Public health and insurance: American addressesNewsholme, Arthur, Sir
History
Public health and insurance: American addresses
Newsholme, Arthur, Sir
Health insurance -- Great Britain; Public health; Public health -- Great Britain
_A_. Domiciliary treatment.
_B_. Institutional treatment.
(_a_) Non-residential—Dispensaries.
(_b_) Residential—Sanatoria,
Hospitals,
Convalescent Homes and
“Farm Colonies.”
Soon after the passing of the National Insurance Act in 1911
representations were made that tuberculosis affected non-insured as
well as insured; that treatment of insured could have only partial
success so long as non-insured members of the same household were
neglected; and that this was work for public health authorities which
they were already partially undertaking. It was evident that the
inextricably interlaced measures for the prevention and the treatment
of tuberculosis must accrue to the whole population; and the mistake
of the National Insurance Act was remedied to the extent that
Public Health Authorities were informed that the National Treasury
was prepared to pay one-half of the approved expenditure incurred
by these authorities in establishing schemes for the treatment of
tuberculosis available for the entire population. Such schemes
were proceeded with, as already indicated; but there remained the
fact that insured persons who had paid their weekly quota and were
therefore entitled to “Sanatorium Benefit” usually interpreted this
as a right to three months’ treatment in a Sanatorium. The choice of
persons to receive treatment in a Sanatorium lay with Local Insurance
Committees appointed under the National Insurance Act, who generally
acted on the advice of the tuberculosis officer; but influences
other than medical led to the unsatisfactory use of institutional
treatment. A large number of patients were sent to and retained
in sanatoria for prolonged periods, who might have been adequately
treated at home, or who should have been in hospitals. Satisfactory
results for sanatorium treatment were not secured under these
conditions; and there will probably be no material improvement until
the Sanatorium Benefit is withdrawn as a special benefit under the
National Insurance Act, and the treatment of tuberculosis becomes an
obligatory duty of Public Health Authorities, with a minimum standard
of provision to which all must attain.
_Residential Institutions_
The extent to which these have been provided in England since 1911
has already been stated. The number of beds available in 1917 was
12,441, in addition to some 9,000 beds in poor-law institutions,
which in 1911 were occupied by consumptives. From the point of
view of the provision required in residential institutions for the
treatment of tuberculosis the following classification is useful. It
is confined to pulmonary cases:
Group _A_—Cases in which permanent improvement or recovery can
usually be anticipated.
Group _B_—Cases in which only temporary, though possibly prolonged,
improvement may be anticipated.
This group will include
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