Omaha daily bee., 1920-01-18
An English Experiment in Social
Medicine

NItIlCJlR.
''In England" says the Journal Of
! the American Medical Association,
"the medical profession and the pub.
lie are apparently in g. state of read
tustment. Social insurance in the
| four years preceding the war, the
needs and emergencies Of war times
and the discussion of the last year
eliminating in the creation of a ma.
tional health ministry, all have COM
bined to arouse and concentrate in
terest and discussion on the improve
ment of medical service. An expert
| ment now being carried on in Glas-
| gov is, therefore, of special interest
DR.. David Mckail, lecturer on public
health at st. Mungos college, and
Mr.. William Jones, clerk and treas
urer of the Glasgow insurance COM
mittee, have worked out a plan for
public medical service as a substi-
tute for the social insurance scheme
now In operation. Beginning with a
criticism of social insurance, which
they condemn for failure to provide
any form of institutional treatment
and for furnishing medical services
to only about one-third Of the total
population, they propose to build up
a complete medical service, furnish
ing unrestricted treatment to every
citizen needing 1t, and involving the
enrolment of the medical profession
and the public control Of all general
hospitals and infirmaries.
''The proposed plan is founded on
the experience gained In efforts to
meet war conditions, when for a
time dispensaries were established
in Glasgow for centralizing the pa
of nhe S~l,x ,f,f1 ia
was divided into districts, and con-
The Bridgetown district, with ap-
proximately 100000 inhabitants, is
taken as a convenient unit for study.
The volume Of sickness as shown by
the number of dispensary visits is
found to be 3.11 per person per year,
varying from maximum OF 7.5
visits for the first year of life to a
minimum of 1872 for ages from 15
to %. House visits are found to
amount to one-fourth Of dispensary
visits. This amount of professional
work would require 27 physicians,
working 33 hours a week. A rs per
cent addition for seasonal increases
would necessitate a staff of 39 ply
sicians, each Of whom would have
an annual vacation in the summer
or fall. Births would average nine
or 10 a day, requiring four obstetri-
clans. Minor surgery and various
specialties would require six, making
a total staff of 43 medical men, ex-
elusive of institutional and consult
ant service. These men are to be
graded in three classes, according to
age, experience, etc. Each Junior
would be allowed time and be re-
quired to do graduate medical work
and special study with a view 70 his
advancement in the service. Sala-
ries would range from $1,500 to
s2,500 for juniors, $4,000 to $3,500
for middle grades, and $4,000 to
made for dentists and for dental
treatment. 1t is estimated that the
expenses Of such a medical service
could be betrayed by a tax of Is
10d in the pound, imposed in the
same manner as the public health
assessment, and that the entire ex-
penses of operation could be supplied
at an individual cost below the Z
shillings capitation basis on which
social insurance Is now being con-
Quoted.
IAN interesting side light is
thrown out on the provision for free
choice Of physicians, under the So
cial insurance plan now in opera
ton. A careful study of the district
shows that since the introduction Of
social insurance and the panel sys
tenn in Glasgow, those affected have
not made an effort to exercise any
choice in the selection of physicians.
but have gone to the nearest and
most conveniently located physician.
The advantages for the physician Of
the proposed medical service are the
limitation of working hours, the
guaranteed adequate income, the
avoidance of waste of time and en-
ergy, the opportunity for increased
income, the accumulation of expert
ence, and the opportunity for grad
uate and special work for every
practicing physician. The advanta-
ges claimed for the individual are
better treatment at much less eX
pense and for the community, econ
omy of administration, and the pre-
vention of large amount of disease
The London Lancet in commenting
on the proposed plan, impresses the
hope that the authors may have an
opportunity Of testing it, as success
or failure would alike afford much
needed experience"