Leading Articles in the Reviews. 



49 



CONTRACT PRACTICE OR FEES? 



Which Pays the Doctor Bkst ? 



To those who have the ready answer, " Fees, of 

 roorse ! " a paper in the Nineteenth Century for July 

 by Mr. B. Hall, M.B., will come as an eye-opener. He 

 determined to investigate his own affairs, as a country 

 practitioner. He found that half his income was derived 

 from contract work, and half from private practice, 

 .md he was surprised to find that the number of his 

 contract clients was less than the number of his 

 patients. " One-third (contract) of my total clients 

 return as much income as the other two-thirds who are 

 private clients." If all his practice were private he 

 would be earning less income by one-fourth than he is 

 now doins;. Manifestly the best thing he could do for 

 himself would be to succeed in persuading all his 

 clients to ensure for medical attendance. 



CLUB WORK .NOT CHARITY. 



The average premium he received from all his club 

 members would work out at five shillings : — 



This discovery, if it is found to have universal application, 

 must have a far-reaching effect — it completely upsets deep- 

 roote<i ideas by which we have all been profoundly influenced. 

 I.et us see what it means to us, now that we know the insurance 

 inethcd is more remunerative to us than the method of payment 

 for work done. Hilherto we have all imagined that our club 

 work was a form of charity to the working-classes, inasmuch as 

 we were under the conviction that we were not being paid 

 idequalcly for what we were giving. My insured are nearly all 

 workers, and the noninsure<l arc workers and masters. The 

 first group pays the same amount in aggregate as the second, 

 ihough the latter is the larger. Surely it follows that the insured 

 are at least paying me adequately as compared with the non- 

 insured. 



THE ADVANTAGE TO THE DOCTOR. 



At the ()rescnt moment not i per cent, of the whole 

 of his clientele is on his visiting list. Having established 

 this discovery, the writer goes on to consider the 

 advantages of the system of payment per capita to 

 the doctor : — 



They are : increase of income in spite of a declining sickness 

 rate ; income comes in like a salary punctually at the quarter : 

 no office work is rcquire<l (most of us would thank heaven for 

 that favour). I don't know what is the money value of this 

 office work, but I believe accountants are recjuired to do the 

 copious bookwork of large pr-icliccs. No worry with debt 

 collecting; a desire (that no cynic will sneer at) to cure the 

 case as soon as possible ; sprightliness in preventing sickness 

 and in cullivaling fwlter habits of life in the insured indlviilual ; 

 cordial co-operation with health authorities in improving the 

 public healili ; the position of the doctor in public regard will 

 l>c greatly enhanced, since the same object is being pursued by 

 every meuilicr of the community— the interests of doctors and 

 people arc then identical. 



"^IX SIIILI.INHS A WI-;EK llENEROLS PAY. 



The writer then turns to the National Insuranrc Ari. 

 M present exact figures have not been furnished on 

 which to liase the estimate. The Council ol the British 



Medical Association insists on 8s. 6d. a week : — 

 " Investigation of the books of my practice shows that 

 an average premium of 5s. gives me better returns 

 than private practice over a group of the same number 

 of fees of which 2S. 6d. is the lowest." The writer esti- 

 mated his patients ; yet not the actual patients, but the 

 clienlNe, the possible patients, should be considered : — 



I am justified from the facts of my own practice in believing 

 that in the majority of practices — nolwithst.inding excessive 

 sickness rates and the most extreme grades of fussiness — the 

 result of this investigation will show an average figure well 

 below the 6s. offered us under the Act. 



I venture to say that the publication of this plan of mine last 

 October would have solved then what is still in dispute, namely, 

 the question what premium fairly represents the 2s. 6d. per 

 visit. My books say emphatically that 5s. is ample cover. 

 The .^ct offers 6s., but the Association threatens to call a 

 general strike of doctors rather than consent to accept less than 

 Ss. 6d. The average club premium throughout the country is 

 said to be 43. With many clubs 6s. has been the customary 

 premium, and wherever this holds the work and pay have been 

 satisfactory to both doctors and club members. 



Now that Jlr. Lloyd George has insisted that an 

 accountant shall examine the books of doctors in town 

 and country in order to ascertain the equivalence of 

 fee in half-crown practice to premium offered and 

 demanded, definite results may be expected. 



THE SCHOOLS PROBLEM IN 

 HOLLAND. 



In the Contemporary Revieia for July ^If- T- W. 

 Robertson .Scott, in discussing the projects of Tariff 

 Reformers in Holland, gives the following description 

 of the real question at issue between the two parties. 

 It may be interesting to persons in this country who 

 imagine that the religious difficulty will be eliminated 

 from the education problem by the complete seculari- 

 sation of the schools. ."Vs is shown below, the Dutch 

 secularised the schools, and have had in consequence 

 a religious dilTicully which has more seriously affected 

 their internal politics than an\thing of the kind we 

 have known in this country : — 



The real difl'crence between the Right and the Left is a 

 religious difference. It came about through that religion in the 

 schools controversy which seems to have plague<l every civilise<l 

 nation. Church and State has been completely separated in 

 Holland. To a country which had suffered so much in past 

 ages from warring creeds, a policy of thorough seemed the only 

 right one. And for a lime the land had peace. .Soon, however, 

 the organis.ation of public instruction on the basis of an efficient 

 social teaching, inoffensive to all beliefs, became the object of 

 denominational animosity. Orthodox and Koman Catholics 

 eventually procecde<l to set up their own schools. But .as they 

 had to keep them going ihc number was limited. .\ demand 

 for Stale endowment of denominational schools inevitably 

 followed, and for many years Dutch poliilcs was a fight over 

 " goillcss" schools and the other kind. .\l Urigih the Orlhoilox 

 and Roman Catholics, bandcil together for denominaiional 

 'schools, prevaile<l at the polls, and subsidies for non-State 

 schools were obtained. The political alliance between the 

 Orthodox and their religious ailvcrsaries had been so serviceable 

 thai there was a natural reluctance to abandon it, or at any rate 

 entirely lo abandon it. 



