall Insurance Committee, 40 Bradford Street, Walsall. Warkingtoit. — The Clerk, Warrington Insurance Committee, Trinity Chambers, Market Gate, Warrington. West Bbomwioh. — The Clerk, West Bromwich Insurance Committee, 2 Lodge Eoad, West Bromwich. West Ham. — ^The Clerk, West Ham Insurance Committee, 399 and 401 High Street, Stratford, B. West Hartlepool. — The Clerk, West Hartlepool Insurance Committee, " Magdala," York Road, West Hartlepool. WisAN. — The Clerk, Wigan Insurance Committee, 23 Market Place, Wigan. Wolveehampton. — The Clerk, Wolverhampton Insurance Committee, 62 Dudley Street, Wolverhampton. WoKOESTEE. — The Clerk, Worcester Insurance Committee, 6 Shaw Street, Worcester. YoEK. — The Clerk, York Insurance Committee, 11 Castlegate, York. (6) Ieeland. Counties. Anteim.^ — •The Clerk, Antrim Insurance Committee, County Courthouse, Belfast. Aemagh. — The Clerk, Armagh Insurance Committee, Courthouse, Armagh. Caelow. — The Clerk, Carlow Insurance Committee, 30 Dublin Street, Carlow- Cavan. — The Clerk, Cavan Insurance Committee, Courthouse, Cavan. Clabe. — The Qerk, Clare Insurance Committee, Courthouse, Ennis. CoEK County. — The Clerk, Cork County Insurance Committee, 10 Grand Parade, Cork. Donegal. — The Clerk, Donegal Insurance Committee, Courthouse, LifEord. Down. — The Clerk, Down Insurance Committee, Courthouse, Downpatrick. Dublin County. — The Clerk, DubUn County Insurance Committee, Cavendish House, Rutland Square, DubUn. Fermanagh. — The Clerk, Fermanagh Insurance Committee, The Orchard, Enniskillen. Galway. — The Clerk, Galway Insurance Committee, 12 Dominick Street, Galway. Kerey. — The Clerk, Kerry Insurance Coinjiaittee, County Hall, Tralee. KiLDAEE. — The Clerk, Kildare Insurance Committee, Courthouse, Naas. Kilkenny. — The Clerk, Kilkenny Insurance Committee, 1 William Street, Kilkenny, King's. — The Qerk, King's County Insurance Committee, Courthouse, TuUamore. Leiteim. — The Clerk, Leitrim Insurance Committee, Cloonaghmore, Glenfame, Enniskillen. 230 Committee. Address. LiMBBiCK CouN'ry. — The Clerk, Limerick County Insurance Committee, 82 O'Connell Street, Limerick. LoNDONDEBBY CoTJNTY. — The Clerk, Londonderry County Insurance Com- mittee, County Courthouse, Londonderry. LOfgbobd. — The Clerk, Longford Insurance Committee, Courthouse, Longford. LoTJTH. — -The Clerk, Louth Insurance Committee, 90 Clanbrassil Street, Dundalk. Mayo. — The Clerk, Mayo Insurance Committee, Spencer Street, Castlebar. Mbath. — The Clerk, Meath Insurance Committee, Courthouse, Navan. MoNAGHAN. — The Clerk, Monaghan Insurance Committee, Courthouse, Monaghan. Queen's. — The Clerk, Queen's Cdunty Insurance Committee, 2 Church Street, Maryborough. RosooMMON. — The Clerk, Roscommon Insurance Committee, Abbey Street, Roscommon. Sugg. — The Clerk, Sligo Insurance Committee, 13 Castle Street, Sligo. TippEBAEY (N.R.). — The Clerk, Tipperary (N.R.) Insurance Committee, Courthouse, Nenagh. TippBBABY (S.E.). — The Clerk, Tipperary (S.R.) Insurance Committee, Courthouse, Clonmel. Tyrone. — The Clerk, Tyrone Insurance Committee, 4 Castle Street, Omagh. WATHHroED CotTNTY. — The Clerk, Waterford County Insurance Committee, County Offices, Dungarvan. Westmbati-i.' — -The Clerk, Westmeath Insiirance Committee, County Chambers, Mullingar. Wexfobd. — The Clerk, Wexford Insurance Committee, 87 North Main Street, Wexford. WiOKLOW. — The Clerk, Wicklow Insurance Committee, Kilmullen, Newtownmountkennedy. County Boroughs. , Belfast. — The Clerk, Belfast Insurance Committee, 64 Royal Avenue, Belfast. Cork. — The Clerk, Cork Insurance Committee, City HaU, Cork. DuBiJN.' — The Clerk, Dublin Insurance Committee, 1 College Street, Dublin. LiMERlOK. — The Clerk, Limerick Insurance Committee, 40 O'Connell Street, Limerick. Londonderry. — The Clerk, Londonderry Insurance Committee, Guildhall, Londonderry. Wateefobd. — The Clerk, Waterford Insurance Committee, 10 John's HiU, Waterford. (c) Wales. Counties. Anglesey.— The Clerk, Anglesey Insurance Committee, Shire Hall, Llangefni. Brecon. — The Clerk, Brecon Insurance Committee, 16 Bridge Street, Brecon. Cardiganshieb. — The Clerk, Cardigan Insurance Committee, Cambrian Chambers, Terrace Road, Aberystwyth. Cabmarthbnshieb. — The Clerk, Carmarthenshire Insurance Committee, County Insurance Offices, Carmarthen. Carnarvonshire. — The Clerk, Carnarvonshire Insurance Committee, 22 Castle Square, Carnarvon. < Deneiqhshire. — The Clerk, Denbighshire Insurance Committee, 25 Bridge Street, Wrexham. Flint. — The Clerk, Ji'lint Insurance Committee, Bank Chambers, Mold. Glamorgan. — The Clerk, Glamorgan Insurance Committee, Glamorgan Buildings, Prederiok Street, Cardiff. Mbeionethshieb.— The Clerk, Merioneth Insurance Committee, Finsbury Square, Dolgelley. 231 Committee. Address. MoNMOUTHSHiEE. — The Clerk, Monmouthshire Insurance Committee, Skinner Street, Newport, Mon. MONTGOMEBYSHIBE. — The Clerk, Montgomeryshire Insurance Committee, Montgomery. Pbmbbokeshibe. — The Clerk, Pembrokeshire Insurance Committee, Shire Hall, Haverfordwest. Radnob. — -The Clerk, Radnor Insurance Committee, County Buildings, Llaudrindod Wells. Ooujiiy Boroughs. Cabdiff. — The Clerk, Cardiff Insurance Committee, City Hall, Cardiff. Mbbthyb Tydfil. — The Clerk, Merthyr Tydfil Insurance Committee, 34 Victoria Street, Merthyr Tydfil. Nkwpobt. — ^The Clerk, Newport Insurance Committee, 35 Commercial Street, Newport, Mon. Swansea. — The Clerk, Swansea Insurance Committee, 18 Castle Street, Swansea. APPENDIX XXII. REFERENCE CIPHERS OF INSURANCE COMMITTEES (UNITED KINGDOM). (See Gap. VIII., paragraph (533).) The ciphers contained in the following lists are officially recognised for use in reference to Insurance Committees in the United Kingdom. (1) SOOTLAHD. Counties. Ad — Aberdeenshire. Al — Argyll. Ar— Ayrshire. Ba— Banff. Bk — Berwick. Bt— Bute. On — Caithness. OK — Clackmannan and Kinross. Df — Dumfriesshire. Db — Dunbarton . EN— Elgin and Nairn. Ff— Fife. Fr— Forfar. Ha — Haddington. In — Inverness-shire. Kd — -Kinoardiue. , Ku^Kirkcudbright. Lr — Lanark, Li — Linlithgow. M— Midlothian. Or — Orkney. Pb— Peebles. Pr — Perthshire. Rn — Renfrew. RC — -Ross and Cromarty. Rx — Roxburgh. Se— Selkirk. Sg — Stirlingshire. Sd — Sutherland. Wg — Wigtown. Zt— Zetland. Burghs. Abd — Aberdeen. Ard — Airdrie. Arb — Arbroath. Ayr — Ayr. Cbk— Clydebank. Ctb — ^Coatbridge. Dbt — Dumbarton . X)Mt — Dumfries and Maxwelltown. Dee — Dundee. Dfu — Dunfermline. Edb — Edinburgh. Flk— Falkirk. Glw — Glasgow. Gnk— Greenock. Htn — Hamilton. Tnv — Inverness. Kmk — Kilmarnock. Kdy — Kirkcaldy. Lth— Leith. Mtl — Motherwell. Psy — Paisley. Pth— Perth. Rgu — Kutherglen. Stg — Stirling. Whw — Wishaw. 232 (2) England. Counties. Bd— Bedford. Be — Berkshire. Bu — Buckinghamshire. Cb — Cambridgeshire. Ch— Cheshire. Cr — Cornwall. Cu — Cumberland. De — Derbyshire. Dn — Devonshire. Do — Dorsetshire. Dr — Durham. • Ex— Essex. Gl: — Gloucestershire. Hr — Herefordshire. Ht — Hertfordshire. Hu — Huntingdonshire. le— Isle of Ely. Iw — Isle of Wight. Is — Isles of SciUy. Ke— Kent. La — Lancashire. Le — Leicestershire. Lh — Linos., Holland. Lk — -Lines, Kesteven. Ll^Lincs., Lindsey. Baa — Barnsley. Bar — Barrow-in-Eurness. Bat— Bath, City of. Bik— Birkenhead. Bir — Birmingham, City of. Bib— Blackburn. Blp — Blackpool. Bol— Bolton. Boo — Bootle Bou — Bournemouth. Bra — Bradford, City of. Bri — Brighton. Brs — Bristol, City of. Bry — Burnley. Bun— Burton-upon-Trent. Buy — Bury. Can — Canterbury, City of. Cal — Carlisle. Che — Chester, City of. Cov — Coventry, City of. Cro — Croydon. Deb — Derby. Dey — Dewsbury. Dud— Dudley. Est — Eastbourne. Exe — Exeter, City of. Gat — Gateshead. Glo — Gloucester, City of. Gry — Great Yarmouth. Gyy— Grimsby. Hal — Halifax. Has — Hastings. Ln — London. Mx — Middlesex. Nf— Norfolk. No — Northamptonshire. Nr — Northumberland. Nt — Nottinghamshire. Ox — Oxfordshire. Ru — Rutlandshire. Sa — Salop. Sk — Soke of Peterborough. Sm — Somerset. So — Southampton. St — Staffordshire. Su— Suffolk, East. Sw— Suffolk, West. Sy — Surrey. Te — Sussex, East. Tw — Sussex, West. Wa — Warwick. Ws — Westmorland. Wl— WUtshire. Wr — Worcestershire. Ye— Yorks., E. Riding. Yn — Yorks., N. Riding. Yw— Yorks., W. Riding. County Boroughs. Hud— Huddersfield. Ips — Ipswich. Khu — Kingston upon-HuU, City of. Lds — Leeds, City of. Lee — Leicester. Lin — Lincoln, City of. Lip — Liverpool, City of. Man — Manchester, City of. Mid — Middlesborough. New — Newcastle-upon-Tyne, City of. Noh — Northampton. Nor — Norwich, City of. Not — Nottingham, City of. Old— Oldham. Oxr— Oxford, City of. Ply— Plymouth. Por — Portsmouth. Pre — Preston. Red — Reading. Roc — Rochdale. Rot — Rotherham. Sai — St. Helens. Sal— Salford. She— Sheffield, City of. Sme — Smethwick. Soh — Southampton. Sth — Southend-on-Sea. Sop — Southport. Sos — South Shields. Spt — Stockport. Sto — Stoke-on-Trent. Sun — Sunderland. 233 Tyn— Tynemouth. Waa — Wallasey. Wal— Walsall. War — Warrington. Wbn— West Bromwich. Wea — West Ham. An — Antrim. Ah — Armagh. Cw^Carlow. Cv — Cavan. CI— aare. Co— Cork. Dg — Donegal. Bw — Down. Dl — Dublin County. Fm — Fermanagh. Qw — Gal way. Ky — Kerry. Ki — Kadare. Kk — Kilkenny. Kg — King's. Lt — Leitrim. Lm — Limerick County. Bel— Belfast. Crk— Cork. Dbl— Dublin. As — Anglesey. Br — Brecon. Cd^Cardigan. Cm — Carmarthen. Ca — Carnarvon. Dh— Denbigh, n— Flint. Cdf— Cardiff. Mer — Merthyr Tydvil. Cowniy Boroughs — (continued). Weh— West Hartlepool. Wig — ^Wigan. Wom — Wolverhampton. Wos — Worcester, City of. Yor— York, City of. (3) lEBLAIfD. Gounties. Ld — Londonderry County. Lf — Longford. Lo — Louth. Ma— Mayo. Me — Meath. Mh — Monaghan. Qc — Queen's. Em — Roscommon. SI— Sligo. Tn— Tipperary (N.R.). Ts— Tipperary (S.R.). Ty— Tyrone. Wf— Waterford. Wm — Westmeath. Wx — Wexford. Wk— Wicklow. County Boroughs. Lmk — Limerick. Ldd — Londonderry. Wfd— Waterford. (4) Wales. Counties. Ga — Glamorgan. Mr — Merioneth. Mt — Monmouth. My — Montgomery. Pk — Pembroke. Ra — Radnor. County Boroughs. Npt — Newport. Swa — Swansea. APPENDIX XXIII. FAIR WAGES CLAUSE IN CONTRACTS. {See Gap. VIII., paragraph (534).) National Health lustrRANOB Commission (Scotland), 83 Pbinobs Stbbbt, EDiNBTJEaH, 14:th April 1913. Sib, — I am directed by the National Health Insurance Commission (Scotland) to draw the attention of Insurance Committees to the accompanying memor- andum embodying the Resolution passed by the House of Commons on the i6 1234 10th March 1909, on the subject of Fair Wage Clauses in Government Contracts, and the recommendations made by the Advisory Committee of representatives of Government Departments which has been established as suggested in paragraph 124 of the Report of the Fair Wages Committee of 1908 (Cd. 4422). It will be seen that the Advisory Committee recommend that clauses such as those-inserted in Government contracts should also be introduced into contracts which are not entered into by Government Departments, but which involve the expenditure of public money or other consideration granted by a Government Department. In view of the terms of this recommendation the Comrhissioners consider it desirable that the policy adopted in the case of Government contracts should be followed in the cases of all contracts for the execution of works or supply of materials entered into by Insurance Committees ; and I am accordingly to suggest that your Committee should give the matter careful consideration with a view to the introduction in their contracts of clauses on the lines of those inserted in Government contracts. I am. Sir, Your obedient Servant, JOHN JEFFREY. To the derk to the Insurance Committee. Secretary. ' Memorandum referred to. FAIR WAGES CLAUSES IN GOVERNMENT CONTRACTS. The following clauses recommended by the Fair Wages Advisory Committee for general use in Government contracts, with a view to carrying out the objects of the Fair Wages Resolutions of the House of Commons, have been generally adopted by the contracting Departments : — FOR INCLUSION IN ALL CONTRACTS. 1. Pair Wages Clause. — The Contractor shall, in the execution of this contract observe and fulfil the obligations upon contractors specified in the Resolution passed by the House of Commons on the 10th March 1909, namely : — " The Contractor shall pay rates of wages and observe hours of labour not less favourable than those commonly recognised by employers and trade societies (or, in the absence of such recognised wages and hours, those which in practice prevail amongst good employers) in the trade in the district where the work is carried out. Where there are no such wages and hours recognised or prevailing in the district, those recognised or prevailing in the nearest district in which the general in- dustrial circumstances are similar shall be adopted. Further, the conditions of employment generally accepted in the district in the trade concerned shall be taken into account in considering how far the terms of the Fair Wages clauses are being observed. The Contractor shall be prohibited from transferring or assigning, directly or indirectly, to any person or persons whatever, any portion of his contract without the written permission of the Department. Sub-letting, other than that which may be customary in the trade concerned, shall be prohibited. The Contractor shall be responsible for the observance of the Fair Wages clauses by the Sub- Contractor." ■ 2. Exhibition o£ Notice at Works. — The Contractor shall cause the preceding condition to be prominently exhibited, for the information of his workpeople, on the premises where work is being executed under the contract. 3. Inspection o£ Wages Books, etc. — The Contractor shall keep proper wages books and time sheets, showing the wages paid and (so far as prac- ticable) the time worked by the workpeople in his employ in and about the dieoution of the contract, and such wages books and time sheets shall be produced whenever required for the inspection of any Officer authorised by the Department.* * Specify the Department. 235 TOR INCLUSION IN CONTRACTS IN CERTAIN TRADES. 4. Factory Clause. — All work executed under the contract shall be carried out at the Contractor's own factory or workshop at , or other place approved by the Department,* and no work under the contract shall be done in the homes of the workpeople. 5. Direct Payment oS Wages. — All wages earned by workers engaged on work under the contract shall be paid directly to them and not through a foreman or others supervising,- or taking part in, the operations on which the workers are engaged. SEMI-GOVERNMENT CONTRACTS. The Fair Wages Advisory Committee have recommended, that in the ■case of contracts which are not entered into by a Government Department but which involve the expenditure of public money or other consideration granted by the Department, or which have to be approved by a Govern- ment Department, the Department concerned should adopt the principle .already followed in some instances, and should require the insertion in such contracts of Fair Wages clauses on the lines of those inserted in Govern- ment contracts, with such modifications as may be necessary in particular ■cases. March 1911. APPENDIX XXIV. CONTRACTS WITH MEMBERS. (See Cap. VIII., paragraph (535).) No. 427. Nationai Health Insttranoe Commission (Scotland). 83 Peincbs Stbbet, Edutbubqh, September 1913. Sm,— I am directed to inform you that the Scottish Insurance Commissioners have had several enquiries as to the position of an Insurance Committee in entering into contracts with one of its members. Town Councils, County Councils, and Parish Councils are, by express provisions in the respective Acts under which they carry on their admini- stration, debarred from entering into contracts with one of their members, and a member may not, except in certain limited cases, — such as being a shareholder of a Railway or other Company, etc.,f — either directly or indirectly share any consideration derived from any contract or employ- ment by the Council. The attention of the Commissioners has also been directed to an Opinion ffiven in the year 1878 by the Scottish Law Officers (afterwards Lord Gordon and Lord Watson) regarding the power of a School Board to enter into a contract with one of its members, to the effect that such contracts were in law not void, but were voidable at the instance of the Board, and -that it was manifestly expedient in general cases that such contracts should not be entered into. The Commissioners appreciate that the position of Insurance Service Tractitioners and Chemists, who are members of Insurance Committees, is special, and contracts between them and the Committee for service on ■the panel must be entered into. In these cases the individual representa- tives on the Committee can secure no better terms for themselves than for the general body of practitioners or chemists, and have no special in- dimidvAil interest in the contracts. * ■- Specify the Department. t See Sec. (220) of the Local Government (Scotland) Act, 1894. 236 As regards other contracts, however, where the effect o£ the Committee- contracting with a member is to exciude a contract with other persons carrying on business, and where the member may thereby obtain personal advantage, it would appear that an Insurance Committee may, by such action, render themselves liable to criticism, and the Commissioners would urge upon Committees the desirability of passing a resolution that in such cases no member of the Committee should be allowed either to contract with the Committee or to share in any consideration derived from such a con- tract. — I am. Sir, your obedient servant, John Jeffrey, Secretary. The Cleric to the Insurance Committee. APPENDIX XXV. {See Cap. VIII., paragraph (540).) No. 382. National Health Insurance Commission (Scotland),, 83 Princes Street, Edinbckgh, July 1913. Eef. I.C. 41,752. Sir,— ADMISSION OP PRESS TO MEETINGS. I am directed by the Scottish Insurance Commissioners to say that representations have recently been made to them as to the desirability of the Press being admitted to meetings of Insurance Committees. It has been pointed out that Insurance Committees are important Local Authorities, representative of varied interests and entrusted with the administration of public moneys contributed by insured persons, em- ployers, and the State, and that it is desirable that their proceedings should receive due publicity. The Commissioners acquiesce in the views presented to them and re- cognise the importance of the question, and while they are advised that the Local Authorities (Admission of the Press to Meetings) Act, 1908, does not apply to an Insurance Committee in view of the definition of a Local Authority in Scotland therein contained, there would appear to be no reason to believe that, had Insurance Committees been in existence at the passing of the Act, Parliament would have regarded the Committees as being in any less responsible position than Distress Committees and similar bodies to whom the Act was applied. The Commissioners accordingly suggest that Insurance Committees should voluntarily apply by resolution the principles of Section 1 of the Admission of the Press Act to their meetings. Under such application, representatives of the Press wiU be granted admission to the meetings of every Insurance Committee. The Committee, however, may temporarily exclude such representatives from a meeting as often as may be desirable at any meeting when, in the opinion of a majority of the members of the Committee present at such meeting, ex- Eressed by resolution, in view of the special nature of the business then eing dealt with or about to be dealt with, such exclusion is advisable in the public interest. The Commissioners are advised that there is no legal prohibition against a Committee admitting representatives of the Press to its meetings. I am. Sir, Your obedient Servant, JOHN JEFFREY, Secretary. The Clerk, Insurance Committee. IJiTDEX. Numiers refer to Paragraphs. Paragraphs Accounting . . . 489-531 Accounts — Alternative .... 530 Bank, entries in . . . 491 „ safeguards for operat- ing on ... 531 Entering up of . . . 489-530 Of Chemists — See Drug Accounts. Of Deposit Contributors, kept by Commissioners . . 429 „ Doctors, for Temporary Residents 450- 15G Administration- Income for . . 476-481 Administration Fund — Accounting . . 490, 501, 526, 527 Payments into, from Sanatorium Benefit Fund . . 464,523 Admiralty and Army Council- Duties in regard to National Health Insurance . Introduction Advances — To Chemists, to be agreed upon by Pharmaceutical Com- mittee and Insurance Com- mittee . . . 159 ,, Doctors, to be agreed upon by Panel Committee and In- surance Committee . . 142 ,, Insurance Committees, for Medical Benefit, from the Scottish National Health In- surance Fund . . 443 Advisory Committee- Purposes of . Introduction Agreements — Entered into by Insurance Committees, register of . . 490 Agreements — Insurance Com- mittees and Chemists- Alterations in . . 203 Breach of . . . 264 Conditions of . . . 191, 192 Disputes as to . . . 192 Period of ... 204 Preparation and approval of . 191 Agreements — Insurance Com- mittees and Doctors — Alterations in . . . 137, 171 237 Paragraphs Application by Doctor to enter into 165 Approval of . . . 167 Breach of . . . 171, 262 Period of .... 173 Places and Hours of Attend- ance to be stated in . . 168 Preparation of ■ . . 137, 167 Terms of . 137, 167, 168, 171, 172 Agreements — Insurance Committees and Local Authorities — For purposes of Sanatorium Benefit 282, 293, 299, 814, 346, 347 Alien Enemies^ Deposit Contributors, no refund to be made to . . . 353 Aliens- Maternity Benefit of . . 408 Sickness „ ,, . . 392 State Grants not payable in respect of . . . 437, 461 Allocation to Doctors of Insured Persons — Duties of Panel Committee in regard to ... 143 Who have not exercised choice . 163 Appeals — By Chemists to Commissioners . 264 ,, Doctors to Commissioners . 260 Appliances- Emergency .... 196 Loan of .... ; 197 Supply of, under Medical Benefit 161, 197, 198 ,, ,, ,, Sanatorium Benefit . 302, 305, 307, 324^326 Approved Dispensaries — For treatment of Tuberculosis 294-297, 348 Approved Institutions- Application and conditions for approval . . . 185, 186 Financial arrangements in re- gard to. . . . 511-515 Issue of lists of persons choosing 169 „ „ medical cards to per- sons choosing . . . 235 Right of- iasured persons to treatment in . ' . , . 23T 238 Paragraphs Eight of insured persons to treatment in, during tempor- ary absence from home . 229 Withdrawal of approval, right of insured persons to select another method of treatment . 242 For treatment of Tuberctdosis — See Institutions for Treatment o£ Tuberculosis. Approved Societies- Contributions _ of, to General Administration Expenses of Insurance Committees . . 476 Contributions of, to cost of Medical Benefit . 436-440 Contributions of, to cost of Ad- ministration of Medical Benefit 476, 478 Contributions of, to cost of Sana- torium Benefit . . . 461 General Duties of . Introduction Grouping of, for Valuation . 77 Issue of Medical Card to mem- bers of . . . .223 Members over 70 — title to benefits . . . ■. 207 Powers of Insurance Committees in regard to the administra- : tion of grouped societies . 77 Register of members of 205-215, 218 Eight of, to represent member at hearing of complaint . 270 Approved Societies — Repre- sentation on Insurance Committees . 9-12,14-25, 27-46 Allocation of Eepresentatives to "A" Societies . . 14,16-24 Allocation of Eepresentatives to " B " Societies . 14, 15, 19-24 Appointment of Eepresentatives of " A " Societies . . 25, 27 Appointment of Representatives of " B" Societies . . 25, 28-36 Count of members in connection with . . . . .11 Default and technical errors in Election ... 39, 45 Disqualification of Eepresenta- tives 41,42 Election entrusted to the Clerk to the Committee . . . 9, 10 Electoral Unit, determination of 12 Notices to Societies in regard to appointment of Representatives 25 Numbers of Eepresentatives of various Societies . . 14-20 Publication of names of Eepre- sentatives .... 37 Regulations governing Election 9 Bepre-seritation of Women , 46 Eepresentatives on more than one Insurance Committee . 38 Eeturn showing allocation of Eepresentatives . . 21-25 Term of Office of Eepresentatives 40 Vacancies . . . . 38, 43, 44 Paragraphs Approved Systems . 185, 186 See also Approved Institutions. Approved Tuberctdosis Dispensaries 294-297, 348 Areas of Insurance Com- mittees .... 3 Army— See Soldiers. Association of Deposit Contributors . . 26, 252 Association of Insurance Committees in Scot- land — Authority for . Introduction Attendance by Doctor — Places and hours of, arrange- ments for alterations in . 168 Places and hours of, to be speci- fied in agreement . . 168 Audit Department . . . 532 Bandages — SuppUed under Medical Benefit 197 Bank Accounts of Insur- ance Committees — Entries in .... 481 Must be in name of Committee, safeguards for operating on . 531 Bedding- Provision of, under Domiciliary treatment . . . 304,310 Benefits— Set also Disablement Benefit, Dlaternity Benefit, Sickness Benefit, etc. Administration of, by Insurance Committees (general) . . 72 Incomeof Insurance Committees for administration of . . 476 Of Deposit Contributors . 366-428 ,, „ ,, rules for administration of . . . 365 Postal Orders for payment of . 486 Suspension of, in case of De- posit Contributors . . 367-372 Suspension of, on Marriage 397 Books- Account. See Accounts, also Ledger, General Cash Book, etc. Insurance. See Insurance Books. Breach— Of Chemists' Agi-eements . 192, 264 ,, J, „ Chem- ists hable to refund expenses incm'red as result of . . 264 ,, Chemists' Agreements, Chemists hable to refund amount of Parhamentary Grant withheld on account of 264 „ Doctors' Agreements . 171, 262 „ Doctors' Agreements, Doctors Uable to refund ex- penses incurred as result of . 171, 262 239 Paragraphs Of Doctors' Agreements, Doctors liable to refund amount of Parliamentary Grant withheld on account of 262 „ rules for administration of Medical Benefit . 245-247, 259, 264 „ rules in regard to Maternity Benefit 410 Burial — Of insured persons dying in Sanatorium . . . 292,333 Cards— iSee Contribution Cards, Medical Caids, etc. Case Values — In coimection with Medical Benefit .... 447, 448 In connection with Sanatorium Benefit . . 464, 466, 469, 474 Cash Book — See General Cash Book. Central Drug Fund — Distribution of, to Chemists . 455 „ „ to Insurance Committees . . . 452 Establishment of . . .449 Central Medical Benefit Fund- Accounting . . . 453, 505 Constitution of . . . 445-449 Distribution of, to Chemists and Doctors. . . . 454r4S6 Distribution of, to Insurance Committees . . . 450-453 Purposes of .... 445 Central Panel Fund- Distribution of, to Doctors 453, 454, 456 ,, „ to Insurance Committees .... 453 Establishment of ... 449 Central Sanatorium Benefit Fund — Payments into . • • 318 „ • from . . 318-320 Centralisation — Of Index and Suspense Registers 219 „ Orange Slips . . • 219 Certificates— For payment of Maternity Bene- fit . . ■ . 422-428 Of Incapacity . 82, 184, 255, m 40o „ Marriage . • • 421, 423 Change of Address— Affecting title of Doctor to dis- pense • ■•".• " Alterations in Index Kegister and Medical Index on accoimt of . . 215, 217, 228, 430, 431 Of Deposit Contributors, pro- cedure in regard to Index Slip, Medical (Jard, «t<^ggg351j^353- Paragraphs Of Deposit Contributors, Exempt persons, procedure in regard to Index Slip, Medical Card, etc. . . 217 „ Own Arrangers . 234, 257, 518 Temporary, procedure regarding Medical Benefit during 215, 219-233 To be notified to Insurance Committees by Approved Societies if prior to 11th January 1914 . . . 215 Change of Status — Alterations in Index Register,":"''^ etc., on account of . 213, 216 Chemists- Accounts. See Drug Accounts. Admission of, to Panel, in- quiries as to . . 177 Agreements. See Agreements — ^Insurance Committees and Chemists. Conditions of Service of 187, 191, 192, 203 Continuance on Panel, repre- sentations by Insurance Com- mittees in regard to . . 264 Continuance on Panel, pro- cedure at inquiries as to . 277 See also Inciuiry as to Ad- mission to 01 Continuance on Panel o! Chemist. Definition of . . . .187 Dispensing by .... 187 Exhibition of Notice by . . 190 Lists of — See Panel Lists (Chemists). Choice of Doctor — Eight of Insured Persons as to . . . . 236-244 Claims — By Deposit Contributors for Maternity Benefit . . 421-428 „ Deposit Contributors for Sickness Benefit . . 401-405 Classified Cash Book. . . 522 Clothing- Provision of, for Domiciliary Cases 303 Provision of, for Sanatorium Cases . ... 288 Combination of Insurance Committees — For establishment of Drug Ac- counts Committee . . 61 General . . . . 59, 60 Commissioners — Accounts of Deposit Contri- butors kept by . _ . 429, 433 Appeal to, by chemist in regard to breach of agreement . . 264 Appeal to, by doctor in regard to breach of agreement 171, 260 Appointment of medical re- ferees by ... . 178 240 Paragraphs Approval of Institutions by, under Section 15 (4) of 1911 Act 185 Approval of necessary, in case of alteration in conditions of service of doctors and chemists . . . 172, 203 Approval of rules by, for ad- ministration of Medical Benefit . . . .245 Ajjproval of schemes by, for issue of emergency drugs and , appliances .... 196 Certificates, contribution cards, and insurance books to be forwarded to, in connection with Sickness Benefit of De- posit Contributors . 402, 404, 405 Certificates in connection with Maternity Benefit of Deposit Contributors to be forwarded . to . . . . 423, 426, 427 Claims of Deposit Contributors for Maternity Benefit to be forwarded to . . 423,424 Consent of, to increase in number of members of Medical Service Sub-Com- mittee ... 79 (Jonsideration by, of repre- sentations of Panel and Phar- maceutical Committees before approval of schemes for Medical Benefit . . 188, 157 Current Accounts of Insurance Committees with. . . 490, 491, 493, 501-503, 526 Pinancial arrangements of Insurance Committees with Institutions for the treatment of Tuberculosis to be to the satisfaction of 287, 289 General Powers of . Introduction Joint Committee Introduction Offices and Staff of . . .532 Power of, to constitute Inquiry Committee . . . 269, 277 Power of, to hold inquiry as to continuance of doctor on Panel 266 Power of, to hold inquiry as to admission to or continuance on Panel of chemist . 266, 277 Power of, to postpone inquiry as to admission to or continu- ance on Panel of chemist . 267, 277 Power of, to postpone inquiry as to continuance of doctor on Panel 267 Powers and duties of, in regard to establishment of General Medical Benefit Fund . 436-440 Recognition of Local Medical Committees by . . . 120 Recognition of Local Medical Committees by, conditions of 122, 123 7,58 328 280 287 73 Paragraphs Representations to, by Insur- ance Committees in serious cases of complaint against doctors or chemists . 261, 264 Representatives of ,on Insurance Committees . Retrospective sanction by, of arrangements of Insurance Committees for Sanatorium Benefit Sanction by^ of arrangements for provision of Sanatorium Benefit Sanction by, of arrangements of Insurance Committees for Dispensary treatment of Tuberculosis. . . 295,296 Sanction by, of arrangements of Insurance Committees for Domiciliary treatment of Tuberculosis . . 299, 301 Sanction by, of arrangements of Insurance Committees for Institutional treatment of Tuberculosis To prescribe reports to be made by Insurance Committees Commissioners of Inland SevenOe — Duties in regard to National Health Insurance . Introduction Committee of Inquiry — Into question of admission to or continuance on Panel of chemist .... Into question of continuance of doctor on Panel . . . 2Da Compensation — For loss of remunerative time by members of Insurance Committee . . 483, 485, 486 Payment of, under Workmen's Compensation Act and Em- ployers' Liability Act, effect on Sickness and "Disablement Benefits Under Workmen's Compe/isa- tion Act and Employers' Liability Act, title of Terri- torials and Special Reservists to Complaints by or against Chemists- Duty of Pharmaceutical Com- mittee to consider Procedure at Hearings by Joint Services Sub-Committee in connection M-ith . . 95, Procedure at Hearings by Phar- maceutical Service Sub- Committee in connection \\ith 277 376-382 382 156 96 91, 263 Proceedings at Hearings to be reported to Insurance Com- mittee ... 92, 98, 264 Referred to Joint Services Sub- Committee ... 97, 265 241 Paragraphs Referred to Pharmaceutical Ser- vice Sub-Committee 92, 263, 264 Removal of chemist from Panel, following . . . 277 Report of Joint Services Sub- committee .... 98 Report of Pharmaceutical Service Sub-Committee . 92 Representations of Insurance Committee to Commissioners, following . . . 264,277 Complaints by or against Doctors — Duty of Local Medical Com- mittee to consider . . 126 Procedure at Hearings by Joint Services Sub-Committee in connection with . . 95, 96 Procedure at Hearings by Medical Service Sub-Com- mittee in connection with 79-88, 259 Procedure following report of Medical Service Sub-Com- mittee to Insurance Com- mittee . . . 259-262 Proceedings to be reported to Insurance Committee . . 86, 98, 259, 265 Referred to Joint Services Sub- committee . . .97, 265 Referred to Medical Service Sub-Committee . . 82, 259 Removal of doctor from Panel, following . . 266-276 Report of Joint Services Sub- Committee to Insurance Committee .... 98 Report of Medical Service Sub- Committee to Insurance Committee . . .86 Representation by Insurance Committee to Commissioners, following .... 261 Right of Panel Committee in regard to conduct of inquiry into . . . . 144 Comptroller and Auditor- General— Duties in regard to National Health Insurance . Introduction Conditions of Service of Chemists . 187,191,192,203 Conditions of Service of Doctors . 167,168,171,172 Confinement — Arrangements by Insurance Committee for attendance of midwife or doctor at, in the case of Deposit Contributors 419, 420 Insiired person has no title to Medical Benefit during . .177 Notice of, in connection with the payment of Maternity Benefit. ... 422 Paragraphs Payment of Sickness Benefit during 398 Constitution of Insurance Committees . . . 4-8 Contracts — Entered into by Insurance Com- mittees .... 534, 535 Contribution Cards — Of Deposit Contributors, de- spatch to Commissioners on death of Contributor . . 364 Of Deposit Contributors, de- spatch to Commissioners in connection with claims for Maternity Benefit . . 423 Of Deposit Contributors, de- spatch to Insurance Com- mittee in connection with claims for Sickness Benefit 401, 404 Contributions — Rates of, for different classes of contributors . . 350, 352 Contributions to Hospitals — Powers of Insurance Com- mittees in regard to . .75 Conveyance of Insured Persons — In connection with Sanatorium Benefit .... 329-333 County Councils — Arrangements for Sanatorium Benefit to dependants . 340, 342-344 Representatives of ,on Insurance Committees . . . 47-49 Schemes for treatment of Tuber- culosis . . . 344,348 Current Account — Insur- ance Committee and Commissioners- Entries in . 491,493,501-503,526 To be entered in Ledger , . 490 Damages — Effect of payment of, on Sick- ness and Disablement Benefits . . 376-382 Day Books — Medical Day Books . . 181, 182 Death — Of Deposit Contributor — Re- fund in case of . 357-363 ,, Deposit Contributor, pro- cedure in regard to Index Slip .... 217,433 „ Doctor, arrangements conse- quent on . . . 238,241 ,, Insured Person, amendment of Index Register, etc. . 213, 214 ,, Insured Person in Sana- torium . . 292,333 Deficit- In funds of Insurance Com- mittee for Sanatorium Bene- fit ... . 335,336 242 Paragraphs Dependants- Domiciliary treatment of . 306, 338 Extension of Sanatorium Bene- fit to . ■'. 306,307,334-348 Deposit Contributors- Accounts of . . . 429,432 Association of . . . 26, 252 Change of Address of. . 216, 351 Classification of ... 73 Contributions, Eates of . 350, 352 Disablement Benefit of . 397, 406 See also Disablement Benefit (Deposit Contiibutors.) Duties of Insurance Committees in regard to classification of . 73 Income of Insurance Com- mittees for payment of benefits to . . . .476 Index SUps of . 205, 207, 214, 216, ,, ,, Medical Cards, etc., procedure in regard to . 429-433 Joining an Approved Society 432-433 Maternity Benefit of . 369, 407-428 See also Matemitjr Benefit (Deposit Gontributois). Medical Benefit of . . 366-372 Over 70— title to Benefits . 207, 372 Position of, as regards payment of Benefits (general) . . 349 Postal Orders for payment of Benefits of , . . .496 Powers" of Insurance Committees in regard to administration of benefits of .... 72 Register of . . 205, 206, 351 Bules for administration of benefits of . . . . 365 Sanatorium Benefit of . 366-372 Sickness Benefit of . 369, 373-405 See also Sickness Benefit (Deposit Contiibuiois). Suspension from Benefits . 368-371, 375, 415 Deposit Contributors Bene- fits Account — Insurance Committee to keep . 490 Purposes of . . : . 528 Deposit Contributors Fund — Payments from . 367, 370, 371, 397 Deposit Contributors — Re- presentation on Insur- ance Committees . 9-13, 21-26, 37-46 Allocation of Representatives . 13 Appointment of „ . 26 Count of Deposit Contributors in connection with . . 11 Default and technical errors in Election . . . 39,45 Disqualification of Kepresenta- tives 42 Electoral Unit, determination of 12 Number of Representatives, cal- culation of . . . .13 Paragraphs Publication of Names of Repre- sentatives . . . _ . 3T Regulations governing Election . 9 Representation of Women . 46 Representatives on more than one Insurance Committee . 38 Return showing allocation of Representatives . . 21-25 Vacancies . . . 43, 44 Deposit Contributors Sub- Committee . ■ .99 See also under Sab-Commitiees o£ Insurance Committees, Deputies — Of Doctors, arrangements for . 170, 174 „ members at Meetings of Insurance Committees . . 536 Diagram — Illustrating Medical Benefit Accounts .... 457 Diligence- Protection of insured persons against 78 Disablement Benefit (De- posit Contributors) — Quahfications for . . . 406 Suspension of, on Marriage . 397 Dispensaries for Treatment of Tuberculosis . 294-297, 348 Dispensary Treatment of Tuberculosis . 282, 294^-297 Approval by Local Government Board .... 282,295 Charges for . ... .296 Conveyance of insured persons in connection with . . 332 Poor Law Authorities, arrange- ments not to be made with . 282 Dispensing— By Chemists . . . .187 „ Doctors . 137, 154, 175, 176 District Insurance Com- • mittees . . . 111-118 Doctors- Accounts of, for Temporary Residents . . . 450-456 Advances to . . . 142 Agreements. See Agreements — ^Insurance Committees and Doctors. Allocation of insured persons to .... 143, 163 iSee also under Allocation. Arrangements by Insurance Committee for attendance of, at confinement, in the case of Deposit Contributors . 419, 420 Choice of, right of insured persons in regard to 163, 236-244 Continuance on Panel, pro- cedure at inquiries as to . 266-276 243 Paragraphs Continuance on Panel, repre- sentations of Insurance Com- mittees in regard to . . 261 See also Inquiry as to Con- tinuance o{ Doctor on Panel' Death of, airangementsy con- sequent on . . . . 241 Death of, transfer of insured | persons from lists of . . 238 Deputies, arrangements for 170, 174 Dispensing by . 137, 154, 175, 176 Lists of insured persons who have chosen . . 169, 236-244 Places and hours of attend- ance of, to be specified in agreement .... 168 Removal from Panel . 126, 174, 238-24D Remuneration of (general) . 180 „ for Domiciliary treatment .... 316 Representation on Insurance Committees . 50-57 iSee also under Doctors — Representation on Insur- ance Committees. Right of Choice of, by insured person . . . 163,236-244 Withdrawal from Panel . 173, 174 Doctors — Representation on Insurance Com- mittees. Disqualification of Represen- tatives 56 Election by association of duly qualifiedmedicalpractitioners 50 Election of Representatives 50-57 Initial appointirlent of Repre- sentatives . . . 50-55 Meeting for election of Repre- sentatives may be convened by Commissioners . . 55 Meeting for election of Repre- sentatives, procedm'e at . 54 Meeting for election of Repre- sentatives, quorum at . . 53 Meeting for election of Repre- sentatives, report of . 54 Meeting for election of Repre- sentatives, summoning of 51, 52 Number of Representatives . 7, 50 Term of Office of „ . 56 Vacancies 57 Doctors' Lists- Preparation and issue of . . 169 Transfers of names of insured persons from . . 236-244 Domiciliary Sixpence Ac- counting . . 436, 457 For remuneration of doctors for treating Domiciliary cases of Tuberculosis. . . .316 Paragraph* Domiciliary Treatment of Tuberculosis- Approval by Local Government Board of manner of treat- ment . . . 282,312,313 Arrangements for . . 299-314 „ with Local Auth- orities . Bedding, provision of By doctors Clothing, provision of Conditions for . Dependants, treatment of 306, 314 304, 310 . 17T . 303 . 299 . 306, 307, 338 Meaning of ... . 298 Medicines, etc., provision of . 302, 305, 307, 324-326 Parish Councils, arrangements not to be made with 282, 299, 314 Payments to patients during 307 Poor Law Authorities, arrange- ments not to be made with 282, 299, 314 Recommendations for, by Insur- ance Committee 322, 323, 327, 328 Rent, extra .... 308 Sanction by Commissioners of arrangements for . . 299, 301 Scheme for . . . .300 Shelters, provision of . 304, 309-311 Drug Accounts- For Temporary Residents . 450-456 Power of Panel Committee to disallow .... 13P Power of Pharmaceutical Com- mittee to disallow . . . 155 Powers and duties of Drug Ac- counts Committee in regard to .... 62,63 Submission to Panel Committee 139 ,, ,, Pharmaceutical Committee .... 155 Drug Accounts Committee 61-69 Authority for . . _ . . 61 Constitution and election of members . . . 64-67 Expenditure, defrayment of . 69 Proceedings of . . . .68 Purposes of . . . 62, 63 Qualifications for membership 64, 66 Quorum of .... 68 Reports by, to Insurance Com- mittees . . .62, 63, 69 Term of Oface of . . 67 Vacancies, . . .67 Drug Fund- Accounting .... 510 Payments from, in error in respect of DomiciUary cases of Tuberculosis .... 199 Payments from, in error in respect of temporary residents 20O Payments from, in respect of treatment of diseases con- current with Tuberculosis . 325 244 Paragraphs Drug Grant, Special Parlia- mentary- Accounting in connection with . 521 Administration of . . . 460 Amount of ... . 460 Available to Insurance Com- mittees 458 Origin and pm'pose of . . 460 Drug Tariff- Consultation by Insurance Com- mittee with Panel Committee in regard to' . . . . 137 Consultation by Insurance Com- mittee with Pharmaceutical Committee in regard to . . 154 Definition of . . . .193 Model Form of . . . .193 To be • sanctioned by Commis- sioners 193 Drugs — Emergency .... 196 Not on Tai'iff . . . .198 Price of' . . . 193-195, 201 Proper and sufficient . 195 "Starred" . . . 194,203 Supply of, aHected by war 195, 201 „ ,, to insm'ed persons, provision for, by Insurance Committees (general) . 161 Supply of, to insured persons, arrangements with chemists for .... 187-192 Supply of, to insured persons, arrangements with doctors for . . . 137, 154, 175, 176 Supply of, under Sanatorium Benefit . 302, 305, 307, 324-326 Duplicate Index Slips . 218, 219 Election of Members of In- surance Committees- Representatives of Approved Societies . 9-12, 14.-25, 27-46 See also Approved Societies — Representation on Insur- ance Committees. Representatives of Chemists . 58 Representatives of Commis- sioners 58 Representatives of County and Town Councils . . 47-49 Representatives of Deposit Gon- tributoi-s . 9-13, 21-26, 37-46 See also Deposit Contributors — Representation on Insur- ance Committees. Representatives of Doctors . 50-57 See also Doctors — Representa- tion on Insurance Com- mittees. Representation of Women . 46 Emergency Drugs and Ap- pliances. . . . 196 Employers' Liability Act— Payment of compensation under, effect on Sickness and Disablement Benefits . 376-382 Paragraphs Epidemics- Provision of Drugs for . 458, 460 Excessive Prescribing— Investigation of, by Panel Com- mittee 140 Representation of Pharmaceu- tical Committee to Panel Committee in regard to . 155 Excessive Sickness- Powers of Insurance Committees in regard to . . .76 Exempt Persons — Index Slips of . 205, 207, 214, 217 Medical Cards, issue to . 223, 235 Sanatorium Benefit, financial aiTangements for . . . 461 Suspension from Benefits, procedure in regard to Index Slips . . . .217 Exempt Persons Fund- Payments to General Sana- torium Benefit Fund . . 461 Extension of Sanatorium Benefit to Dependants 334-348 Arrangements with Local Au- thorities . . . 340-348 Classification of dependants . 339 Domiciliary treatment . . 338 Finance and Accounting of Insurance Committees 434-531 Diagram of ... . 457 Regulations for . . . 434 Finance and General Sub- Committee ... 99 See also under Sub-Committees, Fines — See Penalties. Form Med., 50— Issue of Medical Card on receipt of ... . 218 Gauzes- Supplied under Jledical Benefit . 197 General Administration Fund- Payments into and distribution of 477 General Cash Book — Entries in . 491-500, 502, 309, 510, 515, 519, 522, 524, 527 Insurance Committees to keep . 490 General Medical Benefit Fund- Advances to Insurance Com- mittees .... 443 Distribution to Insurance Com- mittees .... 441-443 Payments into . . . 436-440 General Purposes Fund- Account to be kept in Ledger . 490 Payments into . . . 487 Payments out of . . . 529 245 Paragraphs General Purposes Fund Ac- count — Expenditure chargeable against 529 Income to be credited to . . 487 General Purposes Rate . 344 General Sanatorium Benefit Fund- Constitution of . . . 461-463 Distribution to Insurance Com- mittees .... 464 Health Lectures- Powers and duties of Insurance Committees in regard to . "74 Hearings— By Joint Services Sub-Com- mittee . . . 95-96 By Medical Service Sub-Com- mittee . . .81, 83, 85, 86 ,, Pharmaceutical Service Sub- Committee .... 91 In regard to admission to or continuance on Panel of chemist . . . .277 In regard to continuance of doctor on Panel . . 266-276 Highlands and Islands (Medical Service) Board Purposes of (general) . Introduction Hobhouse Letter . . 345, 347 Hospitals, etc. Payment of Maternity Benefit when mother in . . 416-418 Payment of Sickness Benefit while contributor in . 383-387 Housing — Inadequate, causing- excessive sickness . . _ . _ . 76 Inadequate, in connection with Domiciliary treatment of Tuberculosis .... 308 Incapacity Certificates . 82, 184, 402, 403 Income Limit . . . 137, 141, 155, 158, 251, 252 Index Register- Arrangement of . . . 209 CentraUsation of . . . 219 Preparation and Maintenance of. . . 205-207,208-218 Purposes of ... . 205 Index Slips— Centrahsation of . . . 219 Classes of . . . , . 207 Comparison with Suspense Slips 218 Definition of . ... .207 Despatch of, by Societies to In- surance Committees . 211-215 DupUcates . . . 218,219 Of Deposit Contributors, pro- cedure in regard to 216, 429-433 Of exempt persons, procedure in regard to . . ■ • 217 Of members of Approved Societies, procedure in regard to. . . . . 210-215 Paragraphs Of soldiers, sailors, and marines 2J.0 Of Travellers, procedure in re- gard to 248 Receipt of, by Committees, pro- cedure following . . . 218 Removals, procedure in case of . 215, 217, 228, 430, 431 Inquiry as to Admission to or Continuance on Panel of Chemist . . 277 See also under Inquiry as to Con- tinuance of Doctor on Panel. Inquiry as to Continuance . of Doctor on Panel 266-276 Adjournment of . . . 272 Amendment or withdrawal of representation to hold . , 26§ Appearance at, by proxy . . 270 Committee of Inquiry . . 269 Conditions for holding . . 266 Forms in connection with . 271 May be held at instance of Com- missioners ivithout repre- sentation from Insurance Committee .... 273 May be stopped temporarily by Commissioners .• . . 275 Notices of . 267, 270, 273, 276 Parties who may be present at 270 Regulations governing . . 266 Report of Inquiry Committee 274 Representations to hold . . 266 Rules for procedure at . . 272 Verification of allegations by complainer . . . 266 Inquiry Committee — Into question of admission to or continuance on Panel of chemist 277 Into question of continuance of doctor on Panel . . . 269 Inspectorate— . . . 532 Institutional Treatment of Tuberculosis 282-293, 297 Approval by Local Government Board . . . 282,285-287 Charges for . _ 287, 289, 290, 292 Conveyance of insured persons in connection with . 329-331 Local Authorities, arrange- ments with . . . 292,293 Poor Law Authorities, arrange- ments not to be made with 282, 293 Reconmiendation for . . 322, ■ 323, 327, 328 Institution — Payment of Maternity Benefit when mother in . . 416-418 Payment of Sickness Benefit when contributor in . 383-387 Institutions — Approved for purposes of Medical Benefit . . 185, 186 See also under Approved Institu- tions. 246 Paragraphs Institutions for Treatment of Tuberculosis- Approval by Local Government Board . . . 282,285-287 Available . . . 283, 284, 286 Conveyance of insured persons to or from . . . 329-331 Detention in . . . . 291 Erection of, by Local Authori- ties 348 Institutions Fund- Accounting . . . 490, 511-515 Payments from, to Sanatorium Benefit Fund. . . 514,515 Insurance Books- Despatch to Commissioners in connection with claims for Maternity Benefit . . 423 Despatch to Commissioners in connection with claims for Sickness Benefit . 401, 404, 405 Despatch to Commissioners on death of Deposit Contributor 364 Insurance Commissioners — iSee under Conimissioneis. Insurance Committees — Area* of 3 Association of . . Introduction Bank account of . 491, 531 Bodies corporate ... 2 Business, motions, voting, sign- ing of deeds, etc. Chairman, appointment of Clerks to, names and addresses of . Clerks to, question of holding paid appomtments under Ap- proved Societies . . . Combination of, for establish- ment of Drug Accounts Com- mittee Combination of (general) Constitution of 70 70 533 539 61 59,60 . 4-8 Definition of Disqualification of representa- tives of insured persons on . 41 Employment of Officers . . 70 Expenditure of . . . 489 Finance and Accounting . 434-531 Income of, for administration 476-485 See also under Administra- tion. Income of (general) . . 435 „ for General Purposes 487 „ to defray cost of Medical Benefit . . 435-460 Income of, to defray cost of Sanatorium Benefit . 461-457 Inventory of property of . . 490 Meetings of, absence of members from 42 Meetings of, admission of Press to 539 Meetings of, arrangements for . 70 „ „ attendance of mem- bers in person . . . 535 Paragraphs of, outwitlj area of Committee .... 71 Meetings of, procedure at . .70 „ „ arrangements for . 70 Office accommodation of . . 71 Powers and duties of (general) . 1, 2, 72-78 See Powers and Duties of In- surance Committees. Qualifications for membership 537, 538 Quorum of .... 70 Standing Orders for procedure of 70 Subsistence allowance to mem- bers of. . . 483,484,486 Term of office of . . .40 Travelling expenses of . 481, 482 Vice-Chairman, appointment of 70 Insurance Committees- Election of Members- Representatives of Approved Societies . 9.-12, 14^-25, 27-46 See also under Approved Societies — Representar tion on Insurance Com- mittees Representatives of Chemists . 58 ,, ,, County and Town Councils . . 47-49 Representatives of Deposit Con- tributors . . 9-13, 21-26, 37-46 See also Deposit Contri- butors — ^presentation on Insurance Com- mittees. Representatives of Doctors 50-57 See also Doctors — Representa- tion on Insurance Com- mittees. Representation of Women . 46 Inventory— Of property of Insurance Com- mittees •. . . . 490 Itinerants — In connection with Post Office Medical System . . . 186 Joint Advisory Committee- Purposes of . Introduction Joint Commitee — National Health Insurance Joint Committee, general powers and duties of Introduction Of Insurance Committees . 59, 60 Joint Services Sub-Com- mittee . . . 93-98 Chairman, election of . .94 Constitution of ... 93 Hearings, admission to, proce- cedure, reports, etc. . 95, 96 Powers and duties of . 97, 98 Questions referable to 97, 265 Quorum of .... 96 Report of .... 98 Term of office of . . 96 247 Paragraphs Vice-Chairman, election, powers and duties of ... 94 Journal — Keeping of, by InsurancejCom- mittee 498 Late Entrants- Contributions, rates of . . 352 Sickness Benefit of . . 388-390 Ledger— Accounts in . 490, 491, 498-528 Proving of ... . 499 iints— Supplied" under Medical Benefit 197 Lists of Chemists— See Panel Lists (Chemists). Lists of Doctors— See Panel Lists (Doctors). Local Authorities — Arrangements with, for Domi- ciliary treatment . . . 314 Arrangements with, for Institu- tional treatment . . . 293 Arrangements with, for treat- ment of dependants . 340-348 Definition of . . . 71 Local Government Board- Dispensary treatment, approval of . . . . . 282, 296 Domiciliary treatment, approval of . . . . 282, 312, 313 Excessive sickness, power of, to decide'actioii to betaken^ . 76 Excessive sickness, power* of, to order payment of expenses incurred . . • .76 General powers and duties of, in regard to National Health Insurance . . Introduction Institutional treatment, ap- proval of . . . 282, 285-287 Power of, to appoint diseases to be treated under Sanatorium Benefit . . . • -278 Local Medical Committees— Constitution of . . • 123, 124 Decisions of . . • 128, 178 Powers and duties of . 125-128, 178 Procedure in cases of failure to agree with Insurance Com- rSttee : . . . 128,178 Puij)Oses.of (general) . Introduction, Questions referable to . . 87, . ■ 125-127, 178 Recognition of . . ■ 120, 121 „ conditions for 122,123 „ „ Panel Com- mittees as . . . 122, 136 Statutory provision for . . 119 Term of offtce of . . .1^0 Marines- Index sups of . . • . • 210 Procedure in regard to claims for Maternity Benefit . 428 Paragraphs Sanatorium Benefit of . 320, 475 Sickness Benefit of . . .400 Marriage — Suspension of Benefits on . 397 Marriage Certificates . 421, 423 Married Women Voluntary Contributors — Index Slips of . . . .207 See also Pink Slips. Title to Benefits . . .207 Maternity Benefit (Deposit Contributors) — Amount of . . . 408, 410 Claims for. , . . . 421-428 Conditions modifying payment of 415-420 Definition of . . . .407 Mother's Benefit ... 411 Of Aliens 408 Payable in respect of husband's insurance , . . . . 409 Payment when mother in hos- pital, etc. . . . 416-418 Penalty for breach of rules in regard to .... 410 Provision of Midwife or Doctor 419, 420 Qualifications for payment of . 412 (resi- dential) .... 413, 414 Suspension of . . . 368-370 ,, „ on marriage . 397 Mauve Slips- Purpose of . . . .207 Med. 5Q— See Form, Med. 50. Medical Benefit- Administration of, considera- tion by Insurance Committee of representations of Panel Committee .... 138 Administration of, considera- tion by Insurance Committee of representations of Pharma- ceutical Committee . . 157 Administration of. Income of Insurance Committees for 476, 478-480 Administration of, Powers and Duties of Insurance Commit- tees in regard to (general) 72, 160-163 See also Powers and Dmtie^ oi Insurance Gonunittees. Administration of. Powers and Duties of Panel Committees inregardto . . . 136-138 Admimstration of. Powers and Duties of Pharmaceutical Committees in regard to . 154^-159 Administration of, Kegulations governing . . . 162-163 A(£iiinistration of, Hules for . 83, 245-247 Administration of, to old and disabled members of Societies 163 248 Paragraphs Arrangements by Insurance Committee with doctors and chemists (general) . . 161 Definition of . . . .160 Defrayment of cost of . 436-440 Deposit Contributprs, admini- stration to . . . 366-372 Deposit Contributors over 70 207, 372 During confinement . . . 177 Finance and Accounting in con- nection with . . 435-460, 476, 478-480, 489-521 General Scheme of . . . 163 Income of Insurance Committees for ... . 435-460 Persons over 70, title to . . 207 Standard of treatment to be to the satisfaction of the Com- missioners . . . .179 Suspension of, on marriage . 397 „ „ in case of Deposit Contributors . . . 368-371 Temporary residents, financial arrangements in respect of 445-456 Title of insured persons to, in connection with Income Limit 141, 158, 207 Travellers, financial arrange- ments in respect of . 445-456 Travellers, special arrangements for administration to . 248, 249 Volimtary Contributors, title to 207 Medical Benefit Drug Fund — Payments from, in error, in re- spect of domiciliary cases of tuberculosis . . . . 199 Payments from, in error, in respect of temporary resi- dents 200 Payments from, in respect of treatment of diseases con- current with tuberculosis . 325 Medical Benefit Fund — Accounting . 444, 490, 501, 504 Payments into Panel Service Fund 506 Payments into Institutions Fund . . . . 512 Medical Benefit Fund Ac- count- Payments into . . 444, 501, 504 „ .out of . . , 504 To be kept in Ledger . . 490 Medical Benefit Sub-Com- mittee . . . .99 See also under Sub-Committees. Medical Card- Application for . . . 223 Change of doctor, procedure in regard to ... . 226 Deposit Contributors, procedure in regard to . . . . 430 Form of .... 221,222 Paragraphs Issue of, on receipt of Index Slip (general) . . 218,223 Issue of, to exempt persons . 235 ,, ,, to members of Ap- proved Societies . . _ _ . 211 Issue of, to persons receiving Medical Benefit through the Post Office System . . 235 Issue of, to Own Arrangers . 233, 234, 256 Lost Medical Card . - .227 Presentation of, to doctor. . 224 Procedure in regard to tempo- rary residence . . 229-232 Purposes of . . v 221,222 Kemovals, procedure in regard to. . . 217,228-234,430 Return of, to insured person , 225 Medical Card System— See Medical Card. Medical Certificates . 82, 184, 402, 403 Medical Comforts- Supply of, under Sanatorium Benefit . 302,305,307,324-326 Medical Day Books . 181, 182 Medical Index- Additions to, on receipt of Medical Card signed by doctor 218 Alterations in, on suspension of insured persons from Medical Benefit . . . .214 Alterations in, on change of address of insured persons . 228 Alterations in, on insured persons obtaining travellers' voucher .... 248 Medical Practitioners — See Doctors. Medical Records — General .... 181-183 Own Arrangers . . 255 Travellers . . .249 Medical Record Cards 181, 183 Medical Referees- Appointment of . . 128, 178 Decisions binding on Medical Service Sub-Committee . 87 Powers and Duties of, in regard to decisions .... 178 Medical Research Fund — Payments into . . . 317 Medical Service- Conditions of . 167, 168, 171, 172 Consultation with Panel Com- mittees in regard to terms of . 137 Range of .... 177,178 ,, „ settlement of questions as to . . 87, 127, 128, 178 Standard of treatment to be to the satisfaction of the Com- missioners .... 179 219 Paragraphs Medical Service Sub-Com- mittee . . . 79-88 Appointment of . . 79 Chairman, election of . 80 Constitution of . 79, 80 Hearings, admission to 81, 84 ,, procedui'e at 83, 85 ,, reports on . 80 Jm'isdiction of . . . 82, 87, 259 Meetings of . . . .83 Procedm'e for raising question for hearing .... 83 Questions to be referred to Local Medical Committee 87 Quorum of .... 85 Report of . . . 86, 259, 266 Term of office of ... 85 Vice - Chairman, appointment, powers and duties of 80 Medical Year- Quarters of . . 164 Medicines — See also under Drugs. Dispensing of, by chemists . 187 Dispensing of, by doctors . 137, 154, 175, 176 Proper and sufficient . 195 Supply of, to temporary resi- dents 200 Supply of, under Sanatorium Benefit . 302, 305, 307, 324-326 Meetings of Insurance Com- mittees — Absence of members from 42 Admission of Press to . 540 Arrangements for ... 70 Attendance of members in person 536 Outwith area of Committee 71 Procedure at . . 70 Membership of Insurance Committees — Appointment of reproKentativos of Commissioners . . .58 Appointment of represcmtativi'S of County and Town Coimfils 47-19 Election of reprpscntativi-s of Ap- proved Societies. See also under Approved Societies — Representa- tion on Insurance Com- mittees. Election of representativi>s nf Deposit ConI )'ibutors. See also under Deposit Con- tributors — Representa- tion on Insurance Com- mittees. Election of representatives of Medical Practitioners . 50-57 See also under Doctors — Representation on Insur- ance Committees. General .... 4-8 Representation of Women . 46 Representatives of Chemists . 58 Paragraphs Mercantile Marine- Contributions, rates of . . 352 Sickness Benefit of . . 395,396 Midwife- Arrangements by Insurance Committee for services of, at confinement, in case'of . 419, '420 Migrants- Medical Benefit of Deposit Contributor, financial ar- rangements . . . 445-456 Own Arrangers, title to Medical Benefit . . . .233 Payments from Drug Fund in error on account of . . 200 Procedure in regard to Index ' SHpsof 215 Procedure in regard to Medical Cards of . . . 229-233 Sanatorium Benefit of . 318, 465-474 Special, in connection with Post Office Medical System . 186 Mileage Fund- Accounting . . 444 Mileage Grants for High- land and Lowland Areas- Accounting . . . 444, 521 Amount and distribution of Lowlands Grant . . 458, 459 Distribution of Highlands and Islands Grant ~ 459 Minors- Unmarried, sibkness Benefit of . 391 Minute Book— Of Insurance Committee . . 490 Misconduct of Patient— Penalties for . . . 215, 259 National Health Insurance Fund— Advances to Insurance Com- mittees fi'oni . . 443 National Health Insurance Joint Committee — Geiii'r;il Posits and Duties of Introduction Navy— See Sailors. Navy and Army Insur- ance Fund- Benefits ot Meiribers nf . . 400 Management ot . . Inli'oduction Piivraents from, lor Sanatorium Benefit of membr-is ot . . 320 Purposes ot, general . Introduction Notice — By Approved Society to Insur- ance Committee .Clerk nam- ing representatives elected to be members of Committee . 27 „ chemist to Insurance Com- mittee regarding termination of agreement . , . 204 250 Paragraphs By doctor to Insurance Com- mittee regarding transfer of patient during year „ doctor to insured persons and Insurance Committee of transfer of patients on re- moval of name from panel . „ doctor to Insurance Com- mittee in regard to with- drawal from Panel „ exempt person to Insur- ance Committee, of his duty to make own arrangements . „ Insurance Committee Clerk to Approved Society show- ing number of members of Insurance Committee allo- cated to it . „ Insurance Committee Clerk to Commissioners, naming representatives of insured persons elected to be members of Insurance Committee „ Insurance Committee Clerk to Commissioners, of death of Deposit Contributor „ Insurance Committee Clerk to delegates, of meeting to elect representatives of " B " Societies on Insurance Com- mittee ,, Insurance Committee, of in- tention to fix Income Limit . „ Insurance Committee to chemists, of alteifation in agreements .... „ Insurance Committees to • Commissioners, of alterations in Panel List ,, Insurance Comimittees to Commissioners, of cases of Domiciliary treatment of Tuberculosis ,, Insurance Committees to doctors, of alteration of con- ditions of service . ,, Insurance Committees to insured persons, of death of doctor . ... ,, Insurance Committees to Local Authorities, as to ex- haustion of funds available for Sanatorium Benefit ,, insured person to Insur- ance Committee, of desire to change method of treatment . ,, insured person to Insur- ance Committee, of desire to transfer to list of another doctor . . . 236, 243 ,, insured person to Insurance Committee, of objection to transfer -to list of another doctor .... ,, Local Government Board to Commissioners, of changes in list of Institutions approved for treatment of Tuberculosis. 243 239 173 253 25 37 358 28 251 203 166 287 172 241 322 237 239 286 Paragraphs Failure to give proper, in con- nection with election of repre- sentatives of insured persons on Insurance Committees 45 In connection with inquiry re- garding admission to or con- tinuance on Panel of chemist . 267 270, 271, 273 „ connection with inquiry regarding continuance of doctor on Panel . 267, 270, 271, 273 ,, Press, specifying representa- tives of insured persons elected to be members of In- surance Committee . . 23 ,, regard to representatives of Approved Societies ceas- ing to be members of Insur- ance Committees ... 41 Of Confinement in connection with claim for Maternity Benefit . . . .422 ,, objection of insured persons to transfer to list of another doctor 239 „ question to be raised for hearing of Medical Service Sub-Committee ... 83 „ question to be raised for hearing of Pharmaceutical Service Sub-Committee 91 Summoning meeting for ap- pointment of representatives of medical practitioners on In- surance Committees 51, 52, 55, 57 Summoning meeting for filling vacancy among representa- tives of insured persons on Insurance Committee . . 43 Summoning meeting of doctors to adopt form of constitution of Local Medical Committee . 123 Summoning meetings of Insur- ance Committees . . . . 70 (4) To chemist, of decision of In- surance Committee regard- ing complaint . . . 264 ,, doctor, of decision of In- surance Committee regard- ing complaint . . . 260 Notice as to Supply of Drugs and Appliances- Exhibition of, by chemists 190 Office Buildings of Insur- ance Committees . 71 Operations- Range of, under Medical Benefit 177-178 Range of, under Medical Benefit, settlement of questions as to, 87, 127, 128, 178 Orange Slips- Centralisation of . . . 219 Procedure, in case of Deposit Contributors . . . 216, 431 Procedure, in case of exempt persons . , , . 217 251 Paragraphs Procedure, in case of members of Approved Societies . . 214 Purposes of ... . 213 Outworkers — Contributions, rates of . . 352 Own Arrangements- Accounting and Finance in respect of persons making 516-519 See also Special Arrangements Fund. Allowance to make . . 250, 254 Conditions for making 250-253, 255 Exemptions from require- ments to make . 251, 252 Own Arrangers- Absence from home, right to Medical Benefit 233, 517, 518 Classes of . . . .516 Issue of Medical Cards to . . 233 234, 256 Medical Eecords of . . . 255 Kemoval of . 233, 234, 257, 518 Panel- Admission to or continuance of chemist on, representation of Insurance Committee in re- gard to 264 Admission to or continuance of • chemist on, procedure at in- quiries as to . . . . 277 Continuance of doctor on, re- presentation of Insurance Committee as to . 261 Continuance of doctor on, pro- cedure at inquiries in regard to . . . . 266-276 Removal of doctor from . . 126, 174, 238-240 Withdrawal of chemist from . 204 „ „ doctor from. 173,174 Panel Committees — Advances to doctors, a matter for arrangement with Insur- ance Committee . . . 142 Authority for . . . .129 Complaints, hearing of . . 144 Constitution of . . 131-133 Disqualifications for member- ship of . . . . 133 Drug Accounts, examination of, and power to disallow 139, 140 Election of members of . . 130 Excessive prescribing, hearings, and reports in regard to . 140 Expenditure of, aiTangements for defrayment of . . 145, 146 Income limit, power to dispute right of insured person to Medical Benefit on account of ..... 141 Inquiry into complaint against doctor, rights as to . . 144 Insurance Committees to con- sult 137 Powers and duties of . 136-144 Prescriptions, scrutiny of . 194 Paragraphs Purposes of (general) Introduction Quorum of ... . 134 Recognition as Local Medical Committees . . . 122, 136 Secretary, appointment of . 135 Term of office of members of . 132 Vacancies . , . 132, 133 Panel Lists — Chemists — Preparation, approval, and issue of . . . 188, 189 Removal of Chemist's name from 156 Right of Chemists to have name included in . . . 163, 187 Withdrawal of Chemist's name from 204 Panel Lists— Doctors- Alterations in, to be notified to the Commissioners . 166 Authorised by Regulations . 163 Exhibition of . . .166 Preparation of . . 165, 166 Reference to partnerships may appear in ... . 166 Removal of Doctor's name from 126, 174, 238-240 Right of Doctors to be included in 163, 165 Submission to Pharmaceutical Committee .... 157 Withdrawal of Doctor's name from . . 173,174 Panel Service Fund- Accounting . . 490,506-508 Parish Councils — Arrangements with, for domi- ciliary treatment of tuber- culosis 314 Parliamentary Drug Grant 458, 460, 521 Parliamentary Grant— For defraying cost of Adminis- tration of Medical Benefit 478^80 Parliamentary Grant (of 2/6d. per Insured Person)— Accounting . . . 444, 521 Conditions for Payment of 177, 179, 181, 184 Deductions from, accounting . 521 Deductions from, liability of doctor or chemist to refund to Insurance Committee 262, 264 Payment of, in case of Own Arrangers . . 256 Parliamentary Special Mile- age Grants— See Mileage Grants. Partnerships- Reference to, in Panel Lists . 166 Payments to Chemists- - Accounting . . . 509, 510 Advances to be agreed upon by Pharmaceutical Committee and Insurance Committee . 159 252 509 142 180 316 456 Paragraphs In respect oH temporary resi- dents .... 455 Payments to Doctors- Accounting .... Advances to be agreed upon by- Panel Committee and Insur- ance Committee , . Doctor not to accept fees other '« than^in terms][of Agreement . For doiniciliary treatment ol tuberculosis For temporally residents Penalties— For breach of rulcs;fnr' Adminis- tration of Medical Benefit 245, 259 „ breach of rules in regard to Maternity Benefit . . 410 Pharmaceutical Committees — Authority for . . . 147 Complaints, hearing of . . 156 Constitution of . . . 149 Drug Accounts, examination of, and power to disallow . , Election of, etc. Insurance Committees to con- sult .... Powers and duties of . 154-159 Pui^pose of (general) . Introduction Qualifications for membership of . . . . Quoriun of ... . Kecognition of . . - . Representations of, to Panel Committees in regard to ex- cessive prescribing Secretary, appointment of Term of office of members of . Vacancies . . 150, 151 Pharmaceutical Service Sub- Committee . 89-92 155 148 154 149 152 147 155 153 150 Appointment of Chairman, election of Constitution of Hearings, admission to, proceed- ings, reports on, etc. Powers and duties of Questions referable to Quorum of . . . Report of ... Term of office of members of Vice-Chairman, election, powers and duties of . . . 89 91 90 91 92 263 91 92 91 91 Pharmacy Act, 1868 192, 204 Pink Slips- Procedure in connection with . 214 Purposes of . . 207, 213 Poisons and Pharmacy Act, 1908 . . . 192,204 Poor Law Authority- Dispensary treatment, arrange- ments with, for . . . 282 Domiciliary treatment, arrange- ments with, for . 282, 299, 314, Institutional treatment, arrange- ments with, lor 282, 293, .'i46, 347 Piirat?raphfe- Sanatorium Benefit, general arrangements for . 282, 31(i Poor Law Institutions 293 Poorhouse, etc.— Payment of Maternity Benefit when mother in . . 416-418 Payment of Sickness Benefit while contributor in . 383-387 Post Office- Duties in regard to National Health Insurance Introduction Post Office Medical System 186, 514 Postal Orders — For payment of Benefits of Deposit Contributors . 496 Powers and Duties of In- surance Committees- Accounts . . . 490,531 Administration of Benefits (general) . . Introduction, 72 Agreements with Chemists 191, 203 „ Doctors 137, 165, 167, 168, 171, 172 Business, Motions, Voting, Signing of Deeds, etc. . . 70 Collection of information for guipose of classifying Deposit ontributors ... 73 Consultation with Panel Com- mittees_ . . . 136,137 Consultation with Pharma- ceutical Committees . 154 Contributions to Hospitals . 75 Conveyance of Insured Persons in connection with Sana- torium Benefit . 329-333 Delegation of powers and duties to Sub-Committees 104-109 Drug Accounts Committee, establishment of . 61 Drugs, supply of . 202 Employment of Officers 70 Excessive sickness ... 70 Grouping of Approved Societies for valuation ... 77 Health Lectures, etc. . . 74 Income limit . . . 251, 252 Index Register . . 205-218 Medical Benefit — Administra- tion of . . . 161^164 Medical Service Sub-Com- mittee, appointment of . 79 Office accommodation . . 71 Own Arrangements . 250-258 Panel Lists (Chemists) . 188, 189 „ „ (Doctors) 165, 166, 169 Protection of Insured Persons against diligence ... .78 Removal of Chemist from Panel 204 „ ,, Doctor from Panel 173, 174, 2ag-240 • itcports and Returns . . 73 Sanatorium Benefit, admuii- stration of . 279-282, 322 253 Paragraphs To acquiioiiuiL hold laud . . 2 'J'o sui^ and be sued . . 2 Transfers between Funds . 488 Practitioners— iS'cc Doctors. Practitioners Fund— Accoimling . . . 509 PaynicnLs into, Irom Drug Fund 509 Pregnancy— Payment, ut Sickness Ijciiofll during . . .398 Prescriptions- Scrutiny oX . . . . 195 Specially marked for domiciliary cases .... 324, 326 Specially marked for temporary residents . . 200 Public Health Acts— TuberculosiSjtreatment of , under 343 Quarters of Medical Year . 164 Range of Medical Service 177, 178 Settlement of questions as to 87, 127, 128, 178 Recommendation for Sana- torium Benefit- By Insurance Committees 322, 323, 327, 328 Intimation of, to Doctor . . 327 Period of ... 323 Record Cards- Medical Record Cards . 181, 183 Records — Medical Records (general) . 181-183 ,, ,, own arrangers . 255 ,, „ travellers . 249 Referees- Appointment of 128, 178 Refunds— By Chemist, of expenses in- curred as a result of breach of agreement .... 264 'By Chemist, of Parliamentary Grant withheld as result of breach of agreement . . 264 By Doctor, of expenses incurred as a result of breach of agree- ment .... 171,262 By Doctor, of amount of ParUa- mentary Grant withheld as result of breach of agreement 262 In respect of death of Deposit Contributors . . 357-363 To Deposit Contributors on ceasing to reside in United Kingdom . . . 353-356 Register — Of Instruments, Agreements, etc., entered into by Insur- ance Committees . . . 490 Of medical certificates for pur- pose of protecting insured persons against diligence . 78 Paragraphs Of payments for Benefits of De- posit Contributors . . 490 Of payments for drugs . . 490 Of payments to Approved In- stitutions .... 490 Of payments to Doctor.s . . 490 Of payments to Own Arrangers. 490 Registers— See Index Register, Medical Index, Suspense Register, etc.. Registrar of Friendly Societies . . introduction Reinstatement to Benefits — Of Deposit Contributors . . 216 Of exempt persons . . . 217 Reinstatement List . 216 Removal— Of Chemists from Panel . 156, 204 Of Doctors from Panel 126, 173, 174, 238-240 Removal Oases — Provision of Sanatorium Benefit to — financial arrangements 466-475 Removal Slips — Procedure, in case of members of Approved Societies . . 215 Procedure,Deposit Contributors 217, 430-432 Removals — Abroad . . . 213,353-356 Affecting title of Doctor to dis- pense 175 Alterations in Index Register and Medical Index on account of . 215, 217, 228, 233, 430, 431 Of Deposit Contributors . 351, 353- 356, 430, 431 Of Own Arrangers . 233, 257, 518 Temporary, procedure regard- ing Index Slips . . . 215 Temporary, procedure regard- ing Medical Cards . . 229-233 To be notified to Insurance Committees by Societies if prior to 11th January 1914 . 215 To Ireland . . 215 Remuneration of Doctors — See also Payments to Doctors. For Domiciliary treatment . 316 General . .- . 180 Remunerative Time — Of members of Insurance Com- mittees, compensation for loss of 483, 485, 486 Rent — Extra, in connection with Domiciliary treatment . . 308 Reports and Returns — To be made by Insm'ance Com- mittees .... 73 Research- Medical Research Fund . . 317 254 Paragraphs Reservists (Navy or Army)— See also under Sailors and Soldiers. Procedui'e in regard to claims for Maternity Benefit . . 428 Residence— Outwith area of Insurance Committee, effect on pay- ment of Sickness Benefit 3Y4 Outwith United Kingdom, re- funds to Deposit Contributors on account of . . 353-356 Qualifications for payment of Maternity Benefit . 413, 414 Temporary, in area of other Committee, procedure in re- gard to Medical Benefit 229-234 Right of Insured Person to choose Doctor . . 163 Rules— For administration of benefits of Deposit Contributors . 365 For administration of Medical Benefit . 83,245-247,259,264 Sailors — Index sups of . . .210 Procedure in regard to claims for Maternity Benefit . 428 Sanatorium Benefit, adminis- tration of . . . 320 Sanatorium Benefit, adminis- tration of (financial) arrange- ments . . . 475 Sickness Benefit of . . 399 Sanatoria — Approval by Local Government Board . . . 282, 285-287 Available . . . 283,284,286 Conveyance of insured persons to or from . 329-331 Detention in ... . 291 Erection of, by Local Authorities 348 Sanatorium Benefit- Burial of insured persoriJs dying while in receipt of . . 292, 333 Conveyance of insured persons in connection with . 329, 333 Definition of . . . .278 Delegation to Sub-Committees of powers in regard to . 104-109 Dependants, extension to 306, 307, 334^348 Deposit Contributors over 70, title to. . . . 207,372 Dispensary treatment 282, 294, -297 See also Dispensary Treatment of Tuberculosis. Domiciliary treatment . 177, 282, 298-314 See also Domiciliary treat- ment ot Tuberculosis. Exempt persons, financial ar- rangements . . . 461 Finance and accounting . 461-475, 522-525 Financial arrangements in re- gard to . . . . 315-322 Paragraphs Institutional treatment 282-293, 297 See also Institutional treat- ment o£ Tuberculosis. Local Authorities, arrangements with . . 293,314,340-348 Medicines, etc., provision of 302, 305, 307, 324-326 Migrants .... 318 See also Strays. Navy and Army Fund, pay- ments from, in respect of . 320 Of Deposit Contributors . 366-372 Poor Law Authorities, arrange- ments not to be made with . 282, 293, 299, 314 Powers of Insurance Committees to administer . 72, 104^109, 279 Powers and duties of Sub- Committees in regard to . 104-109 Prescriptions to be specially marked. . . 324-326 Eecommendation for 322, 323, 327, 328 See also Beconamendation for Sanatorium Benefit. Research, funds for . . . 317 Sailors, provision to . . 320, 475 Sickness Benefit, payment of, while in receipt of . 321 Soldiers, provision to . 320-475 Strays, financial arrangements in respect of . . 318, 464-473 Suspension of, on marriage . 397 Travellers, provision to . 319, 474 Sanatorium Benefit Ac- count — Payments from, for Domicili- ary treatment . . . 444 Sanatorium Benefit Fund- Accounting 4S0, 501, 522-525 Payments into, from Institu- tional Fund . . 514, 515 Payments from, to Administra- tion Fund . . 464,488,523 Payments from, to Central Sanatorium Benefit Fund 464 Sanatorium Benefit Regis- ter .... 490 Sanatorium Benefit Sub- Committee ... 99 See also under Sub-Committees. Seamen — Index Slips of . . . .210 Procedure in regard to claims for Maternity Benefit . . 428 Sanatorium Benefit of . 320, 475 Sickness Benefit ot . . . 399 Seamen's National Insur- ance Society . introduction Secretary for Scotland Introduction Section 11— Effect; of, on payment of Sick- ness and Disablement Bene- fits ... , 376-382 255 Section 47 — Rates oJ contributions in respect of contributors insured under 352 Sickness Benefit of contributors insured under . . . 393 Section 53— Rates of contributions in respect of contributors insured under 352 Sickness Benefit of contributors insured under . . . 394 Service by Chemists- Conditions of 187, 191, 192, 203 Service by Doctors- Conditions of . 167, 168, 171, 172 Range of . . . 177, 173 ,, ,, settlement of ques- tions as to . 87, 127, 128, 178 Standard of treatment to be to the satisfaction of the Com- missioners . . . 179 Shelters- Cost of ... . 311 Prorision of, under Domicili- ary treatment 304, 309-311 Sickness Benefit (Deposit Contributors)— AUens . . 392 Claims for ... 401-405 Circumstances by which sus- pended or modified . 375 Late Entrants . 388-390 Mercantile Marine . . 395, 396 - Minors, Vnmarried . . . 391 Payment of, during confine- ment . . . 398 Payment of, where compensa- tion recoverable . . 376-382 Payment of, while outwith area of Committee . . 374 Payment of, while in hospital, etc. . . . 383-387 Payment of, to members of Approved Societies while in Sanatorium . . . 321 Qualifications for payment of . 373 Seamen, Marines, and Soldiers . 399 Suspension of . . 369, 370, 375 ,, „ on marriage . 397 To contributors insured under Section 47 . . .393 „ contributors insured under Section 53 . 394 Waiting period 400 Slips— See under Index Slips, Orange Slips, Suspense Slips, etc. Soldiers — Index Slips of . . . .210 Procedure in regard to claim for Maternity Benefit . . 428 Sanatorium Benefit, admini- stration of . . . . 320 Sanatorium Benefit, admini- stration of (financial) . 475 Sickness Benefit of . . .400 Paragraphs Special Arrangements Fund- Accounting . . 516-519 Special Drug Grant- Accounting in connection with . 521 Administration of . . . 460 Amount of ... . 460 Available to Insurance Com- mittees . . . 458 Origin and purpose of . . 460 Special Married Women Voluntary Contributors- index SUps of . . 207 See also Pink Slips. Title to Benefits . . . 207 Special Mileage Grants— See Mileage Grants. Special Parliamentary Drug Grant . 458,460,521 Special Parliamentary Grant— For defraying cost of administra- tion of Medical Benefit . 478-480 Special Parliamentary Grant (of 2/6d. per in- sured person) Accounting . . . 444-521 Conditions for payment of . 177, 179, 181, 184 Deductions from, accounting . 521 ,, ,, liability of doctor or chemist to refund to Insm'ance Committee . 262, 264 Payment of, in case of Own Arrangers . . . 256 Special Reservists- See also Soldiers. Compensation, title to . . 382 Procedure in regard to claims for Maternity Benefit . . 428 Strays- Provision of Sanatorium Benefit to, financial arrangements . 318, 464-473 Sub-Committees of Insur- ance Committees 99-110 Appointment and Constitution of 100-102 Expenditure, sanction of . . 104 Powers and duties of . 104-110 Proceedings, regulation of 103 Reports of ... . 110 Sub-Committees established by Insurance Committees . 99 Subsistence Allowance — To members of Insurance Com- mittees . . . 483, 484, 486 Sundries- Column of General Cash Book . 495 Suspense Register- Centralisation .of . . 219 Preparation of . . . . 208 Suspense Slips — Centralisation of . . . 219 256 Paragraphs Comparison with Index Slips . 218 Deposit Contributors . . 433 Suspension from Benefits- Alterations in Index Register, etc., on account of . 213, 214, 216, 431 Conditions for .~ See under Medical Benefit, etc. Systems- Approved lor purposes of Medi- cal Benefit . . . 185, 18fi Temporary Eesidents— Definition of . . . 445 Medical Benefit of, financial arrangements . . 445-456 Own Arrangers, title to Medical Benefit 233 Payments from Drug Fund in error, on account of . . 200 Procedure in regard to Index Slips of. . . ..215 Procedure in regard to Medical Cards of . . . 229-233 Sanatorium Benefit of . . 31S Temporary Residents Fund- Accounting . . 453, 490, 520, 521 Terms of Service of Chemists 187, 191, 192, 203 Terms of Service of Doctors 167, 168, 171, 172 Territorials— See also Soldiers. Compensation, title to . . 382 Procedure in regard to claims for Maternity Benefit . 428 Town Councils- Arrangements with, for Sana- torium Benefit to depend- ants . . . 340, 342, 343 RepresentatiTes, of on Insurance Committees .... 47-49 Transfers— Between Societies, adjustments regarding cost of, Medical Benefit 440 Between Societies, notification of, on Index Slips . 212, 21'l BotwcHM various Funds . . IHS From Dorlnrs' Li.sis . 236-244, 259 Of Deposit Cdiitrihntors tn Ap- provi'd hSoi.-i*'ii(*s and vu:e versa, adjustments regardintj cost of Medical Benefit 4-1(1 Of JDeposit Contributors tn Ap- proved Societies, changes in Index Register, rti., on account of 2.16,432 Travellers— .Medical Henefil of, accounting . 445- 456 Mrdical Benefit of . 318,249 Medical Rei'ords n! . . . 249 Prescriptions of, to be specially mark(«l. . . '219 Sanatorium Benefit of . 319 ,, „ „(riiian'c). 474 Paragraphs Supply of drugs to . . . 249 " Vouchers . . . .249 Travelling Expenses— Of members of Insurance Com- mittees . . . 481,482 Treasury- Powers and duties of, in regard to National Health Insurance Introductiiin Tuberculosis Dispensaries 294-297, 348 Tuberculosis, Treatment of— Agreements between Insurance Committees and Local Au- thorities .... 292, 293 Approval of Institutions by Local Government Board . 282, 285, 286, 287 Arrangem»nts for, by In-iurance Committees . . . 279-280 Delegation to Sub-Comiiittees of powers in legard tu . 104-109 Dispensary . . . 282, 294r-297 See also Dispensary treat- ment of Tuberculosis. Domiciliary . . . 282, 298-314 See also Domiciliaiy treatment o{ Tuberculosis. Institutional . . 282-293, 297 See^aho Institutional treat- ment of Tuberculosis. Local Authorities, arrange- ments with . 293, 314, 340-348 Non-pulmonary . . . 281, 284 Payments from Drug Fund in error on account of . . 199 Persons outwith area of Insur- ance Committee . . . 297 Pulmonary . . . 281, 283 Unmarried Minors — Sickness Benefit of . . . 391 Valuation of Approved Societies— Powers and duties of Ins\u'- ance Committees in regard tn 77 Voluntary Contributors — Contributions, rates of . 352 Medical Benefit, title to 207 Waiting Period— For payment of SicUne.'!s Benefit 399- 400 Water Supply — Contaminal.erl, causing exces- sive sickness ... 76 Withdrawal of Doctor from Panel . . . 173,174 Wool- Cotton, Wood, Supply ot, under Medical Benefit . . .197 Workmen's Compensation Act- Payment ot compensation unil(>r, elTc«t on Sickness and Dis- ablementBenefits . 376-238 Cornell University Library HD7102.G72A51915 3 1924 002 405 466