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National Insurance - Royal Commission - First Progress Report - Casual Sickness, Permanent Invalidity, Maternity, Old-age


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1269-

1925.

THE PARLIAMENT OF THE COMM"ONvYEALTH OF AUSTRALIA.

FIRST PROCi-RESS REPC)R1_,

OF THE

AL COMMISSION

ON

NATIONAL INSURANCE.

SIOICNESS, PEltMANENT INVALIDITY-,

· MATERNITY, 011)-AGE.

Presented by Command; ordered to be printed, lOth June, 1925.

[Cost of Pape1·.-Preparation, not given; 1,345 copies; approximate cost of printing and publishing, £68.]

Printed Published for the GOVERNMENT of the of. AUSTRALIA by H. J. GREEN, Government

Printer for the State of Vwtona.

No. 12.-F.l5347.-PRicE ls. 9n.

ROYAL COMMISSIONS

ScOPE OF THE INQUIRY

NEED FOR NATIONAL INSURANCE IN AUSTRALIA Recommendation

(A) NATIONAL INsuRANCE FuND­

I. Sickness Benefit-(a) Australian morbidity e:iperience (i) Friendly Societies (ii) Trade Union Benefit Funds

(iii) Government Departments (iv) Other Organizations (v) Sickness according to age (vi) Sickness according to sex (vii) Sickness according to disease (viii) Sickness according to occupation (b) Sickness benefits available (c) Adequacy of existing sickness benefits (d) Malingering for benefits (e) Recommendation 2. Accident Benefit-

(a) Australian accident experience (b) Accidents according to occupation (c) Accident benefits available (d) Recommendation 3, Invalidity Benefit-

(a) Invalidity benefits available (i) Friendly Societies •.

(ii) Commonwealth Invalid Pensions (b) Recommendation 4, Maternity Benefit-(a) Maternity benefits available

(b) Recommendation 5. Superannuation Benefit-(a) Superannuation benefits available (i) Mutual Benefit Associations, &c.

(ii) Commonwealth Old-age Pensions (b) Recommendation 6. Funeral Benefit-(a) Australian mortality experience

(b) Funeral benefits available (i) Mutual Benefit Associations (ii) Industrial Assurance (c) Recommendation 7. Child Allowance-

Recommendation ..

(B) NATIONAL HEALTH ScHEME­

Recommendation l. Medical Benefif.s....:-(a) Medical attendance (b) Supply of medicine

(c) Other medical benefits 2. Institutional Treatment­ (a) Hospitals (b) Sanatoria

(c) Laboratories (d) District Nurses (e) Ambulance Transport Services 3. Preventive Health Services--

(a) Public Health Organizations (b) Maternal Hygiene ..

(c) Child Welfare ..

(d) Industrial Hygiene (e) Medical Research Work

SUMMARY OF RECOMMENDA'r!ONS

CoNSPECTUS OF THE LEGISLATION ENACTED IN VARIOUS CoUNTRIES­ }, Sickness, Maternity and Funeral Benefits 2. Old-age, Invalidity and Survivors' Benefits

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OOMMONvV:EALTH OE AUSTHil_LlA.

GEORGE 'rHE .I!'U"l'H, by the Grace of God, of the United Kingdom of Great Britain and Ireland and of the British Dominions beyond the Seas King, Defender of the ]'aith, Emperor of India :-TO our trusty and well-beloved SENATOR JoHN DuNLOP MILLEN, SENATOR JAMES FRANCIS GuTHRIE, SENATOR ALLAN McDouGALL, JosiAH .I!'RANCIS, Esquire, M.P., ALBERT ERNEST GREEN, Esquire, M.P., JAMES

AITCHISON JOHNSTON HUNTER, Esquire, M.P., WILLIAM GEORGE MAHONY, Esquire, M.P.

GREETING:

KNOW YE that jWe do, by these Our Letters Patent, issued in Our name by Our Deputy of Our Governor-General of Our Commonwealth of Australia, acting with the ad vice of Our Federal Executive Council, and in pursuance of the Constitution of Our said Commonwealth, the Royal Commissions Act 1902-1912, and all other powers him thereunto enabling, appoint you to be Commissioners to inquire into and report upon :-

(a) National Insurance as a means of making provision for casual sickness, permanent invalidity, old age, and unemployment; and (b) The operation of the maternity allowance system, with a view to the incorporation with national insurance of a scheme for securing effective pre-natal and other assistance to mothers.

AND WE appoint you, the said SENATOR J:,HN DuNLOP MILLEN, to be the Chairman of the said Commissioners.

AND WE direct that, for the purpose of taking evidence, four Commissioners shall be sufficient to constitute a quorum, and may proceed with the inquiry under these Our Letters Patent.

AND WE require you with as little delay as possible to report to Our Governor-General of Our said Commonwealth the resul of your inquiries into the matters intrusted to you by these Our Letters Patent.

IN TESTIMONY WHEREOF we have caused these Our Letters to be made Patent, and the Seal of Our said Commonwealth to be thereunto affixed.

(SEAL OF THE COMMONWEALTH,)

WITNESS Our Trusty and Well-beloved SIR WILLIAM HILL IRVINE, Knight Commander of the Most Distinguished . Order of Saint Michael and Saint George, Our Deputy of the Governor-General in and over Our Commonwealth of Australia, this seventh day of September, in the year of Our Lord, One thousand nine hundred and twenty-three, and in the fourteenth year of Our Reign.

(Sgd.) W. H. IRVINE,

Deputy of the Governor-General.

By His Excellency's Command,

(Sgd.) LI •• ATKINSON, for Acting Prime Minister.

Entered on Record by me in Register of Patents, No. 25, page 234, this eighth day of September, One thousand nine hundred and twenty-three. (Sgd.) W. N. ROWSE.

Commonwealth Gazette, No. 69, 4th October, 1923.

The Governor-General in Council has accepted the resignation of SENATOR FRANCIS GuTHRIE as a member of the Royal Commission appointed to inquire into National Insurance, &c_ LL. ATKINSON, for Acting Prime Minister.

The Governor-General in Council has been pleased to appoint SENATOR BENJAMIN BENNY a Commissioner to inquire into National Insurance, &c., vice SENATOR J. F. GuTHRIE, resigned. (Sgd.) LL. ATKINSON, for Acting Prime Minister.

Commonwealth Gazette, No. 49, 17th July, 1924.

The Governor-General in Council has accepted the resignation of JAMES AITCHISON JoHNSTON HuNTER, Esquire, M.P., as a member of the Royal Commission appointed to inquire into National Insurance, &c. (Sgd.) S. M. BRUCE, Prime Minister.

• The Governor-General in Council has been pleased to appoint ftoLAND FREDERICK HERBERT GRBBM M.P., a Commissioner to inquire into National Insurance, &c., vice J. A .. J. HuNTER, Esquire, M.P., resigned.

(Sgd.) S. M. BRUCE, Prime Minister

GREETING:

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OOMMONWEA.LTH OF AUSTRALIA.

GEORGE THE FIFTH, by the Grace of God, of the United Kingdom. of Great Britain and Ireland and of the British Dom,inions beyond the Soo.s King, Defender of the Faith, Emperor of India :-TO Our Trusty and Well-beloved SENATOR BENJAMIN BENNY, SENATOR JoHN DUNLOP MILLEN, SENATOR ALLAN McDouGALL, JosiAH FRANCIS, Esquire, M.P., ALBERT ERNEST GREEN, Esquire, M.P., RoLAND

FREDERICK HERBERT GREEN, Esquire, M.P., WILLIAM GEORGE MAHONY, Esquire, M.P.

WHEREAS by Letters Patent (hereinafter referred to as " the said Letters Patent ") issued in Our name by Our Deputy of Our Governor-General of Our Commonwealth of Australia, on the seventh day of September, in the year of Our Lord, One thousand nine hundred and twenty-three, and by Our Governor-General of Our Commonwealth of Australia on the twenty-sixth day of September, in the year of Our Lord, One thousand nine hundred and twenty-three, and on the sixth day of October, in the year of Our Lord, One thousand nine hundred and twenty-three, and on the third day of July, in the year of Our Lord, One thousand nine hundred and twenty-four, We did, with the advice of Our Federal Executive Council, and in pursuance of the Constitution of Our said Commonwealth, the Royal Commissions Act 1902-1912, and all other powers Us tl..tereunto enabling, appoint you to be Comm.issioners to inquire into and report upon:-

{a) National Insurance as a m,eans of m,aking provision for casual sickness, permanent invalidity, ol4Ji.ge, and unem,ploym.ent; and (b) The operation of the maternity allowance system., with a view to the incorporation with national insurance of a scheme for securing effective pre-natal and other assistance to mothers :

AND WHEREAS it is desirable that, in addition to the matters specified in the said Letters Patent, you should inquire into and report upon the question of amending the Invalid and Old-age Pensions Act 1908-1923 so as to provide for the payment of destitute allowances.

NOW THEREFORE We do, by these Our Letters Patent, issued in Our nam,e by Our said Governor-General, acting with the advice of the Federal Executive Council, and in pursuance of the Constitution of Our said Commonwealth, the Royal Commissions Act 1902·-1912, aml all other powers Us thereunto enabling, require you to inquire into and report upon the question ofam.ending the Invalid and Old-age Pensions Act 1908-1923, so as to provide for the payment of destitute allowances in addition to the matters specified in the said Letters Patent. ·

AND We do declare that these Letters Patent shall be deem,ed to be and to have been of the same force and effect as if the matter specified in these Letters Patent had been included am,ong the matters specified in the said Letters Patent.

IN TESTIMONY WHEREOF We have caused these Our Letters to be made Patent, and the Seal of Our said Commonwealth to be thereunto affixed.

(SEAL OF THE COMMONWJMLTH.)

WITNESS Our Right Trusty and Well-beloved HENRY WILLIAM, BARON FoRSTER, a Member of Our Most Honorable Privy Council, Knight Grand Cross of Our Most Distinguished Order of Saint Michael and Saint George, Our Governor-General and Commander-in-Chief in and over Our Commonwealth of Australia, this eighth day of August, in the year of Our Lord, One thousand nine hundred and twenty-four, and in the fifteenth year of Our reign.

(Sgd.) FORSTER,

Govamor-General

By His Excellency's Command,

(Sgd.) LL. ATKINSON,

for ·Prime Miuister.

Entered on Record by me in Register of Patents, No. 25, page 277, this sixteenth day of August, One t.housa.nA(nine hundred and twenty-four. . (Sgd.) J. ULMER,.

Oommm&wealth Gazute, No. 2, 15th Janua.ry, 1925.

The Governor-General in Couneil has been pleased to appoint JoliN Gl\AN'l' a to inqUire into N&tional

Insurance, &c., f!ice SENATOR A. McDouGALL, deceased.

(Sgd.) LL. ATKINSON, for Prime Minister.

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FIB,S1., PROGRESS REPORT.

To His Excellency the Right Honorable HENRY WILLIAM, BARON FoRSTER, a Member of His Maiesty's Most Honorable Primj Om,tncil, Knight Grand Cross of the Most Distingl-tished Order of Saint Michael and Saint George, Governor-General and Oommander-ir.-Chief in and over the Common'wealth of AustraUa.

MAY IT PLEASE YouR ExcELLENCY.

In accordance with the Commission issued by Letters Patent dated the 7th September, 1923, the 26th September, 1923l the 3rd July, 1924, the 8th August, 1924) and the 14th January, 1925, empowering us to inquire into and report upon-( a) National Insurance as a means of making provision for casual sickness, permanent

invalidity, old age and unemployment; and (b) the operation of the maternity allowance system, with a view to the incorporation with National Insurance of a scheme for securing effective pre-natal and other , assistance to mothers ; and

(c) the question of amending the Invalid and Old-age Pens,ions Act 1908-1923 so as provide for the payment of destitute allowances,

we have the honour to submit the following First Progress Report of our proceedings and of the conclusions at which we have arrived to the present date. 1. Scope of the Inquiry.-The duties entrusted to us by Your Excellency necessitated the investigation of several questions which are not only most complex and varied, but which also

involve an exceptionally wide range of social problems of the greatest magnitude and national importance. Your Commissioners, therefore, considered it to be essential at the initial stage that the several questions should be grouped in such manner as would enable each phase of the inquiry to receive that adequate, detailed, and individual attention which its importance

merited. In order that the most effective and suitable arrangements might be accordingly made, your Commissioners, before commencing the taking of evidence, undertook considerable research and analysis in connexion with the published reports of the operations of the numerous organizations which are at present functioning in Australia in connexion with the various phases

of the inquiry, and also with respect to the reports on National Insurance schemes which have been instituted in other countries. At the same time the several questions involved were discussed with prominent· Commonwealth, State, and other officials of the various organizations which are, at the present time, i!lterested in the administration of certain functions relating thereto. As the result of this initial work, it was decided to divide the inquiry into the following three sections, and to take evidence consecutively in the order in which they are

placed, viz. ::-(a) Sickness, Invalidity, Maternity; (b) Old-age ; (c) Unemployment.

Arrangements were made in such manner that evidence was taken with respect to one section only at a time, yet the necessary research work relating to the other sections was undertaken concurrently so that all phases of the inquiry were constantly kept in view. Evidence relating to the first two sections has now been taken in all the States, and arrangements are in

hand for completing the taking of evidence relative to unemployment, and also concerning the question of the payment, of dest.itute aHowances which was referred to this Commisc:;ion on the 8th Augu.c:;t, 1924. Many organizations, which have been established in Australia, include in tJ1eir objects the

provision of certain benefits and relief to the wage-earner and his dependants during periods in which he is incapacitated from earning his usual livelihood, and it was ascertained, as will be fully indicated in subsequent pages of this Report, that the following organizations are at the present time functioning in some manner in connexion with certain questions upon which we

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have been instructed to report, viz. :-Friendly Societies, Friendly Societies' Dispensaries and Medical Institutes, Trade Union Benefit Funds, Establishment Benefit Schemes, Industrial Assurance and .State Insurance Offices, HospitoJs, Sanatoria, Charitable Institutions and Societies, Commonwealth and State Health Departments, Commonwealth Old-age and Invalid Pensions and Maternity Allowance Scheme, Government I. .. aboratories, Welfare Schemes, Clinics, Bush Nursing and District Nursing Associations, Ambulance Sen-ices, and the Medical Branch of the Commonwealth Repatriation Department.

Your Commissioners have made every effort to definitely ascertain the necessity, desirability, and practicability of effective provision for the circumstances resulting from sickness, invalidity, maternity, and old age being incorporated in a scheme of National Insurance in Australia, and it has been the aim of your Commissioners to obtain and detailed statements with respect to the functions, objects, operations, administration, and experience of the above­ mentioned organizations so far as the questions under consideration by your Commission are concerned. One hundred and fifty-three, .witnesses were examined in the several States of the Commonwealth and, in addition, the principal organizations interested in the inquiry in each State were asked to appoint a representative to act in an honorary capacity as an independent adviser to the Commission in respect of the organization represented. In the majority of instances such advisory representatives were appointed, and their valuable experience and cordial co-operation have been of the greatest assistance. In New South Wales 33 witnesses were examined; Victoria, 40; Queensland, 21 ; South Australia, 14; Western Australia, 26; and Tasmania, 19. The number of such witnesses who gave evidence in connexion with the various organizations concerned was as follows :-Friendly Societies, 42; Friendly Societies' Dispensaries and Medical Institutes, 12; Government Statisticians, Registrars, and Actuaries of Friendly Societies, 10; Trade Union Benefit Funds, 12 ; Establishment Benefit Funds, 8 ; Pharmaceutical Associations, 17; Government Health Departments andHospitalAdministrations, 14; British Medical Association, 12; State Insurance and Industrial Assurance Offices, 7; Medical Branch, Commonwealth Repatriation Department, 9; Dentists' Associations, 3; and

various Public Health, Nursing, and Ambulance organizations, 7. Of the above-mentioned witnesses, 34 were medical practitioners and 9 were actuaries. In addition, Dr. W. -Mayo and Dr. R. H. Harte, the eminent American surgeons who were visiting Australia, kindly consented to give their valuable opinions on the general questions of Health Insurance.

2. Needfor National Insurance in Australia.-The estimated number of wage and salary earners in Australia, males between the ages of 16 and 65 years, and females between the agett of 16 and 60 yea.rs, as the 30th June, 1924, was as follows:-.

Age Groups. Males. Females. Total.''

•

16-19 . . .. 172,000 100,000 272,000

20-24 . . .. 192,000 102,000 294,000

25-29 . . .. 179,000 58,000 237,000

30-34 . . .. 172,000 35,000 207,000

35-39 . . .. 142,000 24,000 166,000

40-44 .. . . ]17,000 18,000 135,000

45-49 .. . . 96,000 14,000 110,000

50-54 .. . . 87,000 11,000 98,000

55-59 .. . . 71,000 8,000 79,000

60-04 .. . . 50,000 . . 50,000

.

Total .. 1,278,000 370,000 1,648,000

--·-

The estimated average adult wage for a full week's work as at the 30th June, 1924, was £4 14s. 3d. for males, and £2 lOs. for females. The wage-earner is generally unable to provide, unaided, for the circumstances arising from his incapacity to work. His economic position is also seriously affected by the sickness of

his wife or dependants. Very often, under present conditions, these unfortunate circumstances necessitate an immediate request for charitable assistance. Efforts, similar to those in most countries, have been made by the people in Australia towards mutual assistance during periods wnen, as the result of sickness, aceident, or old age their earning capacity is reduced, and when, m addition, the exceptional requirements of the occasion have to be met. Some wage-earners have voluntarily made efforts to provide for themselves through the formation of friendly societies, trade union benefit funds, establishment funds and other mutual associations; many employers of labour have assisted in the establishment of benefit funds for their employees; workers'

compensation legislation has enforced provision for compensation for industrial accidents and

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diseases ; State Governments provide funds for charitable relief and institutions for free treatment of the indigent sick and for the care of the aged and the infirm; numerous private, religious, and local government organizations provide nursing and other charitable assistance; whilst the Commonwealth Government has made provision for the payment of old-age and invalid pensions and the maternity allowance. Some provision is, therefore, being made in Australia at the present time for the wage-earner during such periods of incapacity to work, hut only in a moderate and generally inadequate manner, by organizations which, in many cases, have the

inherent defects of all similar voluntary schemes. It is obvious from the efforts of these organizations that the main principle of National Insurance, i.e., the provision of assistance to the wage-earner when incapacitated for work, is generally acknowledged throughout Australia. These existing organizations represent a stage in the evolution of National Insurance_, and furnish conclusive evidence of the necessity for the institution of a national scheme in Australia.

Existing systems of mutual and other assistance in Australia have failed to adequately assist the majority of wage-earners to make provision for the difficult circumstances in which they may be placed as the result of sickness, accident, permanent invalidity, and old age. It is estimated that only approximately 524,000 out of a total of 1,648,000 wage and salary earners have

made voluntary efforts to provide for themselves through mutual associations. The majority, although they have a constant anxiety as to the possibilities of such unfortunate circumstances, have failed owing either to financial inability, lack of thrift and foresight, or to a number of other causes, to make provision voluntarily against the risks of sickness and accident. Most

schemes in operation in Australia have certain restrictions placed upon them which debar many wage-earners from availing themselves of the benefits offered, and thus often fail to provide assistance for those who most need it. Nevertheless, many of the numerous existing schemes are worthy of encouragement as they are carrying out very desirable objects, and have

undoubtedly, in many instances, been of great assistance and benefit. Some are mainly charitable organizations, and it is not desirable that the philanthropic motives of the people should be discouraged, but on the other hand the recipient of charity in many instances loses his self-respect and spirit of independence. As the result of the multiplicity of these

organizations throughout the Commonwealth, and, the diversity of the purposes for which they have been created, there is considerable overlapping, duplication, unnecessary competition, waste of effort, and a very apparent lack of eo-ordination and uniformity, together with numerous resultant anomalies arising from unscientific methods. The majority operate mainly in the more heavily populated areas, and lack suitable machinery for the less populated areas,

where often assistance is as urgently required. A systematic method of relieving the economic burden resulting from the wage-earner's incapacity to \\ ork will considerably reduce the number of cases of destitution, and the only equitable method of distributing the burden is by insurance.

Your Commissioners are, therefore, of the opinion that it is both desirable and necessary that the Commonwealth Government institute a compulsory system of National Insurance in Australia which will provide for the payment of sickness, invalidity, maternity, and superannuation benefits to insured members. It is considered that only by governmental control and supervision

can equitable arrangements be made whereby definite and adequate benefits will be guaranteed to all insured members, with that necessary economy in cost of administration, uniformity of method, effective co-ordination and· unbiased control of the various sections of one comprehensive scheme. A compulsory basis is recommended provided the system is supervised

by the Government, as compulsory provisions can be effectively control1ed by a · organization only, and are no valid reasons why the Government should transfer 1ts functions and responsibilities to private institutions. Where voluntary schemes have been established in other countries they have generally failed to satisfactorily achieve their purpose, as is indicated by the universal tendency to change from vo]untary to compulsory principles.

There are no grounds for the assumption that, if a voluntary scheme were instituted in Australia it would not have the inherent defects of a1l such schemes, which, as has been conclusively proved, fail to provide for those who most need assi;;.tance, cannot be effectively and generally applied, and only attract the more thrifty. the continuance of existing voluntary

mutual associations should be encouraged as supplementaries to the national scheme. On reviewing such reports and data as are available relating to the operations of national schemes of insurance in other countries, it was found that provision for incapacity is generally made by the payment of a cash benefit during incapacity, by arrangements for medical treatment

during sickness, and by the organization of preventive measures against sickness and accident. Your Commissioners are of the opinion that casual sickness, permanent invalidity, old age, and maternitv should be similarly provided for' in Australia as follows:-(A.) Under a National Insurance Fund, in which provision is made for definite

financial assistance to insured members which will relieve,.'the economic stress occasioned by the above-mentioned circumstances. The greatest and constant

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anxiety of the worker is the possibility of the serious financial difficulties in which he and his dependants will be placed as the result of these contingencies. The average wage-earner is unable during his working life to provide, unaided, for all circumstances throughout life, and only by a governmental system of insurance can the wage-earner be assisted to make adequate financial provision which will give him that essential feeling of security, and which will have beneficial results in encoumging thrift and mutual assistance, mitigating poverty, allaying social unrest, and furthering national efficiency. For this reason it is considered that a National Insurance Fund providing for the payment .of definite cash benefits to all insured members should be instituted. (B) Under a National Health scheme, which will aim at adequate medical treatment

for the people, and which will also provide the requisite mac}Jinery for the prevention of sickness and accident. It is generally recognized that the payment of a cash benefit does not alone provide the essential and desirable objects of any scheme from the standpoint of national health; adequate facilities for medical treatment should also be made available and, in addition,

as much sickness and accident is undoubtedly preventible, efficient preventive measures must be put into operation in the interests of the insured member, of national health, and of the insurance scheme itself. Your Commissioners, however, after reviewing the reports of the experience of. other countries, are of the opinion that it is not desirable that these provisions should be included

in any scheme providing for financial benefits, but that they should be dealt with under a definite National Health scheme which, although closely related to the objects of the National Insurance Fund, can be more effectively and satisfactorily dealt with if dissociated· from the administration of the financial benefits. Where medical benefits have been administered under a scheme providing for cash benefits also, they have invariably been limited and have proved inadequate, whilst the increasing cost of the former has had a detrimental effect on the pro.vision of the latter. .,

A considerable amount of valuable evidence has been submitted to vour Commjssioners witlJ respect to the various benefits and facilities, allied to the subject of thi"s inquiry, provided at the present time in some manner in Australia, and these data, together with our recommendations as to the method under which the several questions could, in our opinion, be most advantageously dealt with, are submitted hereafter in the followin,g order :- . ·

(A) National Insurance Fund­ (1) Sickness Benefit. (2) Accident Benefit. (3) Invalidity Benefit. (4) Maternity Benefit. (5) Superannuation Benefit. (6) Funeral Benefit. (7) Child Allowance.

(B) National Health Scheme­ (1) Medical Benefits. (2) Institutional Treatment. (3) Preventive Health Services.

(A) NATIONAJ.J INSURANCE FUND.

1. SICKNESS BENEFIT. (a) AustratMn Morbidity Experience,

(i) Friendly Societ1:es.-Casual sickness is responsible for a more serious loss in wages and production than industrial accidents, and, although legislation has been introduced which compels provision for the latter, that enacted with respect to sickness benefits has merely ainJed at the supervision of existing mutual organizations. As friendly societies are established largely for the purpose of medical relief during sickness, each society in Australia provides a benefit for its members when they are certified by a lodge doctor as incapacitated for work as

the result of sickness. The records of the sickness experience of such members would be of very considerable value if a comprehensive system of statistical tabulation and analysis were instituted ; the records are now kept mainly for financial purposes, but they present a wide and valuable

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field for investigation as to morbidity according to sex, age, occupation, locality, disease, duration of in?apacity, &c. The value of such analysis is especially important when the total membership of fnendly societies is taken into consideration. At the end of 1923 the adult membership was as follows :-New South Wales*-males 182,564, females 15,70:4, total 198,268; Victoria-males 140,181, females 10,589, totall50,770; 54,663, females 4,986, total 59,649;

South 61,304, females 11,150, total 72,454; ·western Australia-males 17,810,

females 1,008, total 18,818; Tasmania-males 22,866, females 1,501, total 24,367; Common­ wealth-males 479,388, females 44,938, total 524,326. The total adult membership in 1923 was equivalent to approximately 9 per cent. of the total population and to 30 per cent. of the total wage-earners in Australia, whereas in 1917 it was equivalent to 9·7 per cent. and to 36 per

cent. respectively. The average period of sick pay per member in New South Wales during the year 1922 was 10 days, having increased from 7 days during the last ten years; in Victoria the average per was 12 days pe! annum, the rate o"f the leading societies having increased by 2 da.ys

m the last fifteen years; m Queensland the average was 8 da.ys, whereas it was formerly 6 days; the average in South Australia was 10 days in Western Australia and Tasmania H days, having in Tasmania increased from 5 ·7 days during the last 30 years. The average period of sickness per friendly society member in Australia during the year 1922 was, therefore,

approximately 10 days, equivalent to 3 per cent. of the total working days in that year. When this average is applied to the totall).umber of wage and salary earners over fifteen years of age in Australia, the result is as follows :-1,284,700 males lost in one year a total of 1,739,000 weeks' work, with a consequent average loss of £5 17s. 10d. in wages by each male wage-earner,

and a total loss in wages of approximately £7,569,000 in one year. Taking the total number of female wage and salary earners as 383,000, the total time lost as the result of sickness amounted to 399,000 weeks, and the average wage lost £2 4s., representing a total loss of £843,000 in wages by female wage-earners. The total loss in wages in one year by male ·and female wage and salary

earners in Australia, on account of lost time resulting from sickness was, therefore, £8,412,000. During this period of lost time a number of wage and salary earners would be on sick leave with pay granted by their employers, and a total sick pay benefit of £561,000 was paid by friendly societies during the year 1922. Twenty-eight per cent. of the unemployment recorded at the 1921 Census

was due to sickness or accident. This enormous loss in wages, and the heavy consequent loss in production estimated at four times the loss in wages, as the result of sickness and accident, which in many instances is preventible, reveal the necessity that a national scheme should be put into operation which will provide relief and reduce this heavy and increasing annual loss.

Friendly society sickness experience should be better than that for the general population, but although an applicant for membership of a friendly society must be medically examined and certified by the lodge doctor as sound in health, and is thus a selected risk when joining the society, his health is not further inquired into during the period of his membership. The statistics of mortality, however, show that the death-rate for members of friendly societies is lower than that

for the general population, and it is anticipated that the rate of sickness amongst the insured population under National Insurance will be, in t.he earlier years at least, in excess of that experienced by friendly societies. Before sick benefit is paid the societies generally insist on the production of a certificate from the lodge doctor that the member is unfit for work ; further

progressive medical certificates being required, usually at fortnightly intervals, until he is fit to return to work. In the event of any doubt arising, an independent medical officer may be asked to examine the sick member. Friendly societies endeavour to keep their sick payments dovm to a minimum, and each branch appoints certain of its members to visit its sick, usually once a

fortnight, and to report to the branch secretary. Notwithstanding these precautions, there has been a very considerable and serious increase in the average period of sick pay per member in recent years. This increase is ascribed by some to the fact that the average age of friendly society members has increased, as sufficient young members are not being admitted to rejuvenate the societies, and, as sickness increases with age, members are now drawing on the towards which they contributed during their earlier years. Others that the heavier payments

of sickness benefits are due to the consolidation of funds which has taken place in several of the societies, as previouslv, when each branch administered its own funds, many branches were financially unable to pay the full sickness benefit, and some even paying as low as only one-fourth benefit, but under consolidation every incapacitated member of the society now receives full

benefit. It has also been stated that under consolidation the same supervision is not taken in the administration of one central fund as was taken previously in connexion the branch fund, notwithstanding that the central administration urges branches io. exercise ca:e that progressive medical certificates are produced, ard that sick visitors are e:fficiem•y carrymg out their duties.

----- - - - - - -·-- ------ * New South Wales, 30t.h June, 1923.

10

An analysis .of the available data relating to the duration of sickness amongst friendly society members shows that 7 per cent. of the cases were under one week's duration, 49 per cent. were for a period of one and under four weeks, 29 per cent. four and under thirteen weeks, 7 per cent. thirteen and under twenty-six weeks, and 8 per cent. over twenty-six weeks. It will thus be seen that only a small percentage of the cases are of such short duration that financial relief is not required, whereas 44 per cent. of the cases are incapacitated for a period of over four weeks, which would, in all probability, necessitate the provision of financial assistance to the wage-earner and his dependants. Approximately I8 per cent. of friendly society members receive sick pay in one year, and the average duration of sickness per member drawing sick pay is nine weeks per annum, which indicates that at least one-sixth of the wage-earners in Australia require financial assistance and medical treatment for a similar period in each year. · ·

(ii) Trade Union Benefit Funds.-Very few trade unions in Australia ·have sickness benefit funds available for their members, and it is estimated that of the 700,000 members only about 30,000 'are contributing for the sickn'ess benefits provided by the various unions. Trade unions have been organized more for industrial reasons than for the purpose of providing sickness benefits, which, when available, are very limited in their operation, with the exception of those of two large unions. The contributions are not generally based on actuarial calculations, but form portion of the fortnightly contributions to the general union funds, and there is little evidence available as to the sickness experience of the members of these funds. Distress funds are administered by the central organizations, but are very limited in extent, a.nd so many calls are made upon them through sickness troubles of all kinds that only a few cases can be adequately met.

. (iii) Government Departments.-An analysis of investigations carried out by the Commonwealth Department of Health into the sickness experience of the employees of the following Government Departments :-Victorian Education Department, for the years I9I4, I920, I92I, 1922 ; New South Wales Education Department, for the years I920, I92I ; Postmaster­ General's Department, New South Wales, Victoria, and South Australia, I92I ; Federal

Taxation Department, Central, Victoria, and South Australia, I92I; Treasury Note Issue Branch, I92I ; and Victorian Government Railways, I921, employing a total of 75,2I8 officers, revealed the fact that during the abovementioned years an average of 3I per cent. of male, 38 per cent. of female, and 33 per -eent. of all employees were granted sick leave of more than

two days' duration. ..The resultant effects on the administration of the departments are detrimental to efficiency, and clearly indicate that adequate preventive measures should be instituted. The average number of days' sickness per offi:cer per annum was 7 ·7, and is lower than that for friendly society members, which is r.robably due to Jact officers are :etired from Government Departments on account of Ill-health, and whert the ma:xunum age of retrrement has been reached, whereas friendly societies retain their members throughout life.

(iv) Other Organizations.-Benefit funds which have been put into operation by employers for the benefit of their employees are not compelled to register as such. These funds usually provide sickness benefits, but only large firms are able to institute schemes which would adequately meet all requirements, as the cost in small enterprises would be prohibitive. Certain industrial establishments th,roughout Australia now forward statements of ·the sickness . experience of their employees to the Commonwealth Health Department, and in four of these firms the sickness rate ranged from 3 ·I to 9 ·7 days per male employee and from 6 ·I to 8 ·3 days per female employee

per annum. Most of the larger benefit schemes instituted by employers have been established on a fairly sound basis, and in some instances an actuarial examination and report is made every five years. During I922 a total of 2I8,209 indoor patients were treated in public hospitals in Australia, and, in addition, about 300,000 outpatients also received treatment ; the average period of treatment per indoor patient being approximately 2I days.

(v) Sickness according to Age.-Friendly societies accept as members only those who are within certain definite age liniits; the average earliest age of admission to the adult branch is I6 years, and the maximum age 45 years, although in some societies members are accepted for partial benefits up to age 55. In the early years of the friendly society movement in Australia

the membership more than kept pace with the growth of population, and this was reflected in the average age of members. In recent years, however, the moveme:p.t is not holding its own, as sufficient young members are not being initiated, or at least retained, to com-pensate for the increasing age of all members, and to thus keep the average age constant. The annual loss in membership, as the result of secessions from friendly societies is equivalent to 6 per cent.

of the total membership, and to 70 per cent. of the total initiations in each year. Many factors have this rejuvenation process, and the societies have endeavoured to make amends for the deficiency, but without complete success. This has a serious effect on the outlook of friendly societies, as sickness increases with age and the average age of members of the society bears a definite relationship to the average sickness experience. Some members at the older

1279

11

ages are contip.uously on the sick fund, and in branches where there are a number of aged members, sick payments are consequently heavy. The experience of some societies indicates that members the ages of 16 and 21 years are also a heavy burden on the funds. The wage-earner

with dependants endeavours to keep at work as long ashe can, as the sickness benefit is insufficient to enable him to stop work owing to a slight illness, but it has been stated this does not apply to members under 21 years of age who are eligible for the same sickness benefits, but against this statement is the fact that the growing youth is more susceptible to sickness and accident. The

experience of the New South Wales Education Department in the years 1920 and 1921 indicated that the healthiest period was in the under 21 years of age group, which is probably accounted for by · the strict medical examination which each applicant for appointment is required to The average age of insured members is a very important factor which must be adequatelv

considered in connexion with the institution of a National Insurance scheme, but it has beeil. submitted that under a compulsory system the average age will not vary to any appreciable extent from year to year, and will thus tend towards that financial stability which a voluntary scheme does not ensure. · ·

(vi) Sickness according to Sex.-The number of female lodges is small, and the female membership of friendly societies in Australia is limited, the total as at the 31st December, 1923, being -4:4,938. As the longevity of females is greater than that of males, it follows that in the community there is a relatively large pro-portion of females of advanced ages subject to the higher. sickness rates. Married women have a heavy sickness · experience, as is indicated by the demand which they make on the services of the lodge doctor, and in ·some instances a regulation has been brought in which provides that as soon as a female member marries she ceases to be entitled to sick pay. The sickness experience per male member in one large

friendly society in New South Wales in 1923 was 11·4 days, and per female member 8·6 days; in Victoria it averaged 14 ·8 days for males, and 10 ·8 days for females; in Queensland in one society in 1922 the average was 8 ·3 days per male member, and 6 ·6 days per female member; in Tasmania the average duration for males was 9·7 days, and for females 8·5 days, which is

accounted for by the fact that the greater proportion of female members eligible for benefits are single and -of younger age than the males. The average period of sickness of females in Government Departments was 10 ·9 days per annum, as compared with 6 ·2 days for males ; two days and under absences represented 7 ·7 per cent. of the total days lost by male officers, and 16 ·9 per cent. of the days lost by female officers; whilst 31 per cent. of male and 38 per

cent. of female officers were granted sick leave of more than two days' duration. In certain industrial establishments the experience for females was 6 ·2 days, and for males 7 ·8 days. The -friendly societies' experience of females from the sickness stand-point has not been satisfactory, and that of female societies in Victoria has warranted the statement that from ages 18 to 50

the sickness rate of female societies is about 50 per cent. in excess of the sickness rate of male societies. At the inception of National Insurance in Great Britain the basis of the provision made for female _insured members was the same as for male members, but experience proved that the incidence of sickness amongst women was considerably underestimated, with the result that the income of the women's fund was insufficient, and the relatively heavy liability of married

women has been corrected by an annual grant from public funds. It, therefore, is essential to the financial stability of any National Insurance scheme which may be instituted in Australia that the question of ·contributions in respect of female insured members should be given very careful consideration at the inception of the scheme.

(vii) Sickness according to Disease.--The records of sickness experience of friendly society members according to have not been tabulated nor analysed, and, ·as they present such a valuable field for inquiry, it is desirable that such analysis should be up.dertaken. The investigation of the sickness experience in various Government Departments)ndicated that the disease groups responsible for sickness in male officers were as follows :-epidemic, endemic, and infectious

diseases, 24 ·2 per cent. ; external causes (accidents), 21·3 per'tkht. ; diseases of the digestive system, 15 ·5 per cent.; respiratory diseases, 12 ·3 per cent.; and. ' nervous diseases, 8 ·8 per cent. ln female officers, epidemic, endemic, and infectious diseases, 25. 2 per cent; ; digestive diseases, 22 ·7 -per cent. ; nervous diseases, 15 ·9 -per cent. ; and respiratory diseases, 14 ·2 per cent. The

distribution of days lost according to disease groups was as follows :-Male officers--epidemic, endemic, and infectious diseases, 19 ·1 per cent. ; external causes, 18 · 2 per cent. ; nervous diseases, 13 ·7 per cent. ; digestive diseases, 10 ·7 per cent. ; respiratory diseases, 9 · 5 per cent. ; and two days and under absences, 7 ·7 per cent. Female officers--nervous diseases, 18 ·7 per cent. ; epidemic, endemic, and infectious diseases, 17 per cent.; two days and under absences, 16·9 per

cent. ; digestive diseases, 14 ·3 per cent. ; general diseases, 9 ·8 per cent. ; and respiratory diseases, 9 ·3 per cent. It is obvious from these percentages that a considerable amount of the sickness experienced is preventible, and would be avoided if adequate preventive measures were put into operation. No complete analysis has been made of the records of all public hospitals showing

the diseases for which patients were treated, althoug-h such records also present a.n exceptionally

12

valuable :field for investigation. The particulars with respect to the disabilities of .claimants for Commonwealth invalid pensions are not regularly tabulated and analysed, and it is most desirable that such statistical compilation should be immediately put in hand. The experience of uational schemes in other countries has had an important effect on the application of statistical data to public health purpGses, and the comprehensive compilation of such data has considerably increased the knowledge concerning the health of the people. It is very essential that similar statistical investigations should be undertaken in Australia.

(viii) Sickness according to Occupation.-A summary of the sickness experience during the years 1918 to 1922 of 14 dividing societies in Victoria with a total membership of 5,261, which societies donotadmitthe general public, but have a membership confined to the particular industrial organizations concerned, showed that the average duration of sickness per member per arinum was 4.3 days; liquor trade employees, rubber workers, and explosives worke.rs having heavier experience than the average. In a period of seven years the members of minip_g branches in one friendly society received £23,000 more in sick pay than they paid in contributions; the average period of sick pay per member per annum for the whole society was 11 ·14 days, but for mining members in one district it was as high as 20 ·67 days. Friendly societies are now very careful

about opening branches in mining areas, and do not give encouragement in that respect. In mining lodges in Western Australia the expected sickness at the last valuation of friendly societies was 19,249 weeks, and the actual sickness experienced was 30,298 weeks, being 57 per cent. in excess of expectations, whilst the other lodges were normal. A number of miners are on the lodge funds practically for life, as the result of miners' phthisis. An inquiry into the operation of the Mine Workers' Relief Fund in Western Australia. disclosed the fact that the average age of incapacity as the result of miners' phthisis was 51 years, the average number of years employed in the mining industry being 26 ·5. Members. residing in farming districts are tlte best risks from

a friendly society stand-point; in manufacturing centres the sickness experience is high, whilst in timber areas the payments arl:l heavy owing to the numerous accidents to members. This fact emphasizes the necessity for a national scheme, as serious objection is raised to sectional schemes, under which those with heavy sickness experience receive lower benefits, whilst others with better experience are able to accumulate huge reserves, and to pay higher benefits, for the same rate of contribution. The essential basis of a National Insurance scheme is the even distribution of the risks amongst all insured members in one collective group.

(b) Sickness Benftfits Available.

The sickness benefits provided by the friendly societies, with a total membership of 524,326, operating in Australia are generally fairly similar as to the amount of benefit payable per week, and as to the period dming which such benefit is payable. The rates of sick pay granted per week are generally the same to-day as they were over 40 years ago. The period of 26 weeks, during which each of the various rates of sick benefit is paid, is adopted .practically by all societies and has been the same for very many years. Male members are entitled, according to the society to which they belong, to from 20s. to 22s. 6d. per week sick pay for the first 26 weeks' sickness ; from

lOs. to 22s. 6d. per week for the second perwd of 26 weeks; from 5s. to lOs. per week for the third period o£.26 weeks; and thereafter 5s. per week so long as the illness continues. The majority of the societies pay at the lower rates quoted for each period, the higher rates being paid by a few societies only. Female members are usually entitled to hal£ benefits, for which they pay half contributions. Juveniles are• seldom eligible for a sickness benefit,

The maximum sickness .benefit payable per week is laid down by the Friendly Societies Act in each State, viz. ;---New .SoW::h Wales, £2 2s ; Victoria, £3 ; Queensland, £2 ; South Australia, £1; Western Australia, £3; .'.f.ania, £1 Is. In some societies members may contribute for additional sickness benefits maximum provided by the Act is in excess of that provided under the rules as ordinary benefit, but such proVIsion has not been much availed of by

members to date, although there is an indication that it will become more popular as the members become more fully aware of the provision. The Government Actuary decides what benefits shall be pa.id on the basis of the contripution The rate of contribution vruies with the age of the member when joining the and'Jio)oading is made on account of the risk of special occupations. There are instancris, . .',here persons are members of more than one friendly society, and eligible for the sickness bene.. · of eac.· h .. ,s,oc. occasi?nally some benefit fun_d

also. The total amount of be • .·., •. QJ:i the penod durmg whJCh benefit IS payable, IS limited by the societies; after having sickness benefit a member cannot draw on th" sickness fund again for a period of usually one year. It is undesirable that any such restriction should be plaeed in a National Insura,1,1ee scheme. A member is not eligible for benefits when he is unfinancial, and in some cases he i§; penalized for a period of one month after again becoming

financial before he is re-entitled toYsickness benefit. The societies generally have benevolent

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13

funds available for the purpose of assisting a member dUiing periods when he is, owing to unfortunate circumstances, unable to pay his contributions, although no provision for this exists in the rules, and no member can make any claim to such funds. A member of a trade union, with provision for a benefit fund, may voluntarily contribute for such benefits if he so desires, but only a small percentage do so. Sickness· benefit is provided in a few unions only,' and, when available, generally ranges from lOs. to 20s. per week for the

first six months' incapacity, 5.s. to lOs. per week for the second six months, and 5s. per week for a fUither period of from six months to one year, after which the liability to provide sickness benefit ceases. The contributions payable for such benefits are not actuarially certified as adequate, and the funds are not supervised by the Government Actuary, with the result that they are not

generally maintained on solvent lines. In a few friendly societies members are entitled to sickness benefit from the day of joining, but in the majority of cases a member is not entitled to full sickness benefit dUiing a probationary period, which va.ries from three to twelve months from the day when he becomes a member, only half benefits. being paid dUiing this probationary period. This basis has been adopted by the

actuaries in their calculation of the rates of contributions, and has been the custom for many years past, no strong opposition having been made to the system. The principle of paying full benefits to members immediately upon their joining is opposed by several societies, as members may become unfinancial in one society and then drift into another, thus being immediately eligible

for benefits. Under National InsUiance in England no benefit is paid for the first three days of sickness, and for this period, so it is stated, the members, in many cases, avail themselves of the benefits of the voluntary mutual associations. Under the additional benefit schemes in England it is possible for an approved society to pay sickness benefit from the first day, if members so

desire, but that there is no general demand for such payment is indicated by the fact that less than 1 per cent. of the societies have elected to make sickness benefit available from the first day of sickness. An analysis of the sickness statistics of one society for foUI years subsequent to the institution of the \Vorkers' Compensation Act in Australia revealed the fact that the number of

members receiving sick pay for two, three, or four day periods subsequent to the Act coming into operation was considerably less than previously. From the evidence available with respect to duration of sickness; it appears that 7 per cent. of the cases of sickness amongst friendly society members were under one week's duration.

Sick pay for a limited period at full salary rates, with reductions in pay for continued sickness, is provided in the various Government services in Australia, while financial and other institutions employing large staffs usually grant limited periods of sick leave on full pay. Sickness of a permanent character is also provided for under certain conditions under the Commonwealth

Invalid Pension scheme. Government subsidies in a few instances are paid to approved schemes for providing relief for the sufferers from certain industrial diseases, where incapacity is attributable to the industry concerned. The State Governments also provide funds for charitable relief of those in distressed circumstances, as the result. of sickness or of other causes.

Some insurance companies issue policies insUiing the holder against sickness and accident.

(c) Adequacy of Existing Sickness Benefits. The.average sickness benefits of friendly societies, and the period during which each benefit· is payable, have, as previously indicated, been in operation for many years, and, owing to the considerable increase in the cost of living in recent years, these benefits have become of considerably less value for the purpose intended, and are inadequate for the requirements of the present time, although actuarially certified as adequate for the contributions paid. Some larger amount is

required, under present conditions, to provide the relief for which the benefits The smallness of the sickness benefit has been stated as one of the reasons why friendly sqmeties are not attracting so many new members to-day. int.ention o£ the provision of_ such be_nefit is not to make available an adequate amount to mamtam the member of the society durmg the

period of his incapacity, but to assist him during such period, . and if the benefit payable were considered the only available financial resources of a it would be

inadequate for all requirements. The same rate of benefit IS paid to marned and smgle adult members, as they both pay the same rate of contributions, and it has been suggested that some consideration should he given to the question of equitably providing for the additional responsibilities of the married man with dependants. The payment of a sick

benefit above £1 per week to young unmarried men, it is stated, has resulted in malingering, especially where facilities are readily available for joining more than one society. A member of a friendly society, after the probationary period of membership of six or twelve months, has the same financial standing as a member of many years, as both may become unfinancial after the same period of arrears in the payment of contributions. Several societies have indicated

their desire that members' contributions should cease at age 65; this is at present provided fm to a certain extent by the Government subvention scheme in New South Wales. Under that

14

scheme of subvention the State Government pays half the cost of sick pay granted after twelve months' continuous sickness in respect of male members under age 65, and of female members under age 60 ; whole cost of sick pay to male members age 65 and over, and to females age 60 and over proVIded that the amount payable by the State does not exceed 5s. per week per sick member ; an amount equaJ to the total contributions for medical benefits in respect of aged members, and to assure the claim of a funeral benefit not exceeding £50. In the year 1922 £43,000 was paid by the Government, making a total subvention of £308,000 since the scheme

was instituted in 1908. The subvention is looked upon by the societies with considerable favour, as it is of 'great assistance to aged members, who have paid contributions for many years. In National Insurance schemes in other countries it has not been the intention to provide an amount which will meet all the wage-earner's requirements, but to provide for a benefit which will relieve him of the need for other forms of assistance.

(d) Malingering for Benefits.

A certain amount of malingering, so it is stated, occurs amongst members of friendly societies, in order to obtain sick pay benefits, although such malingering is difficult to detect. Various preventive measures have been instituted, and in instances where specia,l committees were appointed to deal with this question, the organized supervision is stated to have reduced the amount of sick pay in . a remarkable degree. The societies depend chiefly upon their secretaries and sick visitors to prevent malingerin:'g, and very little is experienced where an adequate system of sick visitors is in operation. A person may belong to more than one society and to other benefit organizations, with the result, it is stated, that some have been able to draw more in benefits than their ordinary income. The experience of friendly societies shows that when people join more than one society they are seeking sick-pay benefits in particular. There is not much inducement, however, in the amount of friendly society benefit · for a . member to malinger in order to draw sick pay, as in practically every case where a maJ1'ied man leaves his work and goes on the sick fund he loses money. It has been suggested that under the German insurance scheme, notwithstanding improving medical and surgical methods, the duration of cure in some ajlments and apcidents is greater than it was in pre-insurance and that, under the Dutch system, there also appears to be an objective aggravation of ill health, but this may be due to the fact that National Insurance enables a member to receive more ,adequate treatment than formerly. In Great special medical referees are to w:hom

doubtful cases are referred, and It should be possible under Government supervision of a NatiOnal Insurance scheme in Australia to proyide adequate machinery which will the fund against any "irreglilar claims for benefits. · ·· ·· ·

(e) , Sickness Benefit Recommended.

In order that the question of the amount of benefit payable under a National Insurance scheme in Australia might be fully considered, your Commissioners realized that it was essential that actuarial tables should be available, showing the weekly rates of contribution required to provide each of the several benefits under consideration. Mr. C. H . Wickens, F.I.A., F.S.S., Commonwealth Statistician and · Actuary; and President of the Actuarial Society of Australasia, at our request, ·undertook the preparation of the various actuarial -statements required, ·which are included in this Report.

The·weekly rates of contribution required to provide a sickness benefit of 20s., 30s., and 40s. per week during the first six months of sickness are as follows :-Sickness Benefit-Weekly Rates of Contribution. ,

I

Males (to Age 65). Female& (tO Age 60).

Age at Entry,

308. 408. 208. · 80s. 40!. 208. Per Week. Per Week. Per Week. Per Week. Per Week. Per Week.

8. d. 8. d. 8. d. 8.

!

d. 8 . d. 8. d.

16 .. . . .. . . . · ;. 0 4·1 (} 6·2 0 8·2 0 4·0 0 6·0 0 8·0

17 .. .. .. . . .... 0 4·1 0 6·2 0 8•2 0 4·0 0 6•0 0 7•9

18 .. .. .. . . ·.· ·;•, 0 4·1 0 6·2 0 8•2 0 4•0 0 ' 5·9 0 7·9 '' 19 .. . . . . . . .. 0 4·1 0 6·2 0 8·2 0 3·9 0 5·9 0 7·9

20 . . . . .. . . . . 0 4•1 0 6·2 0 8·2 0 3•9 0 5·9 0 7·9

21 . . .. .. . . . . 0 4•1 0 6·2 0 8·2 0 3•9 0 5 ·9 0 7·9

22 . . .. .. . . . . 0 4·1 0 6·2 0 8·2 0 3·9 0 5·9 0 7•9

23 .. .. .. . . . . 0 4·1 0 6·2 0 8·3 0 3•9 0 5··9 0 7•9

24 . . .. . . . . 0 4·2 0 6•2 0 8·3 0 4•0 0 5·9 0 7•9

25 . . . . .. , .. . . 0 4·2 0 6•3 0 8·4 0 4·0 . 0 6•0 0 7•9

2 6 . . . . . . .. 0 4·2 0 6·3 0 8·5 0 4·0 0 6·0 0 8·0 .

27 . . .. .. .. 0 4•3 0 6•4 0 8·5 0 4·0 0 6·0 0 8·0

1283

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Sickness Benefit-Weekly Rates of Contribution--continued.,

Males (to Age 65). Females (to Age 60).

--

-Age at Ent-ry.

20s. 30s. 40s. 20s. 30s. 40g.

Per Week. Per Week. Per Week. Per Week. Per Week. Per Week.

s. d. s. d. s. d. s. d. s. d. s. d.

28 .. . . . . . . . . 0 4·3 0 6·5 0 8·6 0 4·1 0 6·1 0 8·1

29 .. .. .. ·-· 0 4·4 0 6·5 0 8·7 0 4·1 0 6•1 0 8•2

30 • 0 4·4 0 6·6 0 8·8 0 4;1 0 6•2 0 8•3 .. . . . . . . . . 31 .. . . . . . . . . 0 4·5 0 6·7 0 9·0 0 4·2 0 6·3 0 8·4

32 .. . . . . .. . . 0 4·5 0 6·8 0 9·1 0 4·2 0 6·4 0 8•5

33 .. . . . . . . . . 0 4·6 0 6·9 0 9·2 0 4·3 0 6'4 0 8•6

34 .. . . . . . . . . 0 4·7 0 7·0 0 9·4 0 4·3 0 6·5 0 8·7

35 . . . . . . .. . . 0 4·8 0 7·2 0 9·5 0 4·4 0 6·6 0 8•8

36 . . . . . . .. . . 0 4·9 0 7·3 0 9·7 0 4·5 0 6·7 0 9•0

37 . . . . . . .. . . 0 4·9 0 7·4 0 9·9 0 4·5 0 6·8 0 9·1

38 .. . . . . . . . . 0 5·0 0 7·6 0 10·1 0 4·6 0 6·9 0 9·2

39 . . . . . . .. . . 0 5 ·1. 0 7·7 0 10·3 0 4·7 0 7·0 0 9·4

40 .. . . . . . . 0 5·2 0 7·9 0 10·5 0 4·8 0 7·2 0 9·6

41 . . .. . . .. . . 0 5·3 0 8·0 0 10·7 0 4·9 0 7·3 0 9·7

42 .. . . . . . . . . 0 5·5 0 8·2 0 10·9 0 4·9 0 7·4 0 9·9

43 .. .. .. .. . . 0 5·6 0 8·4 0 11·2 0 5·0 0 7·6 0 10•1

44 .. .. . . ···-· . . 0 5·7 0 8·6 0 11·4 0 5·1 0 7·7 0 10·3

45 .. .. .. .. . . 0 5·9 0 8·8 0 11·7 0 5·3 0 7·9 0 10·5

The above rates provide for the payment of a sickness benefit during the first six months of sickness, but not for any sickriess experienced after age 65, in the case of_ males, or after age 60, in the case of females, and are computed on the assumption that contributions are not payable while the person concerned is in receipt of any benefit payable under the scheme.

After consideration of the circumstances associated with sickness benefit payable under the various national and mutual schemes of which particulars are available, your Commissioners recommend :-(i) That a sickness benefit of 308. per week be payable to adult insured members

during the first six months when incapacitated for work as the result of sickness; (ii) That a sickness benefit of not exceeding 20s. per week be payable to insured members under 21 years of age during similar incapacity.

2. AcciDENT BENEFIT.

(a) Australian Accident Experience.

Any inquiry with respect to provisions for .casual sickness and permanent invalidity must necessarily involve the question of the provision of benefits to the wage-earner when he is incapacitated as the result of accident. Although workers' compensation legislation provides for accidents traceable to industry, yet there are many cases of accident which cannot be so defined.

These also throw a heavy burden upon the wage-earner, thus necessitating that some provision should be made under National Insurance for such circumstances. The provision of sickness benefit by friendly societies includes the payment for incapacity as the result of accident, and the foregoing statement as to sickness experience and benefits in friendly societies includes those relating to accident. It is not possible to obtain particulars for accidents separately, as no such analysis of friendly society records has yet been undertaken. _

A large number of deaths in Australia are due every year to accidents, and male deaths predominate. In 1923 the deaths from accident represented approximately 5 per cent. of the total deaths, 7 per cent. of the male deaths, and 2 per cent. of the female deaths. Under the Workers' Compensation Act of the State of Queensland alone the number of policies taken out

has increased from 29,159 in the year 1918--:--19 to 46,089 in 1922-23, with a corresponding increase of premiums payable from £277,826 to £348,191 respectively; 9,768 accident claims were reported in the year 1918-19, and 12,758 in the year 1922-23, the total for the period from 1916 to 1923 being 60,076. The average time lost through incapacity per claimant under workers'

compensation in that State during the year ended 30th June, 1923, was 22 ·62 days; the majority of workers returned to work within 24 days, and the greater portion of that number within 12 days; 14 per cent. averaged from 3 to 6 days; 29 per cent. from 7 to 12 days; 19 per cent. from 13 to 18 days ; 12 per cent. from 19 to 24 days, and 26 per cent. for a longer period.

During the period 1913-1922 in New South Wales 99,638 accident claims were reported, and 34,963 in Victoria for the period 1920-22. During the ten years mentioned in New South Wales it is stated that an average of 6 · 4 per cent. of the total insured persons were injured annually,

16

and of these 0 ·05 per cent. were fatally injured. In the same State during the period 1920-22 the average percentage of persons injured annually for all occupational groups was 6 ·83 per cent. In the Government Departments for which particulars are available 21 ·3 per cent. of the cases of illness of male officers was the direct result of accidents.

(b) Accidents according to Occupation.

In Queensland the experience under workers' compensation to the 30th June, 1923, indicated that the relative distribution of compensation according to occupation was as follows:­ Clerical, 0 ·7 per cent. ; commercial, 4 ·67 per cent. ; handicraft and factories, 21 ·4 per cent. ; engineering, construction, mining and timber, 32 ·8 per cent.; transport, 8 per cent.; local authorities and other public service, 5 ·8 per cent.; farming and pastoral, 23 ·6 per cent. ; sports and amusements, 0 ·7 per cent.; hotels, restaurants, &c., 1·3 per cent.; and miscellaneous, 1 ·1 per cent. In all primary industries the claims ratio has been much higher than in other industries, which may be due to fact that the injured worker is some distance from medical aid, as it is noticeable that the cases which do not receive immediate medical attention are much longer in duration of incapacity. An analysis of accidents in New South Wales in the years 1920-22, according to occupational showed that the highest accident rate occurred in the smelting and mining groups, 19 per cent. of the persons engaged therein being injured annually. The accident incidence in other groups was as fol1ows :-Motor car and motor bus services, 16 ·4 per cent.; sea transport, 14 ·8 per cent. ; pastoral and rural, 14 ·6 per cent.; quarrying, 14 ·3 cent.; mineral treatment, 13 ·O per cent.; iron trades, metals, machines, implements,

conveyances, 11·1 per cent.; brick, cement, pottery, &c., 10·3 per cent.; building, 10 per cent.; furniture and woodworking trades, &c., 9 ·4 per cent.; electric power supply, 9 ·2 per cent.; labouring, general, 9 ·2 per cent. Accidents are obviously more preventible than disease, and it is essential that adequate measures should be introduced. which will aim at their prevention. In Queensland during the year 1922-·23, 7 ·2 per cent. of the non-fatal accidents resulted from machine labour; 47 ·1 per cent. from hand labour; and 45 ·7 per cent. from other non-machine labour.

(c) .Accident Benefits .AVailable.

Friendly society members are entitled to the usual sickness benefits in the case of incapacity as the result of accident. The Workers' Compensation Acts provide that an employer is liable for the personal injury of his employee arising out and in the course of his employment. There is no liability, however, in New South Wales and Victoria in respect of any injury which does

not disable the worker for a period of at least one week from earning full wages, and in Queensland, South Australia, and Tasmania for a period of at least three days. In Western Australia the liability commences on the date of the accident. Where an employee has given notice of an accident, he shall, if so required, submit himself for examination by a duly qualified medical practitioner. Under the Queensland, South Australian, Western Australian, and Victorian Acts insurance is obligatory, and must be made in Queensland with the State Office, but in Victoria it can be made either with private companies or with the State Office; in the other States insurance is not obligatory, and may be made with private insurance offices, and with the State Office also in Tasmania. Under the Workers' Compensation Acts in the several States

the weekly payments are based on a percentage of average earnings, and the maximum week1y payment and maximum total liability are prescribed as follows :-New South Wales, £3 per week, with a maximum payment of £750; Victoria, £2 per week, and £600 respectively; Queensland, £3 lOs. per week, and £750 ; South Australia, £5 per week, with a maximum of £700 ; Western Australia, £3 lOs. per week, and £750; Tasmania, £2 per week, and £500; for Commonwealth workmen, £2 per week, and the total amount is unlimited; the Seamen's Compensation maximum is 30s. per week, and the total amount is unlimited.

In the year 1918-19 in Queensland 7,959 claims, representing 81 ·5 per cent. of those intimated, were paid; in 1922-23 the number of claims paid increased to 10,406, equivalent to 81 ·6 per cent. of the total intimated. It is estimated that workers' compensation in Australia cost £850,000 in the year 1921. ·

(d) Recommendation.

As workers' compensation legislation made the question of industrial accidents a matter of national importance, it is essential llhat steps should be taken to collect and analyse the records of 'the experience of accident frequency in the different trades, as the collection of suc.h statistics upon uniforn: lines is an urgent necessity. _It has that the

satisfactory scheme of NatiOnal Insurance from many pomts of VIew will be one oombmmg workmen's compensation with other benefits. One of the difficulties of the British is that the worker, when he is eligible for the various benefits, has to apply t? a number of organizations for payment. The desirable object of a system of NatiOnal Insurance the combination under one administration of all provisions for assistance to the wage-earner durmg all circumstances of incapacity to work. In other countries provision is made that where incapacity

1285

17

results from _a.n accident for which payable under the Workers' Compensation Act, the benefit paya.b_le 1S restriCted to the amount by which such workers'

compensation IS less than the benefits provided under the scheme. Your Commissioners, therefore, recommend that equivalent benefits be payable to insured members when incapacitated for the result of and that the of including workers' compensation

legislatiOn under the NatiOnal Insurance fund adlllllilstrat10n should be fully considered.

3. JNv ALIDITY BENEFIT. (a) Invalidity BertejitB AvailalJle.

(i) Frieruity Societies.-The provision of a financial benefit during a period of casual sickness is very necessary, but in cases of extended sickness or permanent invalidity, when the wage-e_arner is temporarily disabled for a longer period, or permanently incapacitated from work there lS an even gTeater need that financial assistance should be provided, as under these

unfortunate circumstances the financial resources of the wage-earner are soon exhausted, and he is generally compelled to seek charitable or other assistance. Members of friendly societies in Australia are eligible for a payment varying in the societies of from lOs. to 20s. per week during the second period of six months' illness, and to a payment of 5s. to lOs. per week thereafter, so long as illness continues. Some members are stated to have been drawing the

smaller invalidity benefit continuously for 20 or 30 years; in mining lodges especially, many members are on this benefit for a number of years. Friendly societies will only admit persons to membership who are certified by the lodge doctor as being in sound bodily and mental health, consequently a percentage of the population who most need assistance are unable to obtain the mutual benefits of friendly societies owing to this restriction.

It is undesirable that any restriction as to physical fitness should be placed upon membership of the national scheme, as it is essential that facilities for insurance should be available to those who, through physical incapacity, may most need it. The usual benefit of 5s. per week paid to friendly society members during continued sickness is considered to be totally

inadequate, as during the period when an incapacitated member requires the most assistance he receives a small rate of benefit. . A member may in some cases contribute for double sick­ pay benefits, but only a small number have taken advantage of this provision. The contributions of a member drawing benefits are generally deducted from the benefits payable, but in some

societies when a member is reduced to the 5s. per week rate of sick pay, the society pays his contributions from a fund which has been instituted for the purpose so that he may receive his cash benefits without deduction. Some friendly society members are, in addition, drawing the Commonwealth invalidity

pension ; certain trade unions and employees' benefit funds provide invalidity benefits of a generally limited nature for their members, who in some instances are members of friendly societies also, but the total membership of such benefit funds is, however, comparatively very small. In Government Departments and in many large institutions, schemes have been instituted whereby employees who are permanently invalided are retired on pension. In some

of these schemes it is necessary' for the applicant for membership to undergo a medical examination. (ii) Comrrwnwealth Invalid Pensions.-Under the Commonwealth Invalid and Old Age Pensions Act 1908-1923 an invalid pension of 17s. 6d. per week is payable, subject to certain

property and income qualifications, to all persons over 16 years of age who are permanently incapacitated for work. The invalidity must be permanent, and at the present time considerable difficulty is experienced with respect to the person who is only temporarily incapacitated for work. According to the strict interpretation of the Act, an invalid must have no earnings at

all, as incapacity to work means total incapacity to earn, and a further provision prevents the grant of a pension to a person who is adequately maintained by his or her parents, but such provisions are not literally enforced, as the Commissioner has been granted powers under which he may authorize the payment of pensions in such circumstances. 1,878 invalidity claims were rejected during the year 1923-24, mainly owing to the property and income clauses of the Act.

The fact that income is derived by aged and infirm pensioners from an employees' benefit fund is taken into consideration, and a deduction made from the pension accordingly, but no deduction is made with respect to friendly society, trade union, provident society or other mutual association benefits.

At the 30th June, 1911, the total number of invalid pensioners was 7,451, equivalent to appr?ximately 0·2 per cent. ?f the population; at the 30th June, the of

had mcreased to 42,617, eqmvalent to 0·1 per cent. of the populatiOn and mdicatrng an mcrease far in excess of the increase in population; the percentage of invalid pensioners on the total population of each State being-New South Wales, 0·79 per cent ; Victoria 0·75 per cent.; Queensland 0 · 72 per cent. ; South Australia 0 ·52 per cent. ; Western Australia 0 · 62 per cent. ;

Tasmania 0·95 per cent. Of the total number of invalid pensioners, 19,391 were males and 23,226 females. F.l6347 .-2

18

· No particulars are available showing the ages of those drawing invalid pensions, but of 3,073 male pensioners admitted during the year 1923-24, 9 per cent. were under 20 years of age ; 12 per cent. 20 and under 30 years; 14 per cent. 30 and under 40 years; 22 per cent.

40 and under 50 years ; 37 per cent. 50 and under 60 years ; and 6 per cent. over 60

years. Of 3,000 females admitted in the same year 8 per cent. were under the age of 20 years ; 12 per cent. 20 and under 30 years; 14 per cent. 30 and under 40 years; 18 per cent.

40 and under 50 years ; 43 per cent. 50 and under 60 years ; and 5 per cent. over 60

years. The loss in production as the result of .workers in the early and middle ages becoming permanently invalided, and the increasing financial burdens which the payment of these pensions involves, indicate that urgent action should be taken to institute preventive health services which will aim at a reduction in the incidence of invalidity. A considerable portion of the invalidity for which Commonwealth invalid pensions are now being paid is stated to be the result of

diseases which are preventible, and that 32 per cent. of the persons to whom invalid pensions were paid during the period 1910-1915 were suffering from the after-effects of .infectious diseases. As previously indicated, it is desirable that a systematic tabulation with respect to the disabilities of claimants for invalidity pensions should be undertaken.

Of the male pensioners admitted in 1923- 24, 44 per ·cent. were single; 49 per cent. married; and 7 per cent. widowed. Of the female pensioners admitted, 45 per cent. were single, 25 per cent. married, and 30 per cent. widowed. The unfortunate circumstances in which the dependent children are placed owing t<> the invalidity of the breadwinner necessitates, under present conditions, urgent requests for charitable assistance, and this question requires very careful consideration from a National. Insurance stand-point. At the 30th June, 1924, the Commonwealth Government's annual liability in respect of invalid pensions payable to 42,617 pensioners was £1,897,246; 91 per cent. of the pensioners being in receipt of full pensions; the average pension being 17s. 1d. per week. It has been suggested that invalid and aged persons

should be assisted by the Government to become members of friendly societies, but it is considered that the necessary assistance required could be more .satisfactorily furnished under a scheme of National Insurance. (b) Invalidity Benefit Recommended.

The following rates of contribution provide for the payment of an · invalidity benefit of 20s., 30s., and 40s. per week during that period of sickness extending beyond the first six months of sickness, but not for any sickness experienced after ·age 65 in the case of males, or after agP. 60 in the case of females. · · · · ·

-

16 17 18 19 20 21 22 23 24 25 26

7

8

9

0

I

2

3

4

2

2

2

3

3

3

3

3

3

3

5

6

3 7 8

9

0

3

3

4

4

4

4

4

4

1

2

3

4

5

.. '

. .

..

..

..

..

..

. .

..

..

..

..

..

..

..

..

. .

. .

..

. .

. .

. .

..

..

..

. .

. .

..

..

..

Age at Entry.

.. . .

. . ..

. . . .

. . . .

. . . .

. . . .

. . . .

.. . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

.. . .

.. . .

. . . .

.. . .

.. . .

.. . .

. . . .

. . . . . .. . . .. . . . . .. .. .. .. .. .. . .

I nvalid1"ty. Benefit-Weekly Rates of Contribution.

MAle

30s. 40s. 20s .• 30s. 40•. 20s. Per Week. Per Week. Per Week. Per Week. Per Week. Per Week.

8. d. s. d. s. d. 8. d. .. 8. & 8. d.

. . . . 0 2·0 0 2·9 0 3·9 0 1·4 0 2·2 0 2·9

. . .. 0 2·1 0 3·1 0 4·1 0 1·5 0 2·3 0 3·0

. . . . 0 2·1 0 3·2 0 4•3 0 1;6 0 2·4 0 3·2

. . . . 0 2·2 0 3·4 0 4·5 0 ' 1·7 0 2·5 0 3·3

. . . . 0 2·3 0 3·5 0 4·7 0 1·7 0 2·6 0 3·4

. . . . 0 2·4 0 3,7 0 4·9 0 1·8 0 2·7 0 3·6

. . . . 0 2·5 0 3 ·8 0 5 ·1 0 1·9 0 2·8 0 3·7

. . .. 0 2·6 0 4 ·0 0 5·3 0 1·9 0 2·9 0 3·9

. . . . 0 2·8 0 4·1 0 5·5 0 2·0 0 3·0 0 4·0

. . . . 0 2•9 0 4·3 0 5·8 0 2 ·I 0 3·2 0 4·2

.. . . 0 3•0 0 4·5 0 6·0 0 2·2 0 3·3 0 4·4

. . . . 0 3·1 0 4·7 0 6·3 0 2·3 0 3·4 I. 0 4·5

. . . . 0 3•3 0 4·9 0 6·5 0 .2·4 0 3·5 0 4·7

. . . . 0 3·4 0 5·I 0 6·8 0 2.·5 0 3·7 0 4·9

. . . . 0 3·6 0 5·3 0 7·1 0 2·6 0 3·8 0 5·1

. . . . 0 3•7 0 5·6 0 7·4 0 2•7 0 4·0 0 5·.'3

. . . . 0 3•9 0 5·8 0 7·8 0 2·8 0 4·2 0 5·5

.. . . 0 4·1 0 6·1 0 8·2 0 2·9 0 4·3 0 5·8

. . . . 0 4•3 0 6·4 0 8·5 0 3·0 0 4·5 0 6·0

. . . . 0 4·5 0 6·7 0 9·0 0 3·2 0 4·7 0 6·3

. . . . 0 4•7 0 7·I 0 9·4 o· 3·3 0 5·0 0 6·6

. . . . 0 4·9 0 7·4 0 9·9 0 3·5 0 5·2 0 6·9

. . . . 0 5·2 0 7·8 0 10·4 0 3•6 0 5·4 0 7·3

. . . . 0 5·5 0 8·2 0 10·9 0 3·8 0 5·7 0 7·6

0 5·7 0 8 ·6

l

0 11·5 0 4·0 0 6·0 0 8 ·0 . . .. I

.. . .. 0 6•0 0 9·1 1 O·l 0 4·2 0 6·3 0 8·4

. . .. 0 6•4 0 9·6 1 0·7 0 4·4 0 6·6 0 8·8

. . .. 0 6·7 0 10·1 1 1·4 ()" 4·6 0 6·9 0 9·2

. . .. 0 7•I 0 10·6 1 2·2 0 4·9 0 7·3 0 9·7

. . .. 0 7·5 0 11·2 I 3·0 0 5·I 0 7·7 0 10·2

1?87

19

Your Commissioners recommend that an invalidity benefit of 20s. per week be payable to insured members during that period when incapacitated for .work as the result of sickness or accident extending beyond six months' duration.

4 . .MATERNITY BENEFIT.

(a) Maternity Benefits Available.

In recent years the necessity for the provision of maternity benefits has been recognized . in most countries. The legislation introduced varies in the several countries, but there has been an increasing tendency to include maternity benefits in the scope of National Insurance. Such benefits usually provide for the payment of a weekly amount to the mother for a stated period before and after confinement, and in some cases for medical attendance. The former benefit is

granted partly in order that the wage-earner may be assisted to meet the financial obligations of the time, whilst the latter aims at the provision of adequate medical services which will protect the health of the mother and the child. The family man, especially the wage-earner, is at an economic disadvantage, which necessitates his being granted financial assistance on such an

occasion, and it is especially desirable that a National Insurance scheme should assist the wife of the wage-earner, and also women in employment. Friendly societies do not provide maternity benefits for their members, but the member usually makes arrangements with the lodge doctor for the attendance to his wife at a reduced accouchement fee, of usually three guineas. Married women who are members of friendly societies are not eligible for sick pay during a period of confinement. Friendly society dispensaries usually supply, free of cost, the materials required in maternity cast!s, the member paying the cost price of any extras required.

Under the Commonwealth Maternity Allowance Act 1912, a sum of £5 is payable to every mother, other than an Asiatic, or an aboriginal native of Australia, Papua, or the Pacific Islands, who gives birth to a child in Australia ; only one allowance being payable in cases of multiple birth. For the year ended 30th June, 1924, the allowances paid totalled £670,175 ; the

total payments from the inception of the allowance to that date aggregated £7,733";858. During the year ended 30th June, 1924, there were 133,382 births, and 134,035 claims for maternity allowances were paid during that year, the discrepancy between the totals being due to still-births, indicating that in practically every instance the allowance. was automatically claimed, irrespective

of whether the parents required this financial assistance or not. There is no income restriction on claimants, as is the case in the granting of old-age and invalid pensions. The maternity allowance undoubtedly provides a considerable amouht of the assistance required by many mothers in providing the uecessities of the time. From the national financial stand-point alone

it is most economical to provide for the cost of maternity benefit in order that the subsequent heavy expenditure resulting from invalid mothers and from defective and invalid children may be reduced; from the stand-point of national health it is even more important that an adequate maternity benefit be made available. In the year 1913-14 a total of 86,003 mothers, or 64 per

cent., were attended by a doctor at confinement, and 48,595, or 36 per cent., were not attended; during the year 1923-24, 106,277 mothers were attended, and 27,758 were not attended by a doctor, being equivalent to 79 per cent. and 21 per cent. respectively of the total cases. No particulars are available from which can be ascertained the attention, if any, which the 27,758

mothers received. The allowance has resulted in many women, who otherwise would have done without medical attendance, now calling in a doctor, as is shown by the increase of from 64 per cent. in 1913-14 to 79 per cent. in 1923-24 in the number of mothers who were attended by a doctor at confinement; but in the interests of the health of the mother and of the child it is

desirable that measures should be instituted which will provide for adequate medical attendance at every case of confinement.

A comparison with other countries shows that Australia's birth rate of 23 · 8 births per thousand of population is fairly low, but it is higher than that for the United States, 22 · 5 per thousand, and Great Britain 19 · 9 per thousand. Infantile mortality has been decreasing in Australia for the last 40 years, and in 1922 the rate of 53 deaths per thousand births registered

was the lowest ever recorded, and with the single exception of New Zealand, was the lowest in the world. The infantile mortality rate in 1905 was 81 · S ; in 1910, 7 4 · 8 ; in 1915, 67 · 5 ; in 1920, 69·1; in 1923, 60·5 per thousand births registered. In regard to deaths which occur under one month of age the rate per thousand births in 1907 was 32 ·o; in 1910, 30·4; in 1915, 32 ·4; in 1920, 31·8; and in 1923, 30·7. The puerperal death rate in 1905 was 5·9 deaths for every

thousan.d registered births ; in 1910, 5 ·1 ; 1915, 4 · 3 ; 1920, 5 · 0 ; 1923, 5 ·1. These statistics show that, so far as infantile mortality and puerperal deaths of mothers are concerned, the maternity allowance has not had any apparent effect.

20

(b) Maternity Benefit Rerommended.

It has been suggested that the payment of a definite a'.Qlount per week to the wife of an insured member of a National Insurance scheme for a period prior and subsequent to confinement, would be of much greater value than the present system. A further suggestion has been made that alternative arrangements could be provided for portion of this allowance to be paid to the institution in which the mother is confined, or that the maternity allowance funds could be utilized for establishing maternity hospitals, maternity wards attached to public hospitals, ante-natal and post-natal clinics, and midwifery training schools. Your Commissioners are of the opinion however, that a cash maternity benefit should be made available to the wife of every insured member and to every female insured member of the National Insurance Fund, as it is desirable that the payment of all such benefits should be incorporated in one comprehensive scheme under

one administration. The provision of adequate facilities for pre-natal care, for medical attendance at confinement, and for post-natal care, form an essential part of the national health scheme. . The following rates of contribution are required to be paid in order to provide a maternity benefit of 20s., 30s., and 40s. fer week, payable for. two weeks prior to, and for four weeks after, the confinement of the wife o the insured member :-.

Maternity Benejit.-Weekly &lies of Contribution. Males (to Age 66).

Age at Entry.

20.. i!Oa. 403.

Per Week. Per Week. Per Week.

d. s. d. 8. d.

16 .. .. .. .. . . 0 1·9 0 2·9 0 3·9

17 .. .. .. . . .. 0 2•0 0 3•0 0 4·1

18 .. .. . . .. .. 0 2•1 0 3'2 0 4•3

19 .. .. .. . . .. 0 2•2 0 3•4 0 4•5

20 .. .. . . .. . . 0 2•4: 0 3•5 0 4•7

21 " . . .. . . .. 0 2•6 0 3•7 0 4·9 22 .. .. . . .. . . 0 2•6 0 a·s 0 6·1 ::.3 .. . . .. . . . . 0 2•6 0 4•0 0 6•3 24 .. .. . . .. .. 0 2·7 0 4·0 0 .5·4 25 .. .. .. .. .. 0 ;&•7 0 4·0 0 5·4 26 .. .. .. ... . . 0 2•7 0 4·0 0 5•4 27 .. . . .. .. . . 0 2•1 0 4·0 0 o·a 28 .. . . .. .. . . 0 ;,J-.6 0 3•9 0 5•2 29 .. .. .. .. . . 0 2·5 0 .)•J 0 5•1 30 .. .. .. . . .. 0 2•4 0 3·1 0 4·9 31 .. . . .. .. . . 0 2•3 0 3·5 0 4·7 3J . . .. . . . . .. 0 2•2 0 3•J 0 4:•5 33 .. .. . . .. .. 0 2•1 0 3•2 0 4•2 34 .. .. . . . . . . 0 2•0 I 0 3•0 0 4:·0 35 .. . . .. .. . . 0 1•9 0 2•9 0 3·8 36 .. .. .. . . . . 0 1•8 0 2•7 0 3•6 3{ .. .. .. . . . . 0 1•7 0 2·5 0 3•3 33 .. .. .. .. . . 0 1·9 0 2'.3 0 3•1 39 .. .. .. . . .. 0 1•4: 0 2•1 0 2·8 40 .. . . .. .. . . 0 1•3 0 1·9 0 '2•5 41 .. . . .. . . .. 0 1•1 0 1·7 0 2•2 42 .. . . .. . . .. 0 1·0 0 1·5 0 2•0 43 . . .. .. .. . . 0 0·9 0 1·3 0 1·8 4:4 .. .. .. .. . . 0 0·8 0 1·2 0 1·6 45 .. . . .. .. . . 0 0•7 0 1·0 () hf: No data are available in respect of the confinement of female insured members, but the number of such cases would be relatively small. The above rates provide for maternity benefit for a period of six weeks in respect of the confinement of the wife of an insured member resulting in a live birth, but not for any such confinement after the insured male member reaches the age of 65, nor for any confinement resulting in stillbirth only. If stillbirths are included an addition of about 3 per cent. must be made to the above-mentioned rates of contribution. (i) Your Commissioners recommend that a maternity benefit of 20s. per week be payable for a period of two weeks prior to, and for four weeks after the confinement of a female insured member or the wife of an insured member. (ii) As the cost .of the existing maternity· allowance is at present borne solely by the Commonwealth, your Commissioners are of the opinion t.hat this responsibility should oontinue with respect to the maternity benefit provided under National Insurance.

21

5. SuPERANNUATION' BENEFIT.

(a) Superannuation Benefits Available.

(i) Mutual Benefit Associations, &c.-Mutual benefit associations do not provide for the whole range of benefits which come within the scope of a comprehensive National Insurance scheme, but they mainly aim at partial relief during temporary incapacity, and, to a very limited extent, towards. assistance during an extended period of invalidity. They fail to make any

adequate provision for permanent incapacity to work as the result of invalidity or old age. In more recent legislative enactments in various countries pensions are payable not as a of charity, but, in the majority of cases, are included within the scope of compulsory

Natrona1 Insurance. It has been suggested that the payment of pensions on the basis of services rendered to the community tends to discotmt. thrift, whilst voluntary schemes fail to attract . ather than the more tlu'ifty. There is no evidence, however, to support the former suggestron.

The objects of certain friendly societies include provision for the establishment of a superannuation fund for aged members, but no society at present provides superannuation benefits as such for its members, although in some instances small financial relief for a member between the ages of 60 and 65 is made available, whilst in other societies the contributions of

all memhers over age 70 are paid by the society, and there appears to be a desire that this provision should be generally as soon as the societies' financial position will enable it to be arranged. Very few trade unions have instituted superannuation schemes for their members, and where such are made available they generally provide for a small weekly

benefit varying according to the number of years during which contributions have been paid by the member. Numerous Government, municipal, banking, financial, and other institutions have estahlished superannuation funds for their employees, the benefits payable varying accol'ding to the nature of the institution. In some cases it is compulsory for all employees to

join the superannuation fund, whilst it is voluntary in others, and occasionally provision is made for voluntary contributions towards a benefit additional to that which must be compulsorily contributed for. The employers pay the cqst of administration of the fund

and a subsidy in respect of each member. It ltas not been possible to definitely

ascertain the total membership of the various superannuation funds at present in operation in Australia, but it is estimated at approximately 140,000, the great majority of whom are public servants. In the Commonwealth Public Service superannuation scheme at the end of 1923 there were 26,644 offi'fers contributing with an average salary of about £235 per annum, for an average pension of £1 17s. per week payable at age 65.

The usual pensions provided in the large schemes are based on the unitary system, whereby the employee contributes for so many units of pension in accordance with the rate of wage or salary earned, the contributions being deducted from the employee's wages, and the amount of pension automatically increasing with wage until the maximum pension is reached. Pensions are

paid to employees on retirement through old age, generally at 60 to 65 years. The funds are on a sound actuarial basis, with the contributions varying according to the age of the employee on joining the fund, and sometimes special concessions are provided in respect of employees who, at the inception of the scheme, were above a certain age. Such funds can necessarily only be

provided where there is continuity of employment, as the right of pension terminates with employment, in which case a refund of contributions is generally made, temporary employees not being eligible for membership. The cost to employers is usually heavy, and it is thus only possible for employers who are in a large way of business to establish such superannuation funds. It is desirable that something be done to enable others to provide old-age pensions for their

employees, and it has been that if such pensions are not made available under

National Insurance, the alternative would be to encourage employers, by the assistance of a Government subsidy, to provide pensions voluntarily, but similar optional arrangements have failed in other countries to achieve their objects. Many life insurance companies provide for the purchase of annuities, and several small firms have been able to provide superannuation

benefits' for their employees by this means. State Governments and charitable organizations also assist in the maintenance of homes for the aged. {ii) OommonUJealih Old-age Pensions.-The payment of old-age pensions under the Con;mon­ wealth Invalid and Old-age Pensions Act commenced on the 1st July, 1909, and that portiOn of

the Act which authorizes payment to women attaining the age of 60 years came into operation on the 15th December, 1910. Under the Act an old-age pension of 17s. 6d. per week is payable to evety male aged 65 and over and to every female aged 60 and over, suhject to certain property, income, and length of Tesidence qualifications. The rate of pension was originally

lOs. per week, but was increased to 12s. 6d. in October, 1916; to 15s. in January, 1920; and to 17s. 6d. in September, 1923. Documentary e1-'idence must be produced as to the age of the claimant for old age pension, or the Commissioner may himself accept the claimant's statement

22

as to age if no documentary evidence is available. · The financial Btatus is in the first place upon the declaration of the. applicant, who must then appear before a

mag1_strate for exammatwn thereon, reference being made also to the police. Once a year pensiOners are required to submit a further statement of their financial position. At the 30th June, 1924, the annual liability of the Commonwealth Government in respect of old-age pensions payable to 113,054 pensioners was £4,927,780; 80 per cent. of the pensioners were in receipt of the full pension, the average pension being 16s. 9d. per week.

Statistics indicate that of every 100 people born in Austra.lia, approximately 50 will be living at age 65, and, of these, 16, representing 32 per cent. of the survivors at that age and 16 .per cent. of those born in Australia, will be claimants for the old-age pension. Practically no has taken place since the institution of the Commonwealth old-age pension in the percentage of the population of eligible age who claim the pension, but it is an astounding that. one in every six persons born in Australia will eventually. become a

claimant for the old-age pension. At the 30th June, 1912, 34,897 males and 44,174 totalling 79,071 persons, were in receipt of Commonwealth old-age pensions, being

eqmvalent to· 33 per cent. of the male population, 31 per cent. of the female, and 32 per cent. of the total population eligible according to age. At the 30th June, 1924, the numbers in receipt of old-age pensions had increased to 45,117 males and 67,937 females, totalling 113,054 persons and equivalent to 34 per cent. males and 32 per cent. females, and approximately 33 per cent. of the total population at the eligible ages; the larger number of females being due to the fact that women are admitted at age 60. Australian conditions tend towards a greater probability of people reaching old age than in other countries, and this fact must be taken into consideration when ascertaining the necessity that adequate superanmw.tion benefits should be provided under National Insurance in Australia.

At the census of 1881, the number of males aged 65 and over ih Australia was 34,433, representing 2 · 8 per cent. of the total male population ; the number of females aged 60 years and over at the same date was 37,281, representing 3 · 6 per cent. of the total female population. At the census of 1921, the number of males had increased to 122,841, or 4·5 per cent., and the femsJes to 194,983, or 7·3 per cent., of the male and female population respectively in the

abo,te-mentioned age groups, and comparison with other countries shows that the age distribntion of the Australian population is steadily approaching that of older countries. · When old-age pensions were first introduced they were surrounded with so many restrictions that it has been suggested they were allowances in case of poverty, and consequently applicants did not like having such an imputation placed upon them. Nowadays there is less reluctance to claim the pension, and the number of claimants, so it is stated, is now greater because of the liberalization of the scheme, and the greater adequacy of the pension, which now attracts more people, especially as the cost of living has increased considerably in recent years. It will be seen, however, from the above-mentioned statistics, that although the number of old­ age pensioners has increased very considerably, the percentage of the population eligible according to age in receipt of such pensions has remained practically stationary, the increase· in numbers being due to the growth in population, and to the fact that. as previously indicated, a greater percentage of the population is now in the eligible age groups. During the year ended 30th June, 1924, 1,545 old-age pension claims were rejected mainly owing to the property and income clauses of the Act, and it is desirable that under National Insurance a definite superannuation benefit· should be paid to every insured person, irrespective of property or income qualifications.

(b) 8uperannuat1:on Benefit Recommended.

The average working life of the waO'e-earner varies in the several industries, and a satisfactory basis of insurance for all js possible under a national scheme only, as under sectional schemes the varying circumstances are advantageous to a group of wage-earners in some instances and disadvantageous to others. The provision of an adequate superannuation benefit under National Insurance is a great incentive to the wage-earner, as it assists him to

provide against impecunious old-age, the possibility of which probably weighs more heavily upon him than the risks of sickness or accident. A systematic method of providing for a definite superannuation benefit will grant such relief that the wage-earner will be enabled to give more effective consideration to the questions associated with the ·proper upbringing and maintenance of his children. It has been suggested .that an annuity system should be instituted enabling those who so desire to contribute for a larger amount of pension, as such provision should be attractive to many who are in receipt of higher wages, but where such optional provisions have been included in national schemes in other countries they have not proved satisfactory, owing to the inability of many wage-earners to accurately forecast their capacity to regularly pay the additional contributions required, with th: that many members discontinue contributing for the higher Benefits and based on wages make the system very complex and necessitate a ·very appreCiable mcrease in the administration cost of the scheme, which is not compensated for by the increase in benefits.

1291 23

. The weekly rates of contribution required to provide a superannuation benefit of 20s.: 30s., and 40s. per week, payable to males after attainment of age 65, and to females after age 60, are as follows:-

Sttperannuaiion Benefit-Weekly Rates of Contribution.

! Males (to Age 65). Females (to Age 60).

I Age nt Entry. I 20s. 30s. . 40s. 20s • 30s. 40s.

I Per Week. Per Week. Per Week. Per Week. Per Week. Per Week.

I 8. d. 8. d. 8. d. 8. d. 8. d. s. d. 16 .. .. .. .. . . : 0 9·4 1 2 ·0 1 6·7 1 7·3 2 5·0 3 2·7 17 .. . . .. . . . . 0 9·8 1 2·8 1 7·7 1 8·4 2 6·6 3 4·7 18 .. . . . . . . . . 0 10·4 1 3·5 1 8·7 1 9•5 2 8·2 3 6·9 19 .. . . .. . . . . 0 10·9 1 4·4 1 9·8 110·6 . 2 9·9 3 9·3 20 .. . . . . . . . . 0 11·5 1 5·2 1 11·0 1 11·9 211·8 3 11·7 21 .. .. .. . . . . 1 0·1 1 6·2 2 0·2 2 1·2 3 1·8 4 2·4 22 .. . . .. . . . . ·I 0·8 1 7·2 2 1·6 2 2·6 3 3•9 4 5·2 23 .. . . . . . . . . 1 1·5 I 8·2 2 3·0 2 4·1 3 6•2 4 8·2 24 . . . . . . . . . . 1 2·2 1 9·4 2 4·5 2 5·7 3 8 ·6 4 11·5 25 .. . . . . . . .. 1 3·0 1 10·6 2 6·1 2 7·5 3 11·2 5 2·9 26 .. . . . . . .. . . 1 3·9 1 11·9 2 7·8 2 9·3 4 2·0 5 6·6 27 .. . . . . . . . . 1 4·8 2 1·2 2 9·6 2 11·3 4 5·0 5 10·7 28 . . .. . . . . . . 1 5·8 2 2·7 2 11·6 3 1·5 4 8·2 6 3·0 29 .. . . . . . . . . 1 6•9 2 4•3 3 1·7 3 3·8 4 11•7 6 7·6 30 .. . . . . .. . . 1 8·0 2 6·0 3 4·0 3 6·3 5 3·5 7 0·6 31 .. .. . . . . . . 1 9•2 2 7•9 3 6·5 3 9•0 5 7•5 7 6·0 32 ·- .. . . . . . . 110·6 2 9·8 3 9·1 4 O·O 5 11 ·9 7 11·9 33 .. . . .. . . . . I 2 0·0 3 O·O 4 O·O 4 3·1 6 4·7 8 6·3 34 .. .. . . . . . . 2 1·5 3 2·3 4 3·1 4 6·6 6 9·9 9 1·3 35 .. . . .. . . . . 2 3·2 3 4·8 4 6·4 4 10·4 7 3·6 9 8·9 36 .. . . . . . . . . 2 5·0 3 7·5 4 10·0 5 2 ·6 7 9·9 10 5·2 37 .. . . . . . . . . 2 7•0 3 10·5 5 2·0 5 7·2 8 4•7 11 2·3 38 .. . . . . . . . . 2 9•2 4 1·8 5 6·3 6 0·2 9 0·3 12 0·4 39 .. . . .. . . . . 2 11·5 4 5·3 5 U·l 6 5·8 9 8·6 12 11·5 40 .. . . . . . . . . 3 2·1 4 9 ·2 6 4·3 6 11·9 10 5·9 13 11·9 41 .. . . . . . . . . 3 5·0 5 1·5 6 10·0 7 6·8 11 4·3 15 i·7 42 .. . . . . . . . . 3 8·1 5 6·2 7 4·3 8 2·6 12 3·9 16 5·1 43 .. .. . . . . .. 3 11·6 5 11·4 7 11·3 8 11·3 13 4·9 17 10·6 44 .. . . . . . . . . I 4 3·5 6 5·3 8 7·0 9 9·2 14 7·7 19 6·3 45 .. . . . . .. . . 4 7·8 6 11·8 9 3·7 10 8·4 16 0·7 21 4·9 . (i) Your Commissioners recommend that a superannuation benefit of 20s. per week be payable to male insured members after attainment of age 65 and to female insured members after attainment of age 60. (ii) Your Commissioners are of the opinion that the existing rights of pensioners under the Oommo'ilWealth lr&valid and Old-age Pensions Act 1908-1923 ·should not be interfered with. As previously stated, your Commissioners are now taking evidence with respect to the further question of amending the Commonwealth Invalid and Old-age Pensions Act 1908-1923 so as to provide for the payment of destitute allowances, which enquiry will form the subject of a separate Report. 6. FUNERAL BENEFIT. (a) A. ustralian Mortality Experience. In the various schemes where provision has been made for the payment of sickness, invalidity, and superannuation benefits, it has generally been found necessary to take into consideration the question of providing a funeral benefit for the members, as the demand for this benefit has always been very popular in such funds. With the exception of New Zealand, where the death rate is 9·0 per thousand of the mean population, Australia'e. death rate of 9·9 per thousand is the lowest in the world, the rate for Great Britain being 11·7, and for the United States of America 11· 8. The male death rate for Australia in 1923 of 10 · 9 per thousand of population was considerably higher than the female rate of 8 · 8, notwithstanding the fact that the sickness experience of females is much heavier than that of males. The mortality rate for those under one year of age was equivalent to 58· 4 deaths per thousand of population under that age ; for the group aged one vear and under 20 years the rate was 2 · 5 ; 20 years and under 40 years, 3·8; 40 years and 60 years, 10·1; and 60 years and over, 56·6; approximately two-thirds of the population being within the age group one year and under forty, and subject to a much lower death rate than those in the other age groups. The heaviest mortality is

experienced in the group under one year of age, and indioa.tes the necessity tha.t adequate steps should be taken to remedy this heavy ann.ua1 loss of lifeJ whioh :represents one-seventh of the total deaths. An enquiry made in respect to the decennium 1901-1910 revealed the fact that tlie probable lifetime of males born in Australia was 64 • 3 years, as compared with 58· 3 years in England and Wales, and 57·4 years in the United States of America; that for females being for Australia, 68·5 years, England and Wales 62·9 years, and the United States of America 61·9 years, and this factor of longevity has an important bearing in the annual contributions required toward the cost of benefits under any proposed National Insurance scheme in Australia, where conditions are apparentlv favorable towards longer lives than those experienced in other countries. During the year 1923, the total number of deaths in Australia was 56,236, of which 31,622 were males and 24,614 were females. Of the males that died in that year 4·2 per cent. were engaged in professional occupations; 2·5 per cent. domestic; 9·2 Gominercial; 6·1 per cent. transport and communication; 30·1 per cent. industrial; 18·7 per cent. agricultural, pastoral, mining ; 23 · 3 per cent. were dependants ; and 5 · 9 per cent. occupation indefinitely stated ; and when the numbers engaged in these occupations are taken into consideration it is apparent that the heaviest rate of mortality is amongst industrial workers, ·who represent the largest section in need of the assistance of a National Insurance scheme.

The mortality rate for the whole population of Australia is stated to be heavier than that for friendly society members ; the average mo!'tality rate per thousand members of three of the leafting Victorian frienrtly sociP-t:ies was 9 · 7 as against 13 · 9 for the Australian population of similar ages; in Tasmania for the year 1922 the mortality rate of friendly societies per thousand members was 7 · 7 as against 11 · 4 for the total population, which indicates that friendly society members are, owing to the restrictions as to age and physical standard, selected lives.

(b) Funeral Benefits Available.

(i) Mutual Assooiations.-Friendly societies generally provide for the payment of a funeral benefit at the death of a member, and the majority of members are contributing for such benefit ; the cost of funeral benefit varying in accordance with the age of the member when joining. The Friendly Society Act in each State prescribes the maximum amount of funeral benefit payable, and there is a lack of uniformity in the Acts in this respect ; the maximum amount payable in New South 'Vales being £200 ; Victoria, £100 ; Queensland, £200 ; South Australia, £50 ; 'Vestern

Australia, £300; and Tasmania, £100. The amount of ordinary funeral benefit provided u.nder the rules of the numerous societies in each State also varies to a considerable extent, the minimum amount payable on the death of a male member usually being £20, and the maximum benefit in a :Few instances £100; the average ordinary funeral benefit, however, is about £35. If the wife of a member her husband, a funeral benefit of from £10 to £ 15 is paid to the member in some societies, whilst in a few instances a benefit of from £3 to £5 is paid on the death of the memberts child. The total expenditure of friendly societies in Australia during the yea.r 1922 in respect of funeral benefits was £155,949. Several societies provide for the taking of additional funeral benefits up to the maximum provided by the Act by the payment of furlhe:r contributions. The Victorian Act, however, has only :reoontly been amended, and no particmlars are as yet available as to the extent to which such amended provisions have been availed of. In New South Wales the extended funeral benefits are very popular in certain societie8, as the premiums payable are usually lower than those charged by life assurance companies> owing to the fact that practically no expenses of management are charged by friendly societies against these policies, which are practically life assurance policies payable at death, and are on much the same basis as those provided by life assurance societies. Provision is made also in some societies whereby a member may, by an extra payment, draw a portion of the amount of benefit at age 60. There appears to be a desire that funeral benefits be still :further increased and that friendly societies should further enter into the :field of life assurance, although the Acts do not at present permit such action being taken. A funeral benefit of £50 is stated as being sufficient to meet the necea&ties of the circumstances for which it is provided, and the statement has been made that it was not the intention that friendly societies should engage in life assurance business. The amount of benefit provided is often on the basis of a graduated 8Cale according to the duration of membership. In other societies funeral benefit is increased on the death of a member by a special le-vy of from 6d. to Is. per member, which system is unACientifio in ite basia, and is canied out by the societies of their own accord, and shows that the benefit otherwis6 provided ism these cases considered inadequate. In trade union benefit funds, when the receipts do not come up to expectation, the fund has a right to levy on its members for the ba.lfl.nce, and in auch funds, where there is often a rapid succession of the levies become frequently necessary, aa it would be practically impossible to pay death benefits unless such levies were made; although a smaller funeral benefit ia paid if death were the result of an accident at work, as the Workers' Compensation Act provides

a certain sum under those circlllllSt4mces. ,

\., ..• ,

I

1293

(ii) . lttdUiftrial A88ttNnrA!.-At the end of the year 1922, fourteen assurance in Australia. were transacting industrial aasurance bu@iness, the total number of policies in force 1,061,569, and the total amount £35,303,23.1, representing an annual premium income

of ,148. There has been a considerable m-owth in this class of business in recent years, as is indicated bv the fact that a.t the end of 1917 there were 725,637 policies in force, tbe amount assured being £17,750,883, representing an annual premium income of £1,094,333. It is a noticeable fact that the annual -premiums paid towards industrial assurance poHcies in Australia

amounted to more than the total contributions towards all the benefits of other mutual benefit associations. The operations of industrial assuranee sorieties are restricted to the <'apital cities and large towns: it being estimated t"hat 80 per cent. of the inilustrial business is in the capital cities. This insurance is usually for small amounts, which in 1922 averageil £33 per policv, payable at death or in some cases at the end of a specified 11etiod, in return for sma.ll weekly premiums, averaging less than Is. per policv, genf"'rallv collected bv a.uthorized agents at the home and places of business of the policy-holders. Most of the industrial assurance orga.nizations in Australia are mutual societies. and consequentlv there is no profit to other than the -policv--holders. When a profit has resulted on the year's bonuses are usually issued to holders of

policies which have been in oneration for a perio(] of five vears ; such bontises have averaged from 1 per cent. to 2 per cent. of the sum insured. The societies operate mostly the industrial section of the population whose incomes are small anil are naid weekly, and who are nnahle to pay the annual premiums necessarv in connexion with ordinary life assurance. The mortality

amongst this section is slightly higher than that for the general population. No medical examination of apPlicants is required unless the policy is for a large sum, but a restriction is made that during the first six months, unless death be due to accident, only one-quarter of the amount assured wonld be paid, and for the second six months half of the amount ; the full amount being

paid after the policy has been in force for twelve months. A policy can be terminated at death, maturity, by surrender or exchange for a fully paid up policy issued, or by lapsing. The greatest cause of termination of contracts during the early stages of industrial assurance is by lapsing ; th.e smaller the amount

asSUl'ed, the greater the possibility of lapsing, hence the experience of lapses in England is higher than that in Australia. Many factors operate amongst those who take out industrial assurance policies. Premiums must be paid within a period of four weeks from the date due, and if then not paid the policy automatieally lapses, but the policv-holder has the right to revive the policv at any time during a period of twelve months from the date of Ruch lapse,

subject to certain limitations. Of every 1,000 entrants int.n industrial assurance in I918 in one industrial assurance society in Australia, 289lapsed in the first year, 91 in the second vear, 44 in the third, 25 in the fourth, and 22 in the fifth year, or a total of 471, equivalent to 47·1 per cent., lapsed within five years. Another society had 28 per cent. lapses. in the first three months, I3

per cent. in the second three months, 6 per cent. in the second half of the first year, 5·3 per cent. in the second year, 3 · 7 per cent. in the third year, 3 · 0 per cent. in the fourth vear, and 2 · 5 per cent. in the fifth year, or a total lapse rate of 6I ·5 per cent. within five years. This clearly shows that lapsed policies represent a considerable waste of effort.

It has been stated that industrial assurance has not interfered very much with the work of friendly societies, and that industrial life assurance aims, in a measure, at compensating the loss of the bread-winner, as well as making provision for the children. Industrial assurance societies insure infants from one month old upwards, about 40 per cent. o£ the policies in one large

society being issued on lives of children under age of five years, and about 11 per cent. for those between the ages of six and fifteen years. During the first year of life mortalitv amongst chilc1ren is after one year of age there is a considerable improvement in the mortality rate, and when a child has reached :five years of age the expectation of life is good, and any lapse which takes place thereafter is of benefit to the society, and is regarded as a set-off against losses arising from lapses in the earlier years. The cost of management of one industrial assurance society in Australia

totalled 31·5 per cent. of the premium income; in another the expense rate was 33 per cent.; the expense rate in another instance increased from 34 ·I per cent. to 43 per cent. in a period of three years, owing to the increased cost of obtaining new business. As the societies are now writing larger policies than formerly, there is generally an average reduction in the expense rate,

but the system under which premiums are eollected by agents necessarily results in a very heavy percentage of expenditure on administration. At the end of 1922 there were 245,728 ordinary whole-life policies in force in Australia, the total sum assured being £102,921,I79, the average sum assured per policy being £419. The endowment assurance policies totalled 461,616 for a total sum assured of £82,514,293, the average per policy being £179. Other assurance policies totalled 8,392, for a total sum assured of £4,882,1 nl , the average per policy being £582, and pure endowment policies 54,157, for a total of £6,527,177

assured, or an average of £121 per policy. The total number of policies for all classee was 769,893, for a total sum assured of £196,844,810, or an average sum aasured per policy of £256. As many

26

policy-holders have more than one policy, the average amount of assurance per policy-holder would be higher than the average per policy shown by these figures. At the end of 1922 the sum assured by 769,893 ordinary and 1,061,569 industrial policies combined totalled £232,000,000, l

pdelr for thebpopulation otf anthdfunin addi

1 ·tbion fithte ,

grea rna J or1 y o e · , I en y society mem ers were con r1 u mg or e era ene s

provided by the various friendly societies.

(c) Funeral Benefit Recommended.

In view of the above-mentioned statistics, the same necessity for the provision of a funeral benefit under National Insurance does not exist as in the case of other. benefits under consideration. The provision of a funeral benefit, however, would guarantee a definite benefit in respect of those insured members who may not become eligible for the other benefits provided. Under National Insurance in England no provision is made for the payment of a funeral benefit, but many industrial assurance societies have registered as approved societies under the Act for the administration of health benefits, and their total membership represents 44 per cent. of the total insured persons in Great Britain.

The following weekly rates of contribution will be required to provide a funeral benefit of £20, £30, £40, and £50 on the death of an insured person, whether the death occurred when the insured member was still contributing, or was in receipt of any benefit :-Funeral Benefit-Weekly Rates of Contribution.

Males (to Age 65.) Females (to Age 60).

Age at Entry.

£20. £30. £40. £50. £20. £30. £40. £50.

s. d. s. d. s. d. s. d. s. d. s. d. s. d. s. d.

16 .. .. 0 1·0 0 1•5 0 2·0 0 2·5 0 0·9 0 1·4 0 1·8 0 2•3

17 . . .. 0 1·0 0 1·5 0 2·1 0 2·6 0 0·9 0 1·4 0 1·9 0 2•4

18 . . .. 0 1•1 0 1·6 0 2·1 0 2·7 0 1·0 0 1•5 0 2·0 0 2·5

19 . . .. 0 1·1 0 1·7 0 2·2 0 2·8 0 1·0 0 1•5 0 2·0 0 2·6

20 .. . . 0 1·1 0 1·7 0 2·3 0 2·9 0 1•1 0 1·6 0 2·1 0 2•7

21 . . .. 0 1·2 0 1·8 0 2·4 0 3·0 0 1·1 0 1·7 0 2 ·2' 0 2·8

22 . . .. 0 1•2 0 1·9 0 2·5 0 3·1 0 1·1 0 1·7 0 2·3 0 2·9

23 . . .. 0 1·3 0 1·9 0 2•6 0 3·2 0 1·2 0 1·8 0 2•4 0 3•0

24 . . .. 0 1·3 0 2·0 0 2·7 0 3•3 0 1·2 0 1·9 0 2·5 0 3·1

25 .. .. 0 1•4 0 2·1 0 2·8 0 3•5 0 1·3 0 1·9 0 2•6 0 3•2

26 . . .. .o 1·4 0 2•2 0 2·9 0 3•6 0 1·3 0 2•0 0 2•7 0 3•3

27 . . .. 0 1·5 0 2·2 0 3·0 0 3•7 0 1·4 0 2•1 0 2•8 0 3•5

28 . . .. 0 1·6 0 2•3 0 3•1 0 3•9 0 1·4 0 2·2 0 2•9 0 3·6

29 . . .. 0 1•6 0 2•4 0 3·2 0 4•0 0 1·5 0 2•3 0 3•0 0 3•8

30 .. . . 0 1·7 0 2·5 0 3·4 0 4·2 0 1·6 0 2·4 0 3•1 0 3·9

31 . . .. 0 1·7 0 2·6 0 3·5 0 4·4 0 1·6 0 2•5 0 3·3 0 4·1

32 .. . . 0 1·8 0 2·7 0 3·7 0 4•6 0 1·7 0 2•6 0 3•4 0 4·3

33 . . .. 0 1·9 0 2·9 0 3·8 0 4·8 0 1·8 0 2·7 0 3·6 0 4·5

34 .. . . 0 2·0 0 3·0 0 4·0 0 5•0 0 1·9 0 2·8 0 3•7 0 4·7

35 . . .. 0 2·1 0 3·1 0 4·2 0 5·2 o. 2·0 0 3•0 0 3•9 0 4·9

36 .. . . 0 2•2 0 3·3 0 4·4 0 5·4 0 2·1 0 3·1 0 4·1 0 5·1

37 .. . . 0 2·3 0 3·4 0 4•6 0 5·7 0 2·2 0 3·2 0 4•3 0 5•4

38 . . . .. 0 2•4 0 3·6 0 4·8 0 6·6 0 2·3 0 3·4 0 4·5 0 5·7

39 . . .. 0 2·5 0 3·8 0 5·0 0 6•3 0 2·4 0 3·6 0 4·8 0 6·0

40 . 0 2·6 0 4·0 0 5·3 0 6•6 0 2·5 0 3·8 0 5·1 0 6·3 . . . . 41 . . .. 0 2•8 0 4•2 0 5'5 0 6·9 0 2•7 0 4•0 0 5'4 0 6•7

42 .. . . 0 2•9 0 4•4 0 5'8 0 7•3 0 2·8 0 4•3 0 5•7 0 7•1

43 . . .. 0 3·1 0 4•6 0 6'1 0 7•7 0 3·0 0 4•5 0 6'1 0 7·6

44 . . .. 0 3•2 0 4•9 0 6•5 0 8·1 0 3·2 0 4•9 0 6•5 0 8·1

45 . . .. 0 3·4 0 5·2 0 6•9 0 8•6 0 3·5 0 5·2 0 7·0 0 8•7

The suggestion that a funeral benefit be included in .t:fte.-scheme has been considered, and your Commissioners are of the opinion that the provision ef ·a funeral benefit is not essential at the inauguration of a National Insurance scheme, but may l:>'tl worthy of further consideration when the experience of the administration of the other benefits can be reviewed.

7. CHILD ALLOWANCE.

In order ,.j;Q equitably provide for the distinction between the . single men, married men without depen4ant8, married with dependants,. a supplementary of each dependent child under age siXteen should be pa1d to the wage-earner durmg mcapae1ty resulting fromislckness, accident, and old age ; such allowance to be additional to other benefits receivable by him. The payment of this allowance will remove many anomalies which arise where a flat rate of benefit only is paid, and is a necessary extension to any system of National Insurance

27

1295

which aims at an equal ·distribution of the risks and an equal distribution of ·benefits amongst all insured under a collective scheme. The incidence of the burden on the

when incapacitated for work varies in accordance with the number of his dependent children, and National Insurance is an especially suitable method of assisting him t o make provision to meet future contingencies. The necessity that some satisfact ory and adequate distribution of benefits should be made is shown by the fact that of the male population between ages 16 and 65 in Australia 50 per cent. are married, and of those married 13 per cent. have no children, 15 per cent. have one

child, 15 per cent. have two children, 12 per cent. have three children, 10 per cent. have four children, 8 per cent. have five ·children, and 27 per cent . have over five children, and obviously it would be anomalous for a benefit only to ·be made available in each instance of incapacitation of · the In support of this suggestion it has been stated that the payment of similar

allowances during the war in respect of soldiers' children resulted in a very noticeable in the children's health and was also of great assistance in their maintenance. The weekly rates of contribution required to provide a child allowance of 3s. , 4s. and 5s. per week in respect of dependent children under the age of 16 during the incapacity of the insured '

member are as follows:-CHILD ALLOWANCE- DURING INCAPACITATION.

Weekly Rates of Contribution.

---

Males (to Age 65).

Age at Entry. - 3s. 4s. 5s.

Per Week. Per Week. Per Week.

8 . d. s. d. s d.

16 . . .. . . . . . . 0 0•9 0 1·2 0 1·5

17 . . . . . . .. 0 0•9 0 1·2 0 1·5 . 18 . . .. . . . . . . 0 0·9 0 1·3 0 1·6

19 . . . . . . . . . . 0 1·0 0 1·3 0 1•6

20 . . .. . . . . . . 0 1·0 0 1·3 .o 1·6

21 . . . . . . . . . . 0 1·0 0 1·3 0 1 •6

22 . . .. . . . . . . 0 1·0 0 1·3 0 1·7

23 . . .. . . . . . . 0 1·0 0 hl 0 1•7

24 . . .. . . . . . . 0 1·0 0 1·4 0 1•7

25 . . .. . . . . . . 0 1·1 0 1·4 0 1·8

26 . . .. . . . . . . 0 1·1 0 1·4 0 1·8

27 . . .. . . . . . . 0 1·1 0 1·5 0 1•8

28 . . . . . . . . .. 0 1·1 0 1·5 0 1·9

29 . . .. . . . . . . 0 1·2 0 1·6 0 1•9

30 . . .. . . . . . . 0 1·2 ·o 1·6 0 2•0

31 . . . . . . . . .. 0 1·2 0 1·6 0 2·1

32 . . .. . . . . . . 0 1·3 0 1·7 0 2·1

33 . . •. ; . . . . .. 0 1·3 0 1·7 0 2•2

34 . . . . . . . . .. 0 1·3 0' 1·8 0 2•2

35 . . . . . . . . .. 0 1·4 0 1·8 0 2•3

36 . . . . . . . . .. 0 1•4 0 1·9 0 2·4

37 . . . . . . . . .. 0 1·5 0 2·0 0 2•5

38 • 0 1·5 0 2·0 0 2·6 . . . . . . . . ..

39 . . . . . . . . .. 0 1·6 0 2·1 0 2•6

40 . . . . . . . . . . 0 1 ·6 0 2·2 0 2·7

41 . . . . . . . . . . 0 1·7 0 2•3 0 2·8

42 . . . . . . . . . . 0 1·8 0 2·4 0 3•0

43 . . . . . . . . .. 0 1·8 0 2·5 0 3•1

44 . . . . . . . . .. 0 1·9 0 2·6 0 3·2

45 . . . . . . . . . . 0 2·0 0 2·7 0 3•3

Your Commissioners recommend that provision be made for a child allowance of 5s. per week in respect of each dependent child under age 16, to be payable to the insured member when incapacitated for work.

(B) NATIONAL HEALTH SCHEME.

As previously stated, your Commissioners are of the opinion that a National Health should be instituted which will aim at adequate medical treatment for the people, and whiCh Will provide the requisite machinery for the prevention of sickness and accident ; and also that the Health Scheme should be dissociated from the administration of the National Insurance Fund.

It is further recommended that the functions and objects of the Health Department be extended in such manner as will enable provision to be made as early as possible for the effective supervision of adequate medical services, especially with respect to maternity treatment.

. The functions and operations of existing orf.'(a.ni.iations in AnstraJia and the question& which will require consideration at the inception of a NatiOl'lal Health Scheme are as follows : ......

J. MtmcAL BENEr:r:ts.

(a) 'Medical societies in At1stra.lia make wherever­

possible with local merlical rmu•titioners for meifical attendance on members, such ments being genertt.11v in the form of a, eontmct, although not always sitmed, between the individual branch of the society and the medil"a1 nrartitionel'. in arcordartce with the mooel form of accepted bv the· State branch of the British Medical and the Friendly

Ftocieties' ABMeiation. The mAdicaJ benefits Strpemsed by the bnmchf's of the society, and the members thereof hal"e freedom of cboice with respect to the lodt!e doctor bv whom they dt-sire to be attf'ndeit. e:re termintt.hle at an'\t time upon threP months' notice by either party. The form of agref'ment is the reStllt of the p&rtie8

ooncerne<:l, and there is a variation between those into in the seveml States owing to each State organization having settled the question sepatattily. A memher joining a friendlv societv since the date of the agreement is only entitled to medical attendance if his income (including, if married, that of his wife) at the time of joining is less than the income stated in the agreement. The annual prescribed by the agreements in the several Rtates are as follows :-New Wales, £260; Victoria. sin'lle £260, married £312; Queensland, single £208, married £260: South Australia, £312; Western Australia, single £260, married £320; Tasmania, £208. The mf'mher continues to be entitled to medical

attendance so long as his income does not exceed in New South Wales £S64 per annum, in Queensland £400, in Australia £450, in Western Australia £400, and in Tasmania, £312. A special proviso is usually made with respect to members having a large number of dependants.

The lodge doctor is remunerated on the basis of an agreed contra.ct rate per member per quarter, and in accordance with the number of members on the Jist forwarded to him by the secretary of the branch of the society a.t the bewnning of each quarter. The meoical fee is paid irrespective of whether the member receives medical attendance or not. This remuneration covers the cost of treatment of the lodge member, his wife and dependent children up to the age of sixteen in the case of males, and to age eighteen in the case of females ; the widowerl mother of an unmarried member, if wbolly dependent ; the widow of a deceased member and dependent children ; and the dependent brothers and sisters of an unmarried member.

The most important variation in the terms of the agreement is that relating to the contract rate of remuneration payable to the medical practitioner, wllich varies appreciably in each State ; the annual rate per adult membe.r paya.hle in the metropolitan area in the several States being ·as follows :-New South Wales, 26s.; Victoria, 20s. ; Queensland, 24s.; South Australia, 4ls.

(including medicine); Western Australia, 24s.; and Tasmania, 20s. The country rate varies considerably according to the district, and is invariably higher than that for metropolitan areas, being in some districts as high aa 44s. per member per annum for medical attendance only. In country districts a mileage fee at a rate varying from 2s. 6d. to 7s. 6d. per mile is charged in addition for travelling to the patient's home. Junior members and single female members in some instances

are charged lower rates, but in others they must pay the same.rates for medical attendance as an adult married wage-earner ; such fees helping to pay for the cost of attendance on members' wives and dependants; the contract rate of remuneration being thus regarded from an insurance standpoint. A lodge doctor is not precluded from entering into an agreement to receive more remuneration tban the minimum · stated in the model form of aweemE>nt, but aceording to the British Medical Association's ruling he must not agree to do the work for less than that minimum. A medical practitioner may, and often does, enter into an agreement with more than one friendly society branch.

The services to be given by the doctor cover ordinary general practice. only, special services, if required, being performed by the doctor at an additional fee privately arranged between the friendly society member and the doctor, in whleh case a reduced fee is usually charged. A Jist of minimum charges for such special treatment is, in some States, attached to the agreement. As the scope of treatment is thus limited to minor ailments only, it has been suggested that the agreement should be extended to provide for treatment of a specia] nature, and which must now be paid for separately, in order that breadwinners may obtain the services of surgeons for major operations at reasOnable rates, as the majority are unable to afford major operations, and many are debarred from entering public hospitals. The National Insurance scheme in England only prol'ides for a similar medical service to that now in operation under the friendly system in Australia. It has been suggested that an agreement, having as its basis the payment of a :tla.t rate per attendance; would be more satisfactory and equitable for all concerned than the present contract ra.te.

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It is estimated that in Australia about 40 per cent., of the medical practitioners who are in practice at the are carrying out friendly society work. Most doctors when Commencing in a new distrwt are available for frwndly society work; most country ·medical practitioners undertake lodge practice, and it is stated that most metropolitan doctors have at one stage in their

career carried out the duties of a lodge doctor. On the other hand, many medical practitioners will not undertake friendly .society practice, as their services are otherwise fully engaged. No limit is placed on the number of friendly society members allotted to a doctor, as the largest branch of society seldom exceeds 500 members, and the occasion or necessity for such limitation does

not often occur, although under the present system one. medical practitioner n::tay be appointed lodge doctor for several ·lodges in the district. A medicar practitioner cannot satisfactorily and adequately deal with more than a certain num.ber of patients. In some areas the people are more liable to

and children of members make a heavy practice, and the doctor generally requires considerable time for his ordinary private practice. It is stated that 500 members can be adequately attended by one doctor, 800 become a burden, and 1,000 are considered overwork. In some localities the loc.lge doctors have an arrangement whereby they work in pairs, and this arrangement, together

with a system of centralization of patients, tends to increase the number that can be attended. In country areaa, where there are difficulties in organizing the work, and considerable tra veiling involved, 300 members are considered the maximum. In the early days of National Insurance ·in England there was no limit to the number of insured persons allotted to a doctor, but now,

as the result of experience, it has been found necessary to fix a limit. Friendly societies in some districts have associated together for the purpose of forming a medical inatitute, having as its object the provision of medical attendance for members, such medical attendance being carried out by a full-time medical officer employed by the institute. There has been considerable difficulty, however, in obtaining medical practitioners who will do t4e work under those conditions, as the British Medical Association is entirely opposed to such arrangements. The annlllLl rate of contribution paid by members for the services of the medical

institute doctor is generally less than that paid under the common form of agreement entered into with private px·actitioners. In a few instances a hospital has been established in connexion with medical institutes for the institutional treatment of members, it being provided that the patient must have been a member of the institute for a period of twelve months prior to

treatment, in which case a nominal amount of from 15s. to £1 per week is charged to the member fo.r his treatment and maintenance. whilst ill hospital. It has not bee11 possible to obtain complete data as to the average number of occasions on which a lodge doctor is required to atumd a lodge member, and his dependants, duxing the course of a year. The particulars available, however, show a variation of from seven to fifteen visits per annum for the lodge member, his wife and family, representing an approximate average

of about ten visits per member per annum, of which three would represent visits to the patient's home, and seven consultations in the doctor's surgery. Under National Insurance in England the average is 3 · 5 visits per member per annum for the insured person alone, and in Scotland the average is approximately four visits for the member annually ; medical benefit in the United Kingdom being provided for the insured person only, at a contract rate of 9s. per member per annum ; medical benefit for a member's wife and family being obtained, if required, through the

voluntary friendly oociety system. During the year medical attendance and medicine made available to friendly society members in Auatralia cost £671,921. During the period from .1870 to 1915, the cost of medical benefit per friendly society member throughout Australia oscillated slightly from year to year, and was on the average less than 21s. per member for medical attendance and medicine. In 1915 it was 20s. 5d., and since then there has been a continuous increase up to 26s. 5d. in 1922, representing an increase of 29 per cent. as compared with a rise of 25 per cent in wholesale priced, and 62 per cent. in wages for the same period.

Medical benetits are considered by friendly societies to be essential to their objects, as they are a great attraction to new members, and the societies do not favour opening a branch where a doctor is not available. The majority, so it has been stated, join friendly societies in order to obtain medical benefi:tB, and this statement supports the opinion that the medical service is satisfactory and is now working fairly smoothly, although with a service providing in Australia for over 524,000 friendly society members and their dependants it is only to be expected that difficulties will occasionally arise.

. The present system of medical attendance arranged by friendly societies is stated to be faixly adequate for the purpose required, although the tendency in recent years, so it is suggesteds has been to cut down t.he service included in the contract to the lowest possible limit, but there is no complaint, however, as to the standard of the service rendered. In the metropolitan ate.u

medical beneJits are more nearly adequate than in country districts, as public hospitals llBlldly

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provide facilities for special treatment such as X-ray, bacteriological or vaccine treatment. If the aim to be attained is that adequate medical treatment shall be. available for all requirements, the present arrangements will require considerable extension and co-ordination. Outside the metropolitan areas there are few doctors who practice as specialists, and thel,'e are inadequate facilities locally for special examination and treatment.

At the present time there is one doctor to every 1,400 of population in Australia, and it has been stated that the population of Australia is well served as regards medical attendance; on the other hand, although the poor are provided ·for by public hospitals, and the rich by private hospitals, yet the middle cla!!S, wherein is included the majority of the population, is debarred the benefits available to the needy and has to provide·for itself without any assistance. National Health Insurance, so it is stated, tends to commercialize medical practice, and the medical profession is not agreeable to any existing form of National Health Insurance being instituted in Australia, although it has no objection to the principle of the friendly societies' medical service, but it objects to an extension of contract practice.. No doctor, so it has been suggested, should be compelled to undertake contract practice, as his services would be of less value if such compulsion were used, and further, that under a national insurance medical service the relations between the patient and the medical practitioner are changed, generally to the detriment of the patient's interest, by the. intrusion of a third party in the form of a Government representative.

Once a doctor agreed to do such work, however, he should be compelled to act in accordance with the regulations, and be subject to a penalty for any ·failure to do so. It has been further suggested that 'the cost of ·providing adequate medical service in the sparsely populated areas of Australia would be very heavy. ln recent years in England, a gradualchange is said to have taken place in the character of the medicines ordered by medical practitioners, as the result of the institution of national insurance and the establishment of the Ministry of Health, and since the inception of national insurance in. England the medical · profession is on a better financial basis than formerly.

The provision of medical benefit under National Insurance in the United Kingdom has resulted in a most involved and difficult problem of administration,. and it has been suggested that far more satisfactory results would be obtained in Australia if arrangements were made whereby the insured person received an amount of sick-pay per weekwhich would enablehim to make his own arrangements with any medical practitioner for the services required. · Alternative suggestions have been m,ade that the Government should engage whole-time doctors on a salary basis for any medical attendance required under National Health Insurance, or that the medical

professionshould be nationalized. Your Commissioners are ofthe opinion, however, that health supervision is not necessarily a subject for insurance, and· medical benefit is essentially a matter for the Health Department, as· a patt of a National Health Syst.em, as distinct from a National Insurance Scheme. · · ·

(b) Supply of Medicine.-The arrangements for the supply of medicine to members of friendly societies are delegated by the society to the individual branches. In the metropolitan and provincial urban districts most of the lodge dispensing work is undertaken by friendly society dispensaries which have been established for the purpose. Jn the smaller provincial towns and in the country districts, wh,ere there are no friendly society dispensaries or where the numbeJ: of members is insufficient to warrant the formation of a dispensary, the branches have entered into contracts with private pharmaceutical chemists to undertake the work for a remuneration based on a contract rate per member per quarter. In some . parts of the Commonwealth somewhat similar contracts are entered into with the lodge doctor, who· does the dispensing .work himself; but this practice is not generally approved of and is discouraged as much as possible, alj:;hough in many country districts there is insufficient population to support a chemist under present conditions, and it is thus impossible in t}wse . districts to separate prescribing from dispensing. . In other localities where the contracted to be paid to the lodge doctor also covers the cost of medicine, the doctor sometimes enters into a private arrangement with the chemist for dispensing the prescriptions which he issues.

Friendly society dispensaries are separately constituted organizations, . the capital, at the establishment of the dispensary, having been furnished by the branches of the friendly societies, have affiliated for the purpose, by debentures, or by loans, or in a few instances by loans from t}le State Government. In some instances dispensaries have registered under the Shops Act in order to be in a position to retail chemists' sundries, &c., to the general public as well as to members. Each dispensary is governed by. an . executive appointed from representatives of the various societies connected with it. All the. societies in the district

generally participate . in . a when Members .of trade

funds m some are to of the dispensaries,

and are elJrohfe for the provided. The maJority of friendly somety members contribute it4p•the local dispensary, although a small percentage prefer to make therr own

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priy.ate arrangements for the supply of medicine. Each society regularly forwards to the dispensary a hst, showing the names of the members who are contributing for the supply of medicine, and .. the executive of the dispensary assesses the amount of the members' contributions requrred on the basis of the cost of maintaining the dispensary ; in the event of the contribution

proving insufficient, it is automatically increased to meet requirements. The average contribution for the supply of medicine to a member, his -vvife, and dependltnts (males un'der age sixteen, females under age eighteen) ranges from 8s. to 12s. per annum; for single member 4s., and for a juvenile member 1s. 6d. to 2s. In industrial areas, where there is a heavy demand for medicine, a larger

annual subscription is required from members.. In cases where the dispensaries make a profit from. the sale of chemists' sundries, this profit is used in the reduction of the quarterly contribution reqmred from members. For this contribution anything within the British Pharmacop(J3ia, when prescribed by a qualified medical practitioner, is issued by the but patent or proprietary

medicines must be paid for in addition, usually at a reduced price. Where special medicines form a part of a prescription, they are generally dispensed without additional charges; certain sundries, if included in a prescription, are also supplied without charge-. Some dispensaries lend certain surgical appliances to their members, usually at a small fee, but special surgical appliances must

be purchased by the member. at his own cost. Most dispensaries have been able to accumulate sufficient funds to repay the original loap_s obtained at their establishment, and also to pay for the cost of the buildings occupied. The arrangements for the supply of medicines by dispensaries to friendly society members are generally held to be adequate for the purpose required, although it has been suggested there should be an extension of such benefits, which would enable all drugs ·to be supplied under the same conditions as now operate in respect to those drugs incl.uded in

the British Pharmacop(J3ia. . • .

The contracts entered into with private pharmaceutipal chemists vary throughout the Commonwealth, the contract rate per member ranging from 8s. to 15s. per annum, and for this remuneration the chemist undertakes to supply medicine for the member, his "'ife, and dependent · children, males under age sixteen, and females under age \eighteen, in accordance with the

prescriptions issued by the lodge doctor. The member has the tight of selecting on which available chemist's list he requires to be placed. Special prescriptions must be paid for in addition, and similar provisions apply to patent medicines, but in such cases a reduction in .current prices is usually made. In some districts the chemist, instead of accepting the usual per capita rate payment, undertakes to dispense· all medicines for mern,befS at a fixed percentage, usually from 25 per cent. to 33 pet cent. below current retail'. prices. · TI,.e services rendered by

private pharmaceutical chemists under these contracts are generally to be satisfactory, but the chemists, however, consider lodge work to be somewhat uncertain, as they are unable to estimate whether the contract rate will be sufficient to cover the expenditure during any period. The charges made by dispensaries for the supply of medicine to members are generally ·lower than those of private chemists for similar work, as there is a greater volume and continuity of dispensing ·work in a dispensary, which is also not subjected to the sante overhead expenses as a private

chemist, and also owing to the fact that lodge prescribing· is usually based on a standard pharmacopreia, and this system enables a large percentage of stock medicines to be used.

·. Full particulars, showing the average nu)llber of prescriptions. dispensed per friendly society member per annum cannot be readily obtained from private pharmaceutical chemists und

prescriptions were dispensed for 231,039 members, representing an average of 8 · 3 prescriptions dispensed per annum in respect of the member, his wife, and dependants .. The estimates supplied by private chemists indicated a range of from six to fifteen prescriptiOns per member per annum. It is estimated that from 50 per. cent. to 60 per cent. of the prescriptions were mixtures, 5 per cent. to 9. per cent. ointments, 5 per cent. to 8 per cent. lotions, 5 per cent. to 10 per cent. liniments, 5 per cent. to 7 per cent. powders, 3 per cent. to 4 per cent. pills, and the balance consisted of special preparations. Estimates which have been made by

dispensary officials show that about 35 per cent. of the prescriptions are repeated. Repeat prescriptions were abolished under National Insurance in England in 1920, owing to the danger of a repeat prescription being issued to other than the insured member, and also on account of the time occupied by the chemist in looking up the original prescription record. The above

prescriptions dispensed. by the friendly society dispensaries averaged a total cost .of 12: 6d. per prescription, representmg 5 ·3d: for drug contents, and 7 ·3d. for the cost of d1spensmg and overhead charges, although, owing to the fact that profit is made on cash sales, it is not always possible to accurately arrive at the actual cost per prescription. In private pharmacists' this is especially so, and particulars were furnished showing that the cost of lodge prescnptwns

ranged from 15d. upwards. It has been stated that if chemists were fully oc0upied on dispensing

32

work, and the doctors wrote prescriptions in accordance with a. uniform pharmacop

Under the present contract system, a definite rate is paid per quarter for each member, irrespective of whether the member receives medicine or not, with the result that the remuneration is higher per prescription when members are healthy and when fewer prescriptions are dispensed than at the time of an epidemic, when more prescriptions are dispensed. The average cost of prescriptions varies in certain districts, owing to some medical practitioners prescribing more expensive ingredients than others. The most desirable system for payment of medicines is stated to be that .having for its basis payment for services rendered at an average flat rate per prescription dispensed, a uniform pharmacopooia being adopted for the purpose, and the cost of special prescriptions being met from a special fund earmarked for the purpose. A uniform pharmacopooia would be in order that the scheme could be run on lines, as it would be a means towards quick work and time saving, and in order· that a basis for the calculation of a prescription flat rate could be effectively ascertained.

(c) Other Medical Benefits .. -No general arrangements for dental treatment have been adopted by friendly societies, although in some branches arrangements have been made for the provision of dental benefits for members at reduced rates. Provision is made by some societies whereby, for the payment. of a contribution of 2s. 6d. per annum a payment of from los. to 20s.

per week is made in respect of a member undergoing treatment in any hospital in the Commonwealth. 2. INSTITUTIONAL TREATMENT • . (a) Hoapitals.-At the end of the year 1922 there were 161 general hospitals in New South Wales ; Victoria, 53 ; · Queensland, 97 ; South Australia, 41 ; Western Australia, 52 ; Tasmania, 15; Northern Territory, 5; making a total of 424 for the Commonwealth. The number of beds

available in these hospitals was as follows ;-New South Wales, 7,382; Victoria, 3,627; Queensland, 3,872; South Australia, 1,578; Western Australia, 1,729; Tasmania, 736; Northern Territory, 45; representing a total of 18,969 beds available in all general hospitals throughout Australia, and equivalent to only 3 · 3 beds available for each thousand of population.

The number of beds available in proportion to the population in the metropolitan areas is, however, considerably lower than this figure. The number of persons who received indoor treatment in such hospitals in 1922 was as follows ;-New South Wales, 96,978; Victoria, 34,161; Queensland, South Australia, 16,340·; Western Australia, 14,487; Tasmania, 10,470; Northern Territory, 151; a of 218,209 for Australia, comprising 118,845 males and 99,364 females, equivalent to 39 per thousand of the total population; the estimated average period of indoor treatment per patient being 21 days. In addition a large number of out-patients also received treatment, concerning which no definite particulars are available, but the total number is estimated at 300,000.

Many public hospitals are controlled ·directly by the Government, whilst others are by a specially' constituted central body for the State and are administered by local

orgallifations, which endeavour to obtajn as much local financial support as is possible by subsc:dptions, fees from patients and other efforts, and are subsidized by the Government. Some :hospitals have accumulated large balances for building purposes . . During 1922 the expenditure in connexion with general hospitals in Australia totalled distn. "bu. ted amongst the several States as :-New South Wales, £1,051,40? ;

VIctoria, £385,186; Queensland1 £510,672; South Australia, £245,140; Western Australia, £166,072 ; Tasmania; £77,015 ; and Northern Territory, £5,585; the total cost per in-patient per day ranging 8s. to 12s. The revenue of £2,498,177 consisted of Government grants, £1,106,160; feei''

grants being equivalent to 45 per cent. of the total expenditure. The expenditure on general hospitals has increased from £1,396,361 in 1917 to £2,441,075 in 1922. The bed accomodation in the same period has iricreased from 16,763 to 18,969, and the number of fudoor patients treated from 17 4,387 to 218,209. The increase in accommodation has not conformed to the increase in expenditure.

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The system under which a patient pays for treatment in public hospitals varies in each State. In some cases a :fixed rate of 7s. 6d. per day is charged to cover all treatment with the exception of operations, which must be paid for in addition when the patient is in a position to pay fees. In other States the patient is charged according to his means to pay, the charge

from 6s .. to 9s. per day, indigent patients being treated free of. charge, the

hospital committee having the responsibility of deciding what fees, if any, the patient is in a position to pay. In some instances a wage restriction is placed upon persons applying for t:eatment in public but generally every case is considered on its merits, each patient's crrcumstances being investigated by a hospital official, and the fee which he is asked to pay is

arranged according to his ability to pay. · Hospitals have different methods with regard to arrangements made with medical practitioners. In country hospitals they usually enter into an agreement to pay an annual salary, with the right of private practice and the right to charge for operations. This

arrangement is not encouraged, because it is considered that if a person is a proper subject for hospital treatment, such treatment should include everything necessary. In the. large public hospitals the honorary doctors are not permitted to charge for operations, and the Government subsidy is generally granted with the object of providing treatment for indigent patients.

The voluntary system of contributing fees to general hospitals together with a system of Government subsidies is stated to be more desirable than a system whereby the whole cost of hospital treatment would be borne by the Government, and the necessary funds raised by means of taxation.

. Hospital accommodation in the capital cities throughout Australia is generally inadequate, the larger hospitals being often overcrowded. In most country hospitals, however, this state of affairs does not exist, as there are very often beds vacant, due to the fact that some of the hospitals were built at a time when considerable progress was expected in the districts concerned, but the expectations have not been realized. In mining areas where there has been a reduction of population owing to a slackening of industry, there is generally at the present time more than

sufficient hospital accommodation available. Hospital accommodation throughout the Commonwealth could be more effectively and evenly distributed than at present. There is a centralization on metropolitan institutions owing to the fact that patients are of the opinion that they can receive more satisfactory treatment therein than in country hospitals ; full

facilities for adequate treatment not being available in some country hospitals. It has been suggested that these could be utilized for the semi-chronic cases now treated in the city hospitals, thus relieving to some extent the congestion which undoubtedly exists in metropolitan institutions. During the winter and at the time of an epidemic the facilities for institutional

treatment are totally inadequate to meet demands. In out-back areas it is stated to be impracticable to supply adequate institutional treatment owing to the great sparsely populated areas, but that state of affairs can be met to a great extent in many areas by an effective system of ambulances whereby patients can be transported to the nearest centre for treatment.

Maternity hospital accommodation is generaUy inadequate and the establishment of more maternity hospitals is very necessary in the interests of women and children, as well as for the training of nurses, the facilities for obtaining that training being considered insufficient at the present time ; in the country districts especially there is a great paucity of maternity hospital

accommodation, and the extension of facilities for maternity treatment in country hospitals is essential. In the more populous districts maternity centres should be efficiently staffed training schools from which capable nurses could be requisitioned for domiciliary cases. With skilled medical attendance in well conducted hospitals, the mortality and morbidity amongst maternity

cases is low. Nursing homes of the simplest and most economical character should be established within easy reach of the people's homes. Clinics for pre-natal and post-natal care should be available, as well as child-welfare centres or baby clinics, either in connexion with public hospitals or preferably as separate institutions in order to provide sufficient facilities for the wives of,

bread-winners who are at present very often precluded from the benefits of public hospitals. There should be effective co-ordination of the various services operating under the maternity scheme. A serious shortage of hospital accommodation for infants is also apparent, facilities for such treatment having only recently been instituted, and it is found that the bed accommodatim1

available has not met the demand, considerable extension being imperative and essential. Private hospitals are registered under the local authority, and must conform to a certain standard, the registration dealing more particularly with the question of sanitary arrangements and the suitability of the hospital for the purpose for which it is intended, inspections being made by the public health authorities. It has been suggested that private hospitals could be largely

extended under a system of Government subsidies, as a valuable adjunct to medical attendance. A great deal could be done in increasing the equipment of hospitals and in bringing it up-to-date. New discoveries and new methods render it necessary that a continual expenditure is involved in supplying the various institutions with modern equipment.

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It is rapidly becoming important that adequate provision should be made in the more settled country districts for wards or hospitals for infectious diseases, and in view of the close relationship of the public health administration, a more complete association between the local health authorities and the hospital authorities is possible and desirable.

It is stated that under our present system the rich and the very poor are the best provided for as regards medical attendance, the former being able to obtain adequate medical treatment in private hospitals, and the latter in public hospitals, but the intermediate income class who do not wish to go into or are debarred from entering public hospitals, and who cannot afford to pay private hospital fees, are unable to obtain adequate institutional treatment. Intermediate wards where private practitioners could attend their own patients and where fees would be lower than in private hospitals should be made available in connexion w·ith the public hospital system.

Every member of the community should be able to receive adequate hospital treatment, and there is no doubt that the provision of an intermediate hospital system would give a great measure of relief, as it would enable adequate institutional treatment facilities to be made available to. the large section of breadwinners who can afford to pay something, but not the full cost of the treatment they receive, and who thus require a certain amount of Government assistance.

(b) Sanatoria.-Government and private sanatoria have been established in each State for patients su:ffering from incurable diseases, and for tubercular patients, the functions of a sanatorium being the education and care of the patient and the prevention of the spread of the infection to others. The question of payment by patients in State sanatoria is purely optional and is not pressed. At the present time there are insufficient sanatoria in Australia to cope vvith the demand. Some existing institutions have developed into homes for chronic cases which are kept indefinitely so long as they wish to remain, and, owing to the lack of adequate sanatorium accommodation, persons in advanced stages are treated in the same institution as curable cases, which is a most undesirable arrangement. Tubercular patients are not at present compelled to enter or remain in a sanatorium and a great number of people suffering from tuberculosis are not in such institutions. Even if accommodation were provided for all cases, they would not all avail themselves of it, as many could not be induced to enter such an institution unless

compulsory methods were used. A considerable proportion of pulmonary tuberculosis is directly passed from individual to individual, and a careless patient or su:fferer is a menace to his near associates, especially to his children. A person who has spent a few months in a sanatorium has a far better chance of overcoming the disease and far lesser chance of spreading the infection than one who has not had sanatorium treatment.

Sufficient sanatoria should be established for the treatment of special diseases, and any person in need of such institutional treatment should be able to receive it at once, and should be compelled to enter a sanatorium. Patients should be trained in suitable light occupations which may be useful to them when they leave the institution, and convalescent farms should be established where tubercular ex-patients can do remunemtive work under medical supervision, whilst being trained in suitable branches of farming. E:ffective provisions for after-care should be instituted as it is stated that unless patients are regularly examined after they leave the sanatorium, they

show symptoms of early relapse. When a patient leaves the sanatorium he should not be 'permitted to return to the same environment or occupation as that which caused the disease, and he should be compelled to report at specific periods after release.

(e) Laboratories.-Most of the bacteriological investigations required are undertaken in the capital cities by the Government laboratories or public hospitals. There is very little bacteriological equipment, however, outside the metropolitan areas. The Commonwealth laboratories have been of very considerable assistance, but the laboratory system in Australia should be considerably extended, as it is considered that the purchase of equipment and the · cost of its maintenance is so expensive that the Government should provide this service. The

erection of Government laboratories in the various districts throughout the State is considered essential to an adequate medical service, as no scheme for medical attendance and public health would be adequate unless it included an effective laboratory system, comprising serum laboratories which make biological products, and diagnosis laboratories established to serve as public health agencies, and which aim at providing service for the medical practitioner to enable

him to make an early and accurate diagnosis of his patients. A medical practitioner under present conditions is unable to treat as many patients as was possible formerly, and it would not be possible to carry on any national system ,of contract practice effectively without such laboratories.

(d) District Nurses.-Associations have been formed in the various St.ates for the of providing trained nurses for the outlying districts which are far from medical and nursmg aid. The nurses treat sickness, accident, and maternity cases, and when necessary accompany patients

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to a doctor or hospital The concerned raise the necessary funds locally, and these are su:rplemented by f:he central_ orgamzatwn from funds mainly obtained from charitable donations, or m some casesw1th the assistance of a Similar organizations are operating

. the class _of m the metropolitan areas, and are really charitable

providmg nursmg asmstance and relief for the sick poor in their own homes. The

of these nursing societies is very desirable, as they afford a considerable amount of

rehef to necessitous cases, and it is considered that Government assistance should be granted to such voluntary organizations.

. (e) Ambulance 8erv_ices.-Ambulance transport services have been established

m thmr functwns bemg to render first-aid and to transport cases of sickness and

accident to hospitaL• Funds are raised by voluntary subscriptions and bv fees for services rendered with Government subsidies. In Queensland alone last year" the Ambulance Transport

97,399 ?alls, a_nd travelled over 615,000 miles in connexion with the transport of

patients to hospital. It Is considered that ambulance services should be instituted and extended throughout th_e Commonwealth, as by such means it will be possible to make institutional the population residing in less populated areas, as well as providing

for. Immediate first-aid treatment. In the large areas in Australia where the

very_ sparse a_nd_ scattered, and where it is extremely difficult to provide

medical serviCes, fnendly_ soCieties do not provide such services to-day. The people who go out-bac_k are every help and consideration and it is essential that they

should b.P. '"''::.!;J@•)d m tl1e natwnal health scheme. Your Commissioners are of the opinion a system whereby aeroplanes would be available for transporting patients from out-back

statiOns to a centre should be given full consideration. In view of the aerial mail services have been _established in Australia and the possibility of the extension of these services

It should b: t_o arrange for aerial . of patie11ts to certain centres, at

each of whiCh It IS desirable that a mediCal practitiOner should be located.

3. PREVENTIVE HEALTH SERVICES.

(a) Public Health Organizat£ons.-The control of public health in the several States is usually vested in local government authorities who operate, under the supervision of a central health authority, in the administration of the Public Health Act. Public health legislation in Australia embodies supervision over the following :-Protection of water supplies from pollution ; sewers and drains and disposal of sewage; removal and disposal of night-soil; scavenging, removal ofrefuse, cleaning of streets, &c.; dwellings, boarding-houses, and lodging-houses; public buildings; nuisances and offensive trades; foods and disinfectants; infectious diseases; venereal diseases; vaccination ; private and public hospitals ; morp:ues, cemeteries and crematories ; registration of midwives, and general and mental nurses; maintenance of laboratories; the medical and dental inspection of school children ; the medical care of aboriginals ; the supervision of industrial hygiene regulations. This is a composite list representing the whole range of activities, but in no one State does the Health Act include all these functions. The Commonwealth Health Department's functions relate to quarantine, laboratories, prevention of disease, industrial

diseases, the Institute of Tropical Medicine, and to infectious diseases. In public health legislation there is an increasing tendency to control sanitation by means of by-laws and regulations, which, owing to their flexibility, are specially adapted for the purpose. With the increase in population throughout Australia there has been a corresponding increase in the responsibility of local government authorities, and the administration of public health matters

throughout Australia has been decentralized to such an extent that it is overburdened with administrative bases, few of which are in receipt of revenues which will enable them to out the duties evolved upon them. Inadequacy of effort and lack of funds have. resulted m the aim of effective control and prevention of infectious diseases not being fully achieved. The local

part-time medical officer of health is not made fullv responsible for health matters, whereas his functions in the community should be preventive. Uiitil a medical health officer is as an activ.e unit of public health administration, respo_nsible to the central no

considerable progress can be expected. The local health mspectors generally have msuffiCient status to enable them to properly perform their duties. Local authorities should grouped into districts in each of which a full-time medical officer of health would act as authorized deputy of the central health l:mthority.

The health of the people is of paramount importance, and dealt with by the

Government on more scientific lines than at present. A healthy commumty IS the greatest asset, as every incapacitated brea:d-winner is a loss to the_ State, and_ the he is made fit, the he will be of some economic value to the commumtv. NotWithstandmg the fact that Australia R general mortality rate compares very favorably with that of other countries, yet in the question

36

?f preventive medicme we are far behind. The science of preventive medicine is concerning and more with the health of the individual and the medical supervision of large numbers

of mdivrduals has become recognized as an integral part of the campaign to prevent the inception or the rrogress of disease. At the present time there are extensive legal provisions relating to e_nvrronment, whilst there is practically no legal provision with respect to the health of the

mdrv1dual, which is of the most vital importance in any system of insurance. Friendly societies have never dealt with their members from the preventive aspect. Public health activities should be extended in very many ways. Experience shows it is now essential for the success of preventive medicine that all practising physicians should become actively engaged in the official health campaign. The general practitioner should be co-opted in the scheme to 'vork with the public health authorities, as by such means a great advanee should be made in the direction of making medicine an part in the practice of medieine generally without affecting the independence of the

practitiOner. Adequate provision should be made for wards or hospitals for infectious diseases, and a more complete association between health authorities and hospital authorities is very essential. It has been suggested that all health matters should be supervised by the Commonwealth, and that a National Health Scheme should be formulated whereby there would be a combined Commonwealth and State Health Service under which general questions \vould be dealt with by the Commonwealth, whilst questions of local application would be dealt in the States under a system of district administration. It is essential that practical co-operation and efficient standards of administration throughout Australia should be realized, as it is onlyC)- ouch means that an adequate National Health Service can be attained.

(b) 111aternal Hygiene.-The principal causes of deaths of mothers in child-birth are five in number, viz., accidents of pregnancy; puerperal hremorrhage; other accidents of labour; puerperal septicaemia ; puerperal albuminuria and convulsions. It would appear that in hospitals or where skilled attention is available these last four causes of death can be largely eliminated. Pre-natal influences together with injuries at birth accounted for 48 per cent. of all deaths under one year of age in Australia during the year 1923. Skilled assistance should be available to all mothers before, during, and after labour, as in all cases it demands the attendance of an adequately trained doctor and an adequately trained nurse. The legislation with respect to the registration of midwifery nurses, and to the control of private maternity hospitals could be improved. In some States maternal welfare is not associated in any way with the Health Department, which should be the official agency charged with the supervision and direction of maternal hygiene.

(c) Child Welfare.-Baby clinics and child welfare centres are maintained by private organizations, usually assisted by municipal or Government subsidies, in the metropolitan areas and also in some country centres, for the purpose of giving pre-natal and post-natal advice to mothers. Some of the organizations endeavour to co-ordinate and extend the various activities dealing with the _welfare of mothers and babies, others care for the young children of poor working women during the hours when the mothers are at work. Homes for foundlings and for infants where parents are ;unable to provide proper care have also been instituted, and temporary homes for unmarried mothers with their first child. Full-time nurses are maintained in some cases by State Departments to visit expectant mothers and the homes of people in distressed circumstances, for the purpose of rendering assistance and giving advice in connexion

with the care of infants and the principles of personal and general hygiene. At the present time a system of medical examination of school children has been put into operation in the various States, but owing to the inadequacy in numbers of the staff engaged on the work-the number of scholars in the State Schools in Australia totals over 830,000-and the tremendous area to be covered, it has not been found possible to adequately carry out the work which requires to be done. Dental clinics have been established in some metropolitan areas for free dental treatment of children of parents who are unable to pay for treatment, but these clinics only deal with urgent cases, and whilst doing good work, are unable to cope with the full demands. A system of motor vans, properly equipped- as travelling surgeries, for country districts would be a very important feature of dental treatment. The need for medical care of school children in Australia, especially in regard to their teeth is apparent when it is appreciated that 50 per cent. of adult sickness is stated to be due to the neglect of the teeth in childhood and early adult life. The schools are a very important feature of any preventive health work, and periodical examinations of school children are considered to he most important from the national health stand-point. A child should be medically examined when entering school life, again when about half-way through school life, and again just before leaving school and going into industry. Health lectures should form part of the school curriculum and an educational publicity campaign should also be undertaken in an endeavour to impress the importance of this question upon the people.

1305

37

(d) Industrial Hyg,iene.--As industrial workers will constitute a. large majority of the insured members of any National Insurance scheme instituted in Australia, it is essential that the question of industrial hygiene be given the utmost consideration. Medical examinations of recruits during the war revealed an extraordinary amount of disease and defects. The national loss in wages and

production as the result of sickness amongst wage-earners is enormous; such illnesses, largely preventible, cause an absence each day of about 3 per cent. of the wage-earners in Australia. The Commonwealth Statistician has estimated that the accumulated cost of maintenance and education, &c., of a boy to age fifteen, is £;430, and that the capitalized present value of his future earnings at

age sixteen is £2,025. It is apparent, therefore, that if the question of the wage-earner's health and value to the community is considered merely from the financial stand-point, every effort should be made to safeguard him from the time he first enters into industry. More effective governmental control over health conditions in industry is necessary. Although it is practically impossible to provide regulations which will cover every possible cause of accident or danger to health, it is essential that the more dangerous trades be effectively controlled. Such regulations should not

only prescribe measures for eliminating or minimizing the risks concerned, hut in the more dangerous occupations should require periodical medical examination of employees to be made by an authorized medical practitioner. An attempt should be made to define the majority of cliseases which should be covered by such regulations, and it has been recommended that regulations

modelled on those operating in England should he brought into force for the industries concerned in Australia. Unless any particular climatic conditions in any locality necessitate a modification it is desirable that industrial legislation in Australia should be uniform. Some employers of labour have established rest-rooms and provided skilled medical

attendants for their staffs, surgeries being equipped in the factory and the warehouse ; rest homes in some cases are maintained in the country, and physical culture, recreation, and athletic facilities are also, in many instances, provided. An increasing number of employers of labour is making arrangements with medical practitioners in order to reduce the amount of sickness amongst their

employees. In Queensland the State Insurance Department provides substantial discounts to employers who maintain an approved ambulance service on their premises as a means towards minimizing the results of accidents. Some American insurance companies examine their policy­ holders free every two years in an endeavour to prevent disease and lessen the risks covered.

Friendly societies generally have no welfare schemes in operation for the benefit of their members, apart from the sickness and hospital benefits, and this is a most serious omission from their functions. A few industrial assurance companies in Australia have established welfare schemes and nursing services in the interests of their policy-holders, with an aim to the prolongation of

life of the policy-holder and the consequent reduction in claims, and, although such schemes have only been in operation for a few years, it has already been claimed that the beneficial results have more than justified the expenditure. Employers should be encouraged to start similar systems of medical supervision for their employees, and some arrangement whereby they would receive a rebate on contributions to the insurance fund if they adopted approved methods of medical

examination of employees is worthy of consideration, as it is of the greatest importance not only to the insurance scheme but in the interest of national health that skilled medical advice for the worker should be constantly available. National Health Insurance schemes in other countries have not yet, in any instance,

provided for periodical medical examinations of insured members, although it has been suggested that such would be an excellent provision if it could be carried into effect. It has been stated that the only system which would provide f?r adequate medical of

would be that making the medical examinatiOn compulsory each year. This penodical medical examination of insured persons, which must be very exact and scientific would be of great value. from the stand-point of national health, as numerous instances of .disease would thus be discove:ed in the early stages when a speedy cure could be .effected, .m man:y: cases a loss of

time prevented. The periodical compulsory medical of diSah.led .returned soldwrs is a striking instance of the beneficial effect of a system of penodical exammatwns. At Broken Hill compulsory routine examination of miners is for. the specific .purpose of .protecting their own health. It should be possible to classify the vanous occupations to the

physical standard required of the workman t? perform work, ap:rhcants for

employment should undergo a medical exammatwn whiCh would mdiCate their physical fitness for the position for which they are applicants. Under such system, however, adequate arrange­ ments would be necessary to provide for that small percentage of sub-standard men who would be unable to secure normal employment.

(e) _Medicctl Research Work.--Extensive medical research work is being canied out in other countries and as the conditions in Australia differ appreciably from those which exist elsewhere it is very desirable that they should be investigated. the _time there are

many diseases about which little is known for the purpose of preventiOn, and It IS Important that

3S

full investigation with respect to these should be undertaken. A certain amount of research work has already been carried out in Australia by private practitioners and in the laboratories ·" ., of the Health Departments and at public hospitals, but this work should ·be very considerably extended, as health research should be closely associated with health administration. It is

suggested that a central establishment for· the investigation of preventible diseases, working in association with existing institutions, with branch establishments throughout the Commonwealth, should be instituted. Investigations should be undertaken with the object of elucidating the principal factors concerned in the spread of infectious diseases and as to the means of arresting their spread. Although the diphtheria mortality rate has been reduced yet there has been a very serious increase in the number of cases of diphtheria; the cancer death rate has shown a steady and serious increase for a considerable number of years ; no reduction in tl1e mortality of women during chjld-birth has taken place; and there has been no reduction in the mortality rate from congenital causes during the first month of life. A considerable portion of the invalidity for which Commonwealth invalid pensions are now paid is stated to result from diseases which are preventible. The above are instances of the important 'II investigations which should be undertaken under Government supervision in the interest of national health.

SUMMARY OF RECOMMENDATIONS.

Your Commissioners recommend :-(a) that a National Insurance Fund be instituted which will provide for the payment of sickness, invalidity, maternity and superannuation benefits to insured members, and

(i) that membership of such fund be compulsory;

(ii) that a sickness benefit of 30s. per week be payable to adult insured members during the first six months when incapacitated for work as the result of

(iii)

(iv)

sickness; ·

that a sickness benefit not exceeding 20s. per week be payable to insured members under 21 years of age during similar incapacity;

that equivalent benefits be payable to insured members when incapacitated for work as the result of accident, and that the question of including workers' compensation legislation under National Insurance Fund administration be fully considered ;

(v) that an invalidity benefit of 20s. per week be payable to insured members during that period when incapacitated for work as the result of sickness or accident extending beyond six months' duration ;

(vi) that a maternity benefit of 20s. per week be payable for a period of two weeks prior to and for four weeks after the confinement of a female insured member, or the wife of an insured member ;

(vii) that, as the cost of the existing maternity allowance is at present borne solely by the Commonwealth, this responsibility . should continue with respect to the maternity benefit provided under the National Insurance Fund; (viii) that a superannuation benefit of 20s. per week be payable to male insured

members after attainment of age 65 and to female insured members after attainment of age 60 ;

(ix) that the existing rights of pensioners under the Commonwealth lnval1'.d and Ol.d-age Pensions Act 1908-23 should not be interfered with ;

(x) that a child allowance of 5s. per week, in respect of each dependent child under age 16, be payable to the insured member when incapacitated for work;

(b) that a National Health Scheme be instituted which will provide adequate medical treatment for the people, and wmch will provide the requisite machinery for the prevention of sickness and accident, and (i) that such scheme be dissociated from the administration of the National Insurance

Fund;

(ii) that the functions and objects of the Health Department be extended in such manner as will enable provision to be made as early as possible for the effective supervision of adequate medical services, especially with respect to materruty treatment.

1307

39

As previously indicated, the inquiry in connexion with unemployment and destitute aJlowances is now proceeding, and, as the questions of membership, finance and administration of any proposed National Insurance scheme must be considered in relation to all sections of the inquiry, these questions will form the subject of a further report when the inquiry with respect

to unemployment and destitute allowances has been completed.

In order that a comparison may be made of the main features of the schemes in operation in various countries, your Commissioners have compiled a conspectus of the legislation which has been enacted in the several countries with respect to the provision of (a) sickness, maternity and funeral benefits and (b) old-age, invalidity and survivors' benefits. The conspectus,

which bas involved very considerable and detailed research, is appended to this Report.

We have the honour to be,

Your Excellency's most obedient Servants,

H. C. GREEN, Secretary.

'\felbourne, 3rd March, 1925.

J. D. MILLEN, Chairman.

ROLAND F. H. GREEr<.

J. GRANT.

W. G. MAHONY .

.TOS. FRANCIS.

A. E. GREEN.

BENJ. BENNY.

CONSPECTUS OF ACTS RELATING TO SICKNESS, MATERNITY, AND FUNERAL BENEFITS IN VARIOUS COUNTRIES.

Country.

Amrtralia ..

Canada

Finland

Holland

[taly

New Zealand

South Africa

Spain

Belgium

Denmark

Date of Original Act and Method of Organization.

I Registered friendly societies under State supervision

1919 Friendly societies under State super- vision

1897 Mutual benefit soci- eties under State supervision

--

Mutual and other

benefit societies, many of which are organized by trade unions or employers' associations Medical institutes

founded by physicians

1886 Mutual benefit SO· cieties, the registra· tion of which is

dependent on cori-ditions of orgll.niza-tion and exempts from stamp

other duties and

1909 Registered friendly so-cieties under Gov-ernment supervision

Friendly societies

I887 Mutual and commer- cial sickness insur-ance societies and

companies

1 1851 Mutual benefit soci­ eties, of which those

situated in Belgium and restricted to

one function must be recognized, others may be recognized Reinsurance funds

1892 Sick funds which, in order to be recog­ nized, must comply

with certain condi­ tions and be under the supervision of the Sick Funds In­ spector

Scope of System. Sources of Income. Benefits.

A.-VoLUNTARY INSURANCE. (a) Socielie..• no! .subsidized by !he &ate.

Generally, persons in Contributions of members. In I (a,) Medical attendance good health, be- New South Wales only, a sub· (b) Sick pay, generally £1 per tween the ages of vention is made by the State week for 26 weeks, lOs. for a

16 and 45. Some in oases of aged persons in further 26 weeks, and 5s. per

societies have re- receipt of continuous sick pay week thereafter ligious, local or (c) Funeral benefit varying from

other restrictions £10 t.o£200

According to the rules Contributions of members According to the rules of the of the society society

According to the rules Contributions of members The majority of the societies pro- of the society vide sickness and funeral bene-

fits ; a few also provide for

old-age pensions or funeJ:Il.l expenses

According to the rules Contributions of members About one-third of the societies of the society In some instauoes, employers provide medical attendance

also contribute only, more than one-half pro-

vide sickness benefits only, the remainder provide both bene-tits

According to the rules Contributione of members According to the rules of the of the society society

..

According to the rules Contributions of members According to the rules of the of the society society

According to the rules Contributions of members According to the rules of the of the society ! society

According to the rules Contributions of members, rang- All furnish medical attendance, of the society or ing from one-half to two and mutual societies, in some

company pesetas per month instances, also provide_ sick

pay and funeral benefit 1 peseta = 9ld.

(b) Societies subsidized by lk,e Stale.

According to the rules of the society

Recognized sooieties must have a minimum membership and trade or local limi­

tations and admit all persons between the ages of I4 and 40 years, subject to property

and mcome qualifi-

Contributions of members State does not subsidize recog· ni zed or other societies, but only the Reinsurance Funds,

which are supported by the societies

Contributions of members State contributes 3 krone per member per annum, and one­ quarter of the amount ex­

pended on sickness benefit and a further amount for

chronic or incurable cases Communes must also contribute towards chronic and incurable ca.aes

Generally, a society pays benefits for six months, after which period a member receives benefits from the Reinsurance Funds, up to a period of four

and one-half years

(a) Medical and hospital treat­ ment must be provided for members and their children under I5 years of age (b) Sick pay, minimum 40 ore,

maximum 6 krone per day (c) Maternity benetit, minimum I krone per day for ten days I krone = ls. 1 }d.

1 cations

--------t.. ____ _.!,..._ __ __! ____ ___!. ____ _

1309

eo.NS!'&C

Country.

Iceland

.Sweden

Switzerland

Austria

C().U.()//.

Date of Origin:¥ Act and Method of Orgl\nization.

(b) Societies aubaidized b;y the State-continued.

-- 1;850

,

Jlot to sub- _

sidj,es. '

inQ. .eetahlillhments 91 utility,

- -Aad jp celia.in ad·

1911 :fqnc;ls _

A sick fund must com-1ptise,;,t llict, ,acqe,p:t _;,tp_y pe.r!i.;w .h!li\Weep. J;5

and 4"0 _ rjf J}ge

below · certain in­ come limits, and consist of at least 50 members

1.891 , _A ,fun.d

sipk'funds " must· hav.e JoO

iuAds , prp-

_ ,_ .and

"funeralbenefits only, must not pay more than 200 krone in flmeral a.n.d

.I!lASt a<:lnj_it . a

JAe.mber ,of fJ.Ind

19ll Registered siqk fu.nas, · ,pn®r tbe ;s:gpero-. $ion 1Wthe

'Q'ffi:ee Pi Soqib:l :ilqra.uce

.1888 Dlittict.f®ds · 5E.l!t;i,lill&b'ment fJUi,WJ

'G:wldluuds

fl

• funds

·,agricilltural sick funds !llJ!A9-etSta.te super-vi_si-9n

:A reinsurance mJ.Ist tJ_Qo

ID"!!-mbera

A registered sick fund must guarantee

l;t).alli\gemen.t,

equa'lii)y 9f alld · unrestricted one

"'fund to_a.nqt}ier ·

.Afi w:Me,ea.rJ.!ers, . in­ i!Ju!ling a,gr.i.cwtural .. (IJ;l.d .. J4ome-woJ."l>!lrs, . w:ith011t .r!!llt,ictio.ns \

as to amount of

income Employees classified according to earn­ ings

;Contributions oi members :State subsidy fixed from year ,t? year, according to voted by Parliament _

Contributions of membeta ;St;l.te.ll'\\h\lidy,l.kfP-IW mem­ J:ter a;nnWJl ip. a tOc¥'0- -W whioh a ,resijles, 1!

krone in other places

, CoJ:lttiQJl#I>J;J,S ,o(rnoobers ;State subsidies to (a) Si<¥dunds, I krone per member per annum 25 ore per day sick pay, and

one-quarter of the exPJilnditure .t9 _1

krone ·per member; •(b) Re­ :i-\,5 per

rnWP-b·f/r ,p!jr A.llp.Jlm ja,ml . fl5 i.j:re "9,&y _11jqk .. W

60, ol;C. Mr

'ltP to A2 ·

to the ru,)SJj! 9£ the

!!?()ieJoy have special funds

for ,of long-continued

s,.i'*Il:llj!S

(a) Medical afld hospital treat­ ment (b) Si<:JJ>: .pf\1, minimum 50 ore per day, J:wiXii¥um two-thirds of

of the sick

JU:e_ll).ps,i: 1 =;= Is. lid.

-bCflelits in Ql'f1,ljr

obtain subsid;Y:= (a) Medical attendancl),JFWfficine of value at least 90 ore (b) Sick pay,' minimum 50 ore,

_p{lr.

90 days. ; urtner 90 days

providli!d fpr by reiiJ.sumll£!l

(

'270 days 1 krone I!d.

Contributions of members Minimum benefits :-State subsidy, one:eighth of (a) and medi­

the co};ltrib,u.j;ions , of each in- cine oqick pay of l sured ,.persQ.n, :whose anpual , _:day days in each,pet.ipd income ,(\Ot exceed .

trancs ... benefit, ordinary

Special subsidies in mo:untainous· - -sick ·benefi,t for six weeks districts (c) Nursing benefit, 20 francs

II franc = 9!d.

funds, I (.a) Medical attendance, medicine

, per five-tenths -tb,erapeutical

of the .,wv:erage. -9-aily w,age; I (b) Sick ,P!>Y• SO per cent. of aver· oP.4er - ;in acpordance , .!WI'l daily .el!'rnings for 26 weeks with b!)n,.\lfits .pro'>ided '1 Maternity benefit, sick pay

EmplQy. er cont. iibu. tes one-third,

1

· for 6 . w:ileks before and

enq\l.oyee two--thj.rds weeks after confinement

, {q) ,N,ursing benefit, half sick pay 1. ·

. (e) Funeral benefit, thirty times I the average daily earnings

.J3 -.-u-lg_a_I_·ia-.--------I--I-9_1_8--------------I--All---w-a-g-e--e-a-rn_e_r_s_a_n_d __ __ e\

1

Socia,l,iusuranceoffice salaried employees from l•uu to l •ll per cent. of 1 (a) Medical a,ttendance, medicine and hospit;tl treat-ment

]j' .153'·17 .-4

Local factory inspec- in public and private wages. tion depa11tments undertakings, with- Employer and State !(ach con-out to sex, tribute sim.il;tr. alll{)Ullt

. p.atwe of elll,ploy-' or x!ite of

'Elll. ployees . dassified iiCCIJfding to W\1-ges

(b) $ick_pay, from 80 to50_per cent. of__...:_ earnings for nine months pension after ex­

Jlirati()U o_f sick pay (d) Maternity benefit, medical and midwifery attendance and sick pay for six weeks before

and six W!)eks after confine­ ment

42

tloNSPECTUS oF AcTs RELATING TO SICKNEss, MATERNITY, AND FuNERAL BENEFITS I!i VARIOUS continued.

Country.

Slovakia-/

(a) General /

workers

Date of Original Act and .Method ol Orgaruzatlon.

I919 Workers' insurance department District sick funds Establishment sick

funds Guild sick funds Association sick

funds Agricultural sick

funds

Scope of l ources of Income.

B.-COMPULSORY INSURANCE-continued.

Practically all wage­ earners Contributions of employees graded according to their

income classification Employer contributes an equal amount to his employees

Benefits •

I (a) Medical attendance, medicine and therapeutical appliances (b) Sick pay, 80 per cent. of earn-ings for 39 weeks (c) Maternity benefit, sick pay for six weeks before and six weeks after confinement (d) Nursing benefit, half sick pay for twelve weeks (e) Funeral benefit, 30 times aver­age daily earnings, minimum 90 krone I krone = Is. l!d. (b) Miners 1922 Central benefit society ·District benefit so­cieties under super­vision of mining authorities Denmark- . I Special sick funds Alien seasonal workers Esthonia ]'ranee-­Miners Germany Holland 1922

Insurance institution Trade funds, managed by representatives of insured persons

1894 Mutual benefit so­ cieties, established by employers

1883 Local sick funds Rural sick funds Establishment funds Guild funds Miners' sick funds

Substitute funds All under supervision of the Imperial In­ surance Bureau

1913 Insurance councils councils

.1.11 persons employed in the mining in­ dustry

Alien seasonal workers

All workers, with the exception of agricul­ tural workers, irre­ spective of the

amounts of their

incomes

All workers and

salaried employees on mines

All workmen, journey­ men, apprentices and servants with­ out regard to

amount of income Officials, olerks, teach­ ers, tutors, home­ workers, crews of

ships, &c., with in­ comes within cer­ tain limits

All workers with in­ comes up to an

amount fixed by

the Labour Councils (not less than 2 •50 gulden per day) F.mployeos elas>

according to wages

Conkibutions of employees and employers in equal amounts, fixed according to anticipated expenditure

Contributions payable wholly by employers State subsidy, I krone per

insured person per annum

Contributions, not exceeding 6 per cent. of daily wage,

payable in equal proportions by employee, employer and the State Employer pays cost of medical

attendance and medicine

Employees, not exceeding 2 per cent. of earnings or 48 francs per annum Employers, one half that of

employees State subsidy fixed annually

Contributions, not exceeding 7t per cent. of the basic wage of each class of workers, payable two-thirds by insured persons and one-third by employers

Contributions, payable in equal proportions by employers and employees, fixed by the Gov­ ernment for each Labour

Council and based upon

da.sHified rla.ily wages

Benefits similar to those provided for g-eneral workers

Medical attendance, meilicine and hospital treatment up to six months 1 krone = Is. I!d.

(a) Medical attendance and

• medicine •

(b) Sick pay, one-half to two· thirds of daily wage for 26

weeks (c) Maternity benefit, one-half -Wages for two weeks before and four weeks after confinement (d) Dependants, benefits optional

Benefits fixed by societies, which may also grant relief to mem­ bers' families in cash and kind At least 5 per cent. of expendi;

ture on sick pay must be paid into the old-age insurance fund in respect of each J1lernber of such fund 1 franc = 9!d.

{a) Medical attendance, medi­ cine, spectacles, trusses, &c. (b) Sick pay, one-half basic wage for 26 weeks (c) Hospital treatment with half

sick pay (d) Maternity benefit, medical attendance and sick pay for ten weeks and an allowance equal

to six times the index-number (e) Nursing benefit, half sick pay for twelve weeks (f) Funeral benefit, an amount

equivalent to 20 times the

daily basic wage (g) Dependants receive maternity benefits

(a) Sick pay, 70 per cent. of basic t daily wage for six months,

excluding Sunrlays (b) Maternity benefit, similar to siek pay I gnldrm = ls S I.

1311

43

CoNSPECTus oF Ac:ts RELATING TO SICKNEss, MATERNITY AND FuNERAL BENEFITS IN VARIOUs CouNTRIES_ continued.

Country.

Hungary

Irish Free State

Italy

Japan

JugoSlavia

Date o! Original Act and :Method of Organization.

1891 National Workmen's Sickness and Acci­ dent Insurance

Fund District workmen's insurance funds Establishment sick

funds

1923 National Health In­ surance Commis­ sioners

Insuranco committees Approved societies

1910 National Invalidity and Old-age Fund Maternity Branch,

administered by a board of nino

persons

1922 H ealth Insurance So­ cieties Persons not it1sured

in these aro ins ured directly by the

State

1922 Central workers' 'in­ surance institution Local workers' in­

surance institutions \V orkers' insurance funds for transport undertakings

Miners' mutual bene-fit societies

Scope of System. of Income.

B.-Col\U'ULSORY INSURANCE-continued.

All workers in indus­ tries and trade and employees in Gov-ernment under-

. takings, e a;rning

less than 2,400

laone per annum or S krone pe:r day

All employed persona of both sexes, over 16 years of age, ex­ cepting those .em­

ployed otherwise than by manual

labour with incomes of over £250 per

annum

All women between the ages of 15 a,nd 50 years employed

subject to the Fac­ tory Act of 1907

All porsons working in factories and mines, to whom the Fac­ tory or Mining Acts

u.pply Administmtive em­ ployees with a,nnual incomes over 1,200

yen are exempt

from insumnce

All persons who p er­ form physical or

mental work for

remuneration, in­ cluding home­

workers and seamen Employees classified according to earn­ ings

Contributions, payable in equal proportions by employers and employees, not less than 2 per cent. and not more tha,n 4 per

cent. of average daily wage

Employee, male, 4d. ; female, 3d. per week Employer, 4d. per week State pays two-ninths of the

cost of insurance

Employ<'.e, llira per annum Employer, 1· 25 lire per annum State subsidy, 12 lire for each case of confinement

Employee, up to 3 per cent. of da\ly remuneration Employers, same . amount as . employees

State, lO per cent. of the expen­ dit ure, maximum 2 yen per insured person

Weekly contributions range frorn 24 to 42 per cent. of the

basic daily wage Fixed contribution for funeral benefit, which is included with old-age and invalidity

insurance Employer and employee each pay one-half of the contribu­ tions

llenefite.

(a) Medica,la,ttendance, medicine, baths and therapeutical ap­ pliances for 20 weeks (b) Si ck pay, half basic wage

for 20 weeks (c) Maternity benefit, midwife and sick pay for six weeks

after confinement (d) Ftuleral benefit, 20 times

the daily basic wage (e) Dependants, the same with the exception of funeral benefit 1 krone = lOd.

Sam.e as United Ki11gdom, except no medical attendance or

medicine, and with the addi­ tion of sanatorium benefit

Maternity benefit, after six

months' membership, 100 lire !lira= 9ld.

(a) Medical or hospital treatment for 180 days (b) Sick pay, 60 per cent. of daily wage for 180 days ·

(c) Maternity benefit, 20 yen and a,nd sick pay (d) Funera,l benefit, 20 times the daily wage, minimum, 20 yen 1 yen = 2s.

(a) Medical attendance, medicine, baths, &c., for 26 weeks (b) Sick pay, two-third basic wage for 26 weeks (c) Maternity benefit, medical

attendance and midwife and three-quarters basic wage for two months before and two months after confinement (d) Nursing benefit, half basic

wage for 20 weeks (e) Child endowment, 14 times basic wage (f) Funeral benefit, 30 times

basic wage (g) Dependants, similar modi­ fied benefits

--------------I------------------I---------------------------------------------1------------------------- Latvia

Lux.emlmrg

1922 Special sick funds Joint sick funds Under supervision of

Miniater of Labour

1!)01 Hccogniscu n:at- ua-1 benefit societies 'Rst.ahlishment funt!s

of the Stt•ic

All workers in private, Employee, from l to 3 per cent. (a) Medical attendance :for 26 communalandState of wages weeks

undertakings who Employer and State p11y the (b) Sick pay, from two-thirds to receive remunera- same amount as employee, and full wages for 26 weeks tion the employer also pays the (c) Maternity benefit, full wages

cost of medical attendance for four weeks before and eight weeks after confinement

All work(•rs in indus­ tl'inJ t r::-.ding n.ntl transport establish­ lishments in which motive power is

m;ed, of

agricultural workers

Contributions, nonnally up to 2 per cent. of wages, but may Le raised to 3 per cent., payable one-thil"t! by employers, and 1,wo -t.hitclR hy P-mplny•"·-s

(d) Child maintenance, one-fourth wages for eight months

I

(e) Funeral benefit, 20 to 30

times daily w&ge (f) Dependants, similar benefits

(11.) Medical attendance and medi­ eine for thirteen weel;H (/')Sick pay, one-half average wage for thirteen weeks

(c) M>1ternity Lenc;fit·., 8i<:k pay for four.· W(:e],;; (d) Funcr&l benefit, 20 times daily wage

CoNsFillO'I)Uf.l OF Ao'l's IiEtATING To Sro.ItNEss, MATERNITY, AND FuNERAt BENEFITS rN V .. uuous CouNTltlES,....., continued.

Country. Date of Original Aot and

Method of Orgallization.

Poland

Portugal

Rumania

Russia

1909 Royal insur;1)J.oe in­ f!titution Local fund in each

municipality or

town E.smblishment funds Private fundi!

1920 Central insurance office. District sick funds

1919 Mutual insurance as­ sociation in each municipality, under

supervision of Com. pulsory Soc!al fu­ l!!lta11ceand General Ptpvid(lnt Iustitllte

l!U2 Central fund CimM fqnds Est#qlf;lhment iun41! funds

191.2 in ac-

. cordance with in­ structions issu!ld by the Council of

People's Commis­ saries, the Council of Labour and De­ f6noe and the

P6ople's Labour Commissariat

1911 Jidinktry of Health (England and Wales) .. .. . Insurance Commis­

sioners (Scotland) Mini!> try of Lab our (Northern Ireland) lAsurance coiUD:Uttees AP.m-oved l;:>epo.!lii contributors

Seope of System.

AU workers in public and private service over 15 years of age, and other persons

with incomes under 6,000 krone per

annum Employees classified according toincome

All worker,s of both sexes, irrespective of incomes, includ­ ing agricultural

workers, domestic l!!lrvants, workers Employees classified

according to wages

.AU llmployed persons between 15 and 75 years of age, whose incomes do not ex­ ceed . 900 escudos perannwn P-ersons with higher

must

contribuw, 1:>\lt are · nQt to

Every member of a guild or trade union ¥mployeea classified aCCj)rd!ng to

Sources of lneome.

Contributions fixed by local .sur­

Compulsorily insured person I gigll!l for 26 weeks

pays one, (b) Sic!>; p;l.y, 62! per cent. of clas-

tenth, municipality one,tenth, sifi!ld daily wage for 26 weeks and state two-tenths. (c) benefit, nursing

Voluntary iusurer pays ileven- e.wl, at least 1! krone per

tenths, m.unicipality on!'l· dl}y f()f two weeks before and te:l).th, an.d lilta.te two-tenths $ weeks p.fter confinement (d) fuqa,ral benefit up to 50 kr.

Centl'ibutions, 6! ·per oont. of classified wage Employer paya three-fi1ths, em­ ployee two • .fiftha State refunds one,.half pf c()Bi; of

maternity nursing

benllfits

PersQM to · b!Jnefita,

fl'Qtn 0 •. 30 $Q j),5Q flSC\ldOS per month Persons not entitled to benefits, from 0. 50 to 3. 00 escudos

p!'lrmonth

(e) Member's wife, maternity benefit, midwife and 30 krone 1 krone = Is. ltd.

(a) Medical attend!HJ.ce, dressings, 1or 26 to 39 weeks (b) Sick pay, .60 per ®nt. of ):>p.sie f.pr 26 to 39 weeks

(c) benefit, medical

and midwife and

Ml 111M!ill wage for eight weeks 2 to 5 m. arks

per twelve weeks

(e) Funeral benefit, three times ba.aio wage

{f) similar modified

(a) baths and open-air

tre;l.tpJ.ent (b) Sick pa,y, 0.16 to 0.30

per diem for 30 days,

0,12 t9 escudos per diem fora,furtlter 30 days, 0;08 to {),14 per diem for' a

further 30 days, and 0.06 to 0.10 per diem for a

fl,lrther ptlriod of 275 days (c) '!Jenefit

(d) children's benefits,

clinical se:tvices and medicine

Cont:ributim:lll }>ll

1 escudo = · 4s. 6d.

(a) Medical .and hospital treat­ ment, medicine, dressings, &c. for sixteen weeks (b.) p&Y• 35 and 50 per cent.

().f Wfl,ge for sixteen weeks to !)il:l,gle and married men . rey>e!)tivtdy (c) :M!I.wxW-ty benefit, sick pay

for sh:: weeks after confinement {d) Nwsing benefit, sick pay for tlu:ee mo.aths · (!l) FUJ1tlral benefit, 60 to 9lei (J) Wife and children's benefit,

medical treatment llei =

All employees Employer pays all

which are fixed by orders of the Council of People's Com­ missaries l).ccorcling to the undertaking

{a) Sick pay, full wages (b) Maternity benefit, full wages for eight weeks before and eight weeks after confinement for

workers, six for

workers, and a

benefit of one

wages

All employed persons, of both sexes, over 16 years of age,

excepting those em­ ployed otherwise than by way of man­ ual labour with in" comes over ;/,:250 per annum

England, Wales. and Scotland, employee, male 5d. ; female, 4d. per week ; employer, 5d. Northern Ireland, employee,

male, 4d. ; fen;tale, 3d. ; em­ ployer, 4d. Where wagw do not exceed 4s. per qay e.tnpWyer pays a larger

proportio!l, MW where they do Mt exceed 3s., employer the w'l\$

State pays two-ninths of the cost of insurance

(c) NJ».'Jiing benefit,quarterwages 'for one IliOnth ·

(d) FuneraL benefit, up to one month's wages

{a) Medical attendance, medicine and appliances (except in Northcrr! Ireland) (b) Si >k pay, 15s. per week for

males. for females for 26

Wtleks .

(c) :Pisablement benefit, 7s. 6d. p!'lf W!Mlk, after expiration of siek pay (d) benefit, £2

(e) SiJ.nlttorj.um benefit in North­ ern Irela».d only

1313

OO'fSPIWTUS OF ACTS RELATING 'iOO .OLD-AG,E, ANP SURVIVDRS' B;ENE;FITS IN VARIOUS COUNTRIES.

Conntl'y.

Cana.da.

Finlai'ld

Belgium

Date of Act and

Method 1 f Organization. ,

l9.0S Government

1897 Mutual benefit so­ cieties

iSM GenerM Pensions Frtnd, either

or

Benefits.

A.-VoLUNTARY !N'SURANOE. (It} Not otllb8iiiizeii by 'ffhe State

AI}Y person domiciled :I Premiums paid 'by instalments m Canada : or in a lump sum, according ,

to ,a,liJ.0un.t Gi a..n®ity, which must he 1ess . tb.f!.n .5!J 1

dGllallB nor ;mQr,e than o ;OOO

(a) Immediate annuity (b) Deferred annuity, with or with6ut repayment of pre­ miums

· i

dollam per 1

kcl D.efm:red annuity, with or · without guarantee of payment f.ar 20 years or death, which­ ever period is longer {d} .l\®uity on joint lives = 4s.2d.

li!A-enles I Premiums fixed by the ,Anp.J.lfries as fixed by the society

il

AD,- persce by .imtalments (a) anmdty

6f Jive y.eaDS ! <(b) annuity

1 -(}f IHli!lUity, wlll'cll :(c) 'Lu.wp sum payable at ages 55,

; he than £1 , Ci) or ,65 years, or sooner in th'e

.evflllt of death

(b) · by the State

Any pers.oo QV-tll' 18 years of age Annuities may also be acquired Jor other

perao:us JJYef .s;ix ,

Premiums payable at !llfiy time, I (a) Annuity on alienated capital, minimum one franc, for annu- payable at age 65 ities ranging from 12 francs (b) Annuity on reserved capital, 50 centimes to 1,200 francs , payable at age 50 to 65, with subsidy-(n) for persons _ r eturn of 97 per cent. of de-

no.twemb.fi'rs .of l'l'IJ,ltuaibenefit posits .a.t death .fQi' e;J.c.h (c) annuity, maxi-

paid .!JP ito 15Jrancs ; nwm 'll-6fJl francs in case of

,(Ji) .f.o.r ;me:mp.er.s df ll;IUtJlli.J mvalidity after five years' bene:fij; oocie:ti!IS 2 frauos. for st&n:ding 6,;1,,e.lt accnunt .opened a.nQ. ill- (d') Im:mediate annuity, not ex-;w.hich l;tave been paid ,ceMlng 300 francs

1 franc . = 9!d.

(e') 'Temporary annuity, payable 'until date when beneficiary enters upon ordinary annuity

HoUaud

Hungary

i850 Old-age Re­

W' i

deposits,

®f pu.t:ioE¥1 ,

Jtl;le at ·

dual 1>el).eJi!il;i:afif.S, : or t.bfQ!ig_ll- r

1919 Inau;ra,n.ce Ba.nk Insar.anoo Ooun.cilll

.w jiWlll\WiJ,S J.i:vili\g i;n Fr,ovn

.. ... . ...,_.

1900 All either

N a. tiona] Ji&J!: tliJil.JI.OOted JJith

]fund, under super- agriculture, forestry vision of Govern- and hydraulic en-

ment gineering

1

1

J.ocal Committee in Four elassea of ordin-each Commune ary membeFs-{a)

i and

' forest workers with

j wgr}j:l')q' books; l/1)

j 1

1

other simifar

. wqrk!lrs betwf)en l4

I , p.gfl3ii years of age ;

1

(c) up to

' I 50 years who insll)"e

qea.th only ;

l a.P4 (4) those wbo

Pr.e:r;liliu.ms paya.ble .at any time, f.l:

outl 'J'plial deposits npt

to e+AOOd aroount sQ.f!lcient pensioJ;t ,of l,.200 per

J!Jlftll))l Sf;a.te .tiubsi.dy,. one-fifth of · pension at age !l5

Special subsiuy for pa.r!lnts who have reared four cr more '

children

The amount of premium is deter­ .@.ned by regulation and de­ pend.$ {a) fp;r a pension up t.\> 6 gW.den weekly, 11@ £(), UJJOn age at entry

ai:J.(i upo;o. amount of pensio;\, provided tM:t tlle taxable in­ come is less than 2,000 gulden · p er annum ; ( b r in other cases on the age of the insured per­ son, theamountofpensionand

the expenses of ma-nagem ent

Weekly contribution from group (a) 28 heller; (b) 11 heller; (c) 5 heller; and (d} 10 heller. EKemption from contributions after paying for 25 years Employer pays 1. 20 krone for

every employee per anmun State subsidy, 150,000 krone per annum

(a) 01d-B;ge pension at from 150 to 65 years of age, ·mtlh or

without :retttrn 'Of mpital at death. Minimum l! francs,

JJJ.l}ximJlm 2,400 francs per annum Invl'lld pension, at any age

in ca-se ·of invalidity lfmnc =

An old-age pension of not loss than 3 gulden nor more than 20 gu1den weekly l .guld:en = 1-s. Sd.

Group (a), (i) Invalid pension, at least 10 krone per month; {ii) Old-age at 65 years, lump SU.Ill 100 krone; (iii) Survivors

benefit, lump sum, 200 to

270 krone (b) Half the benefits under (a) (c) Survivors benefit from 60 to 200 krone per annum (d) Old.age pension at o5 years,

frOJll 65 to 215 krone. Con­ iir!butions refunded, plus 15 per cent, if insured person dies before drawing pension

1 = Is. lid.

j ill!!l!l'e against old

:= ··==== -=-=='='= _________ ____, __ a-"'g_e _____ --.-:--·---------- ---------

46

CONSPECTUS OF ACTS RELATING TO OLD-AGE, INVALIDITY, AND SURVIVORS' BENEFITS IN VARIOUS CoUNTRIES­ continued.

Country. Date of Original Act and Scope System. Sources of Income. Benefits. Method of Organization.

A.-VoLUNTARY INSURANCE-continued. (b) Subsidized by the State-continued.

1898 I

National Workmen's '

Haly

New Zealand

Invalidity and Old­ age Fund, under

supervision of the Department of Agri­ culture, Industry and Commerce, with

branches in pro­ vinces and com­ munes

1908 National Provident Fund, with a :Board of five members ap­

pointed ·by Gov­ ernment

Any Italian citizen, of either sex, occupied in manual work,

provided he does not pay taxes to

the State in excess of 30 lire per annum

Any person who (a) is . resident in New Zealand; (b)is over 16 and under 50

years of age ; and

{c) has an income of less than £300 per annum

Contributions of members, mini­ mum 6 lire per annum, paid into alienated or reserved fund, in latter case thev are refunded if insured person dies before drawing any pension ·

State subsidy, 10 lire per annum for each insured member, whose pension does not exceed 1,000 lire, with additional ·IO lire for members of mutual benefit soci eti cs

Weekly contribution for pension of lOs. weekly, from 9d. to 9s. 4d., according to age at entry State subsidy equal to one-fourth

of the total contributions, or one-half for those who are also members of friendly societies Cost of administration borne by

the Government

(a) Old-age pension based on amount of cmitributions paid, commencing at age 60 for males and age 55 for females after

payment of contributions for 25 years (b) Invalidity pension, after five years' membership, increased

to a minimum of 120 lire from a special invalidity fund I lira = 9!d.

(a) Old-age pension at age 60, I Os. to 40s. per week, according . to contributions paid (b) Invalidity benefit, 7s. 6d. per

week for each child under l4 years {c) Survivors' benefit, 7s. 6d. [ler week for each child under U

years; if no children, con­ tribut.ions refunded (d) Maternity benefit, £6, if in­ come of insured person and

wife does not exceed £300 per annum

Portugal

Switzerland-(i) Canton Neuf­

1907 Pension fund for the working classes, administered by the

GeneraJ Deposit and Provident In­ stitution

1898 Cantonal Fund for People's Insurance under State control District assemblies

and committees Administrative Coun­ cils Committee.s of Control

(ii) Canton Vaud 1907

Argentine­ {a) General workers

Cantonal Fund for People's · Insurance (mutual fund under guarantee of the

State)

1923 One Provident Fund for each group of insured persons

administered by a :Board of Manage­ ment of nine mem­ bers {chairman and four representatives each of employers · and employees) r

All workers, who are Portuguese subjects between 15 and 60 years of age, pro­ vided. they are not aJready entitled to a pension of more than 15 milreis per month ·

Contribution for single pension, 250 .reis per month, propor­ tionately higher for double, treble or quadruple pension State subsidy. 200,009 mih·eis

yearly and an additional

· amount equal to each premium but not payable in respect of a . pension above 15 milreis per month

·Contributions of insurers based -on age at entry

Persons domiciled in the Canton, without restriction as to

nationality Natives domiciled I

outaide the Canton . may insure against

No contributions required after reaching age 80 State subsidy ranges from 48 cents per 100 franos of capital

insured at age 18, to 19 cents at age 39, and for old-age pensions from 2. 76 francs per monthly pension of 10 francs at age 18 to 1. 32 francs a.t age 39

old age ·

Every person domi­ ciled in the Canton, also natives domi­ riled outside the

Canton

State pays cost of administrat.ion

Contributions paid into alienated or reserved fund, payable at any time, and immediately converted into capital provi­ sion for pension. Maximum premium in first vear, 3,000 francs, in subsequent years,

1,000 francs, and in last ten years, 500 francs. State subsidy from 6 to lOfrancs for each annual contribution

of from 6 tO 60 francs State pays cost of administration

:B.-COMPULSORY INSURANCE,

{a) Old-agE) pension, payable at end of period to which his

premiums rela.te, minimum 3 monthly

(b) Invalidity pension, ponding to amount tributions or refund tributions I milreis = 4s. 6d.

corre., of con­ of con·

Lump sum payable at death or old-age pension at 60 years, or both, in accordance with ar­ rangements made at time of entry sum must not be less than

100 francs nor more than

5,000 francs and old-age pen­ sion must not exceed 100

francs per month 1 franc = 9!d.

(a) Old-age pension dependent upon amount of contributions, payable between ages of 50 and 65, in accordance with a,rrangements at time of entry (b) Invalid pension corresponding

to age and amount of con­ tribution

All wage-earners and salaried workers in -{a) the Argentine mercantile marine ; (b) industrial estab­ lishments; (c) print­ ing industries; (d) commercial estab · lishments

Five per eent. deduction from wages (a) Special superannuation al- . lowance for invalidity First month's wages in instal-

ments First month's increase in wages Employers, 5 per cent. of wages Interest on funds Fines Guarantee funds set apart Wages over 1,500 pesos per

month not considered

(b) Same for employees when in­ capacitated during employ­ ment (c) Ordinary superannuation

allowance (d) Survivors' pensions The amounts 11.re fixed by the :Board of Management

1315

47

CoNSPECTUS OF AcTs RELATING To OLD-AGE, INVALIDI'l'Y, AND SuRVIVORs' BEN:EF!TS IN VAmous CoUNTRIES­ continued.

Country.

Date of Act and

Method of rganization. Scope of Sy.tem. Sources of Income. Benefit.'!,

B.-CoMPULSORY INsURANCE-continued.

Argentine-cMtd. (b) Bank Em­ ployees

(c) Employees of private com­ panies

Austria--(a) Private em­ ployees

(b) Miners

Belgium­ Miners

Bulgaria­ (a) General workers

1923 Bank employees

Provident Fund ad-ministered by Chair-man and three

rep res en ta ti ves each of employers and employees

flame as for general workers, Same as for general workers escept--Employers, 8 per cent. of wages Extra contributions of em­

ployees and employers are required in order to meet any deficit

1921 National Pension and Subsidy Fund, ad­

ministered by a

President and one representative each of the employers and employees of

each public service included in the Act

1906 Pensions Institute, administered by a President and 20

members, half of whom are employers and half employees Provincial branches in

capital towns of

provinces

I

1854 Miners' Relief Funds

I

1868 General Pension Fund Provident Funds, ad­

ministered by com­ mittees of employers and employees under supervision of Minis­

ter of Labour Mutual Benefit So­ cieties

1918 Social Insurance Office under the Ministry of Commerce, In­

dustry and Labour Local Factory Inspec­ tion Departments act as local organi­

zations

All permanent em-ployees of the i

private companies engaged in the vari­ ous lines of public service, escepting railways

Employees in private service over 18

years of age, with earnings over 600 krone per annum Employees in public

service who have no claim to other

pension Persons engaged in manual labour ex­ pressly excluded classified

according to salaries

All persons working in mines in which" re­ served " minerals are obtained, ·and

workers in estab­ lishments connected with mining

All workers in coal mines, below the age of 60 on the 1st

January, 1912 All workers in metalli­ ferous mines under concessions

All wage-earners and salaried employees in public or private undertakings, with­

out distinction as to sex or income Employees classified aooording to wages

Five per cent. deduction from wages One month's pay in 36 instal­ ments Payments on account of

increased wages Employers, 8 per cent. of wages Previous pension funds of

companies State subsidy of an amount to be determined ·wages in escess i>f 1,000 pesos

per month not considered

Monthly contributions from 6 krone in Class I to 30 krone in Class VI. Employer pays two-thirds of

premiums in Classes I. to IV., and one-half in Classes V. and VI. State contributes 100,000 krone

annually towards cost of

Pensions Institute Contributions cease after 480 monthly payments have been made Persons with incomes over 6,000

krone pay their own premiums

Contributions vary according to the industry and are paid in equal proportions by employer and employee The rates for females are one­

half those for males Employee with over 3,500 krone per annum pays his own

contributions

Contributions to General Pension Fund by employees under 21 years, 18francs; over2lyears, 24 francs, minimum per year Contributions to Provident

Funds--Employee, l franc monthly; employer, 2! per cent. of wages Surplus paid to National Miners'

Pension Fund. If there is a deficit, State and province each contribute one-half of deficiency

Employees contribute from 1. 66 per cent. of their wages for the lowest class to 1. 11 per cent. for the highest class Employers and the State each

contribute an equal amount to employees

(a) Ordinary pension, after 30 years service, at age 50 ranging from 95 per cent. of wages

downwards; or if conditions not fulfillea, refund of con­ tributions with 5 per cent.

interest (b) Invalidity pension, 5 per cent. of ordinary pension for each year of service (c) Survivors' benefit, 50 per cent.

of deceased's pension

(a) Old-age pension. After 480 contributions, from 500 krone in Class I. to 2,500 krone in Class VI. per annum (b) Invalidity pension. After

120 contributions, 180 to 900 krone per annum, plus 9 to 45 krone for each extra twelve payments (c) Widow's pension. One-half

that of the deceased husband (d) Children'smaintenance. One third of deceased's pension for each child, two, thirds for full

orphans up to 18 years of age

(a) Old-age and invalidity pen­ sion, minimum 200 krone for males, 100 krone for females per annum (b) Widow's pension, one-half

that of the deceased husband, each child one-sixth up to

maximum three-fourths, full orphan one-third I krone = IOd.

(a) Old-age pension, not less than 720 francs per annum to

insured persons who have

worked for ·30 years and are 60 years of age (b) Widow's pension, 360 francs per annum, at age 60

1 franc = 9td.

(a) Old-age pension, payable at age 60, after payment of 1,040 contributions, 30 per cent. of earnings and a proportional pension for contributions over

156

(b) Invalidity pension, between ages of 14 and 60years, on same basis, after payment of 156 contributions (c) Refund of contributions to

deceased's nearest relative, provided his annual income does not exceed 6,000 levas, and provided no pension has

been drawn 1 leva = 9!d.

0.'*' A'd'J'S' tb' :fu'VA:LIDITY; £Ntr :ffENMn'i'S' tJ!r

conti'nned;

Country .. Method of Orgilnlzatlon. 1 Sll

B.-'-COMPULSORY INSURANCE-continued.

--------·1

(b) State work­ m&n 1906 T.&e Act is. admin.is­

tefecf 1\"y tie· finan-cial department .

of the central ·

administra;tive I

authority in eacl\: · district

State employees

Employ.ees qi" trie ln-­ terpoloni«,l and Pii':trce l!r&ward.Is,. · fanE! Rai1ways

One per cent. of wages One month's increas&i.Jt wages : Donations and oeqoe8t8 . 1 State subsidy to makei up &R;}:' ! deficiency

i .3" cent.

, fm- jirst month'" 1 i cent.

su"f>sequent Ill.JHJ.thS : .. State, same amount, U:J to iL maximum of 100,000 dellara per annum

(a) InvaliditY' poo.sion,. on.e-thir.d to thi!ee-qoar.liels annual eru-n­ aeeotding to ililgree o

fn.v:jjidity, . minimum 2tf0 levas, maxfmum 1,800 Ievas per annum . (o} Wloow,. uom 50 to 100 .per

ceat •. of deceased's pension, ·.· of children

(c) Fiill.fi111J1h&.n.a..21i ceat. each up. te, roo per cent.

J. diice,ased's pensioo

m caae of permanent disable­ equal t-o 1 t per cent. of

· monthly wages, multi­

plild by number of years of Diaximum 20 dollars

per month! or two-thirds wages (a) At age 78, (b) incapacitation, (c) voluntary retirement at age

, I dollar = 4s. 2d.

60,. (dl perin!l>nent disablement

C'zecho-Skvafiia-,- HiW . A1f .. empfoye"M . in I from. If krona (a,} oui-a.Se peil&iQa. p&;y:6bl.e at

(a/ Safarie& em'· I·. Gen .• eia. f .p: · ensiortB (J:mce offices, OOllllBercial a.mmm.. ior C1ass l. to- M 8.f!JA . g(j. Basic . for jJ!oyces Reeogilil3ed _ :mutoo1. establishmerifu and Cl'ass Xvt . I. to vt., from I80

heneO:€ st}Ciletfetil a!J.8j!ff. and' super- !E"mp.li;lye:r, t"tto-tb.iRds 4bc!kt.W:.· ' per annum to 900 . · be- liiQD.a.:O for other classes, basic

.. tween l{f and. 55 Wt V: b .A.Vl..,. . 900 krone, plus from

FraH.Cil--(a.) Ollnl!tnl workers

I --

Bentfit S'a­

ienefit so-

19l!t Invatfdfiy Illsufanct'! Fund, iii.ana.gec:I by a board of three

directors Invalidity Inslifanoo Court investigates cases of inV'alidity

1910 J.q'atloiia.t Old- · e

Retifeifient F'un'l Mutual befl.efit Eo· cillties DeptffiiiiE!iltal retire­

milflt i1inds Il:iitabll!ilil:lltmt funds Flmdil ot gUarantee syndl(JAtes Fuiitls of occupational

Uiiloii§ .

talit five fu11.ds under conttol ol Minister of Finance

of ag.e, pt&- . eiiJployee pa.Jll! the baliuibe. um ·bwe to I5 krone for

.v:idea .tMf are .oot · eaJa, . • month's registration

w"My engaged in period

ma.riual work · (b)Wfdow'a pension, one: half of

sixth of tile hasic pension for

I

..

- one-

each child up to maximum 50 . per c.eut .. thereof I

mTetj •. _peri!ar) em- I' Con.triliutlom&;. payable-' one-haff .. (aJ at age 55

ptoyea!ntlre;mir;Ung each UJJ eltlplc.\yers and em- with30years'service,(ii)atage . . . plt;lyees.. oaaed.. ()D. wages or on 60, with fifteen years' service;

a. £f.ied or QJI. bath basic sum 900 krone per an­

num with not less than 8 krone extra for tis-ch month of con· tributions after five yoors

Evety person . over eighteen yeats of age, W"h0 is a mem­ ber of a sick fund, if poSi!eSSed of

ilatiollal rights and resident in :Oen­ mark, sttbjeci to certain.. . propertr and qua.li­

Jloatii>ns

Empioyee, · a,t date of krone 40 ore per allllUlll.

thereafter at rate aecordin!f to age Employer, 5 krone 40 ore per adult workerjer annl!m Balance derive from 1111bsidies

from State and COlllillunes, one-half each

Alt t'linployeas, o! both Employees, minimum, 9 sexes, in industry, · francs ; fema.les, . 6 commerce, the lib- minors, under eighteen years, eralprofess1on,agri- 4.50 francs per annum

culture, servants, Employers alSo pay tbe mini-employees of De- . mum rate of contribution partments and State increases pension by IOO communes, whose francs, plus I 0 francs if insured annual remunera- person has brought up at least tion does not exceed three children, provided that 10,000 francs 30 annual payments of I5

1

I francs each have been paid

I

by a male or 10 francs by a female I frano - 9Jd.

(b) Invalidity pension fol.' same am.o®t wit\hout IJ.IlY waiting period (c) benefits, widow not

tha.n one-half the hustland's

child one-fourth,

one-half. Maxi­

thrile-fourths

'

:W,v-a.lidity pflnsion, 800 krone per lil.1UI.\4W; if pensioner reaches 62 pension is continued

until the cost being de­

. one-half each by the

State ·and the commune of residence; three-fourths of the latter is refoud.e

l ls. I td.

(a) pension, at age 60.

on age at eritry and

of contributions

(b) pension, antici-.

pa,tllf.l liquidation of pension, plus state subsidy, maximum IOO francs, or three times the liquidation amount (c) Survivors' pension, 50 francs

per month for-(i) 3 months, widow ; (li) 6 months, 3

or more children under 16 years ; (iii) 5 months, 2 child­ ren; (iv) 4 months, 1 child

l3t7

CeNB:t>ECTW. OF' AcTs R:ELA'CllNG· '1!0 . SuRiV•IiVORSt :BiwNEma C0;r:TNtiJB>Jilj:&-

cQmirMtfJd,. . .

Country. Benefits. Date of Original Act and I Method of Organization. . ·

Frren-ee-cunti-!11!t'!lffl. fb )' Sl=nen 1'6'73'

(c) Miners

(d) Railwa:1 employees

Germany-( a) General workers

(b) Salaried em­ ploy('eE;

Na;vaJ. Invalids- Fbm¥ I

1894 Autonomous pensions fund for miners,

administered by a couu.cil of eighteen membEll"&, com;pcis­ ing t) employers. 6;

employees,, and: 6 representing the

State

1800 Pensions fund, for

which the, railway companies are re­ a,n,q qt

l!ll fl.lPlished. t.o the of }\J.bli..C.

Wort¢

1889 Insuranoe i:nstitutes for the tewitory of

1!1\iP.n& of 1!-nd other parts of the teJ.Titory, man­ aged by

of official l!lembers and ol employers and emplu,vees

l9U Imperial in­

!ltitute for salaried employees, managed by a directorate of a. pre!;\dent, officials by Gov­

ernw.eut and re­

presentatives of

persons

and employers

i Alf F-i-eml'n registered semnett including

All miners and

persons of French nationality em·

ptoyed: on mines Foreigp. miners, these dh no:t par­ ticipate m t:rre State

subsfd.v Mfuers" del;eg)l.tes QVer 3-,fiOO

francs W apnum noil constdere.d'

All officials, employees and workers on the larger railway com­ panies and· State wlw, i.Q.,

®re,d: 111,1der :ereidous !iAect

to. come u11.det tftis, ot who l;J;;l.ve 'f\ad ®e. yea.r'!! ous

All workmen, journey­ men and household servants, crews of GermtW, wssels. ®fl a,ss.illta-nts a:ud a p­ prentices, if over 16 years of age and

working for remun­ eration: and home vorke.ra classifiE>d

ll;ccording t<> ings

('la)aried employetlll who are unde:r 60 y!lar& of 11ge, 11nd whose aiil.W

an amount fixed by the Ministry of

of Labour Employees according to earn­ ings

! s; pev. eent. ofi W&geSl G1A)'• JpensioD; a.ft &gQ 50,

i Eini•l"tl:yeJ.is, 1 aftoo3.00 from

I fiftl!ts· Gf . tli.at. paid by· em:.- i 36el tfil 1,000 francs per annum : pl'oyees; 8: per cent. cri . :m.v1!Jidit3( pension, after 180

i wages of$tweigll'seamea, : mo11Ah's service, on same scale W:ikh;Jw's Qr children's pension

• fl:em 290 to 680 francs per

allllV!!l\1 pension of 4

fira.Bs }lei! month for each : chilli lll!lder thirteen years

j I

j Ordinary fund-Miners, per· · at age 55,

J cent. of earnings ; employe!IS, ' · aiJt&· working 7,920 days in 30

: same amount years, i:q.creased by State

i Special fund: for guaJlanteefflg- Bttbsi:dy- 6f 100 francs annually; l and increasing minimum of 2,000 francs guar-

! M.i'ner&, 2t eent. of wages; an teed: loy special WwJ, I employers, same amol'lnt ;: ea) IN.valicliity pension. Liqui-State subsidy, not than d'at@d' peJision at any age

1 per cent. of total wages brought l!P to minimum of

2,000 franps per annum

Employees, 5 per cent. of wages, the whole of the first; month's pay and one-twelfth of every increase in wages com:panies a11d State

raHwayg an amount

lr;r

Contributiuns of employers and employees in equal proportions graduated in accord;:tnce with the wage and

subsidized by the State

. Equal contributipns by 11nd employees', vary:mg ao­ cording tQ the wag() cla.ssifl­ cation

(c) Widow's pension, at age 55 one-half of her deceased hus­ band's (d) Orphans' pensions. Same as

that provided for general

workers Ul).der the 1910 Act

(a) Old-age pension, after 25

years' ser\lice, at ages 50 or 55 years, onerhalf average wage, plus one-fifi;ieth rol" eaeh year of service over 25 years (b) fu.va)Mjtl pension, 15

Y

fo}W'!OOw-'1!! pension, one-half of husband's pension

fll}. pension, full orphan

18 of age, same as

widow's

(a) Old-age pension at age 65 after 1,200 weekly contribu­ tions have been p;ud (b) In validity pension, after th6

of the weelts

durlllg which sick Jl8)l ha.s

been paiq and aft i) 500

weekly co11tributions have been paid Pension coli!.sists of a basic

amount, with add:ilie,nal

for extra contributory weeks (c) W:idow's pension, if incapaci­ tated anl!ual State subsidy

and of her deceased

husband's pensiGn (d) Orphan's pension, annual State and two-tenths

of the pension

{a) payable at age 65 or

in event tatlon, one-fourth of contribu­ tions paid in during 120 months and one-eighth of those paid in

(b) benefits-Widow,

two-fifths of that of the de­ ceased ; child, one-fifth of

the widow's pension; and full orphans, one.third thereof up to age 18

50

CoNSPECTus OF AcTs RELATING TO OLD-AGE, INVALIDITY, AND SuRVIVORS' BENEFITS IN VARIOus CouNTRIES­ continued.

CounGry,

Greece-( a) General workers

(b) Seamen

Holland

Hungary Miners

Iceland

Itaiy-(a) General workers

-

Date of Original Act and Scope of Syst,m. Sources of Income. Benefits. Method of Organization.

B.-COMPULSORY INSURANCE-continued,

1922 Pension funds of s fied undertakings, of workers' organi­

zations and of min­ ing undertakinge, and State pension funds for wo.ge-earn­ ing and salaried

employees

All persons engaged otherwise than on their own account in industrial handi­ craft and commercial establishments, in­ cluding building and transport industries

The rates of contributions are fixed by regulations issued on t.he recommendation of the Ministry of National Economy

Pensions, the amounts of which are fixed by regulations, are granted-(a) in the event of accident in connexion with em­ ployment, (b) in cases of in­ capacity due t.o old-a.ge or long period of work or to physical or mental disorders

In the former, two­ thirds of the gov­ erning body must reprosent insured

persons, and one­ third employers and public officials

1907 Marine Invalidity Pension Fund

1913 State Insurance Bank Labour councils, with insurance councils

for groups of labour councils

1854 Miners' guilds

1909 Funds establi11hed in every town and

commune

1919 National Social In­ surance Institution with branch pro­

vincial institutes

All registered seamen

All workers, over 14 years of age, with incomes of less than 1,200 gulden per annum as well as workers employed abroad by Dutch firms or on Dutch ships Employees classified

according to wages

All miners

Every man and woman between the ages of 18 and 60 years

Workmen, learners, apprenticos, persons in public offices and in liberal pro­ fessions, domostic servants and similar persons in private serviee, between the ages of 15 and 65 years Employees with

monthly incomes exceeding 800 lire are exempt

Contributions by seamen, sea­ men's marriage fees, sale of service books, wages of deser­ ters, fines, flotsam and jetsam, contributions by maritime communes, from port funds and from shipowners, &e. Contributions by seamen, from

1 · 5 drachmas to 15 drachmas monthly 1 drachma = 9!d.

Weekly contributions ranging from 16 cents from the em­ ployer and 4 cents from the employee for Class I., to 24 cents from each for Class V. State subsidy 21,500,000 gulden

annually 1 gulden = ls. 8d.

Contributions by members, ac­ cording to rulos of guild

Males 1.50 krone annually Females, 75 ore annually State, 50 ore annually for each contributor

1 krone = ls. ltd.

Employeos, from 0·50 lire per fortnight to 3 lire, according to income Employers pay the same con­

tribution State contributes 50,0oo,OOO lire annually llira = 9!d.

Pensions are also granted to the survivors of a deceased insured person

(a) Old-age pension, at age 56, after 25 years of sen·ice, the twenty-fifth part of the basic sum multiplied by seven and by the number of years served (b) Invalidity pension, basic sum

multiplied by seven, plus two­ seventy-fifths for each year's service over ten (c) Widow's pension, one half

that of her decea

half to one-third of the de­ ceased's pension

(a) Old-age pension, at age 70, is _ .. _325 timos the amount of con­ tributions divided by the num­ ber of weeks insured, plus 14

per cent. of the premiums paid (b) Invalidity pension on same basis after 150 contributions are paid (c) Orphans are also entitled to

pensions

Old-age, invalidity, widow's and orphans' pensions according to the constitution of the guild

Annual distribution of two-thirds of the contributions, one-half of the State subsidy and one­ half of the interost to indigent persons over 60 years of age, in amounts of not less than 20

nor more than 200 krone

(a) Old-age pension, at age 65, after 240 contributions paid (b) Invalidity pension, after 120 contributions paid Pension, 66 per cent. of first 120

fortnight's contributions, 50 per cent of next 120 fortnight's contributions, and 25 per cent of further contributions, plus State subsidy of 100 lire (c) Widow's pension, 50 lire for

six months, provided no liqui­ dation of pension has taken place

_____ __;_ ______ -!.-________

1319

51

CoNSPECTus oF AcTs RELATING To OLD-AGE, INVALIDITY, AND SuRVIVoRs' BENEFITS IN VARious CouNTRIES­ continued.

Country.

Italy-continued. I (b) Seamen

Jugo-Slavia

Luxemburg

Portugal

Rumania

Russia

Date of Original Act and Method of Organizatio '·

1913 Invalidity Fund the Mercantile Marine

1922

for

Central Workers' In­ stitution Local workers' insur­ ance institutions Workers' insurance

funds for transport undertakings Miners' mutual benefit societies.

19U National Insurance Fund Act administered by

a committee of man­ agement, composed of president, coun­ cillors and members n'ominated by em­ ployers and em­ ployees

1919 Compulsory Social Insurance and Gen­ eral Provident

1912 Invalidity and Old-age Insurance Fund, managed by a board

of nine members, appointed by the State, including two employers and two employees

1922 Administered in ac­ cordance with in­ structions issued by

the Council of

People's Commis­ saries, the Council of Labour and De­ fence and the

People's Labour Commissariat

Scope of System. 3 ources of Income.

B.-COMPULSORY INSURANOE--Continued.

All persons engaged on board ships, in­ cluding officcrs,deck hands, engineers, firemen, &c.

Every person who

performs manual or mental work for

remuneration, with­ out distinction of sex, age or nation­ ality Employees classified

according to earn­ ings

All workmen, assis­ tants, journeymen, apprentices; ser­ vants, employees in industries and

offices, foremen, clerks and commer­ cial apprentices,

with incomes under 3, 750 francs for

annum

All persons earning less than 900 escu­ dos p<'r annum

All master workmen, journeymen, ap­ prentices and la­ bourers in mines, factories

n.nd trades, between the ages of 16 and 65 years

All workers in all un­ dertakings

Contributions of employees from 2. 50 lire to 1. 50 lire per 30 days at sea Contributions from employers,

from 7 ·50 to 1 ·50 lire for each employee per 30 days at sea Fines, bequests and legacies Sale of unclaimed goods of

deceased seamen State subsidy fixed annually

Employees, It per cent. of the daily basic wage Employers contribute the same amount

State subsidy to increase pen­ sions of less than 1,500 dinar per annum and t.he corres­ ponding \Oidows' and orphans' pensions 1 dinar = 9-!d.

Contributions of 2 • 1 per cent of wages payable one-half each by employers and employees State reimburses to Insurance

Fund one-third of each pension Commune refunds to State, one­ fifth of each pension State subsidies Insurance Fund

with 125,000 francs annually from receipts of mine-rents 1 franc = 9-!d.

Employees, 1! per cent. of wages Employers, 6 per cent. on all wages up to 900 escudos State subsidy of 13•33 escudos

for each soldier recruited 1 escudo = 4s. 6d.

Employee, 15 bani per week Employer and State each con­ contribute the same amount

I lei = 9-!d.

Insurance contributions borne by employers solely

Benefits.

(a) Old-age pension at age 60, after 20 years service,. from 240 to 900 lire per annum, also increased by one-twentieth for each year of service over 33 years (b) Invalidity pension on same.

scale after 10 years' service (c) Widow's pension, one-half, and each child one-tenth of old-age pension up to total

amount of deceased's pension

(a) Old-age pension, at age 70, after 500 weekly contributions, equal to twelve times the

average annual contributions (b) Invalidity pension, after 200 contributions eight times, after 500 contributions helve times

the average annual contribu­ tions (c) Widow's pension one-fourth !or three years, and children's

one-fourth of deceased parent's pension to age sixteen

(a) Old-age pension at age 65, after 2, 700 days work. Basic pension 180 francs for males, and 140 francs for females, plus

7t centimes for each six days work over 1,350, to maximum 420 francs for males and 400 francs for females (b) Invalidity pension, after 1,350

days' work, on same basis as old-age pension, but with 15 cents increase instead of 7! cents .

(c) Survivors' benefits. Lump sums for periods up to six

months

(a) Old-age pension, at age 70, after payment of 1,410 weekly premiums (b) Invalidity pension, after 235

weekly premiums, ont>-sixth of old-age pension, plus one-sixth for each additional 235 prem­ iums (c) Lump sums for survivors pro­

vided for by additional contri­ !:JUtions of I per cent. of earn­ Ings

(a) Old-age pension at age 65, after 1;200 weekly contribu­ tions, 150 lei per annum, but if pensioner is unable to work, this amount is increased by 10

bani for each week of con­ tributions in excess of 200 (b) Invalidity pension, after 200 contributions, on same basis

The scope and form of old-age and invalidity pensions are determined by the Council of People's Commissaries.

O.T.!J;>.-.4.@.., :t:.N.

Country.

Spain

E}laPis-

t Date of Act and t Method of Orglp!lzatJon. I•

1919 __

I of ;

I OOihJ.\q. ·

rating· witq the in· . 41. l

p;r:o;viooe ·

.

1 sma-oo6. Instml.•. ·

.

B.'-COMPULSORY INSURANCE-:-continued.

Ail wage-earners be- : For persons under 45 yeif-rs of age tween the ages ofl6 • (i} State, 12 pesetas per head 66. yea.m. ; . •

aruwal in.eo.m.es. do ' (lis). not 4),.@00 . W. pensi'M\

• . (Wi). lW;t,Wpe _ - - i%\)Onrertedin-

. to bj. contri-

; butions from insureq persons ; For persons over 45 ye!fS of age ; contributions paidintp savings bank ·

Contributions may bot supple­ mented by regional, provin, cial, or municipal aui;horities

J¥neflta.

(a) Initial MJlSion, at 65 years' 365 peset¥ \w.,f creasw ll.y: to

of 2,000 pesetas or

rmtal §1liD. of 5,000 pesetas at death

( b r If ainoun. in bank insufficient pension b:rought up to 180 pesetas bY: t;he National Inst

may be reraid or pension pro­ vided by t.p.e institution (d) PremiulDjl refunded with in­

reaching 6 years 1 pesett m Jd.

t .,.f!,.- -· "- · ·; n- ... -...

%W!UI!! PJilftllliUJll of 3 pension at age 67

)f{PljlJ% -\Jy W• i-, fo to age at entry,

. I;

Bo¥d, with and wo- be-

· l/lg.IIIJ,

Mll8; in in ; ltit a:n

· in - lnSlil;l'el'llE ac·

tGW'l'lS- andj i-B. JIJAJ,'>. • c0lldmg. - W. -kat towns incomes

as

·w· · , 15 per cent. of con-

of for males and from

; krone to 30 JriwP.e W, cent. for females

. w _ -, .. {tl !iY4tJidity pension, at any· i\00 ?.Wif fifteen yea.rs, on same krone · W' efcii:q the h\ Ja11,uary1 1858, who has means equal to Olj greater than thE} amount of the pen; sion Commonwealth bears l'hole cost of pensions State pays Gile,ejghtJl an\! ·pommunes two•eightha o.i thE! c.Ql!t pf pensions · .· {a) Old-age pension, at age 65, for maio;,"; and age 60 for fe malea, lQa. pru: Tot-al incpme {including pen­sion) 1mt to exceed lUUll'\ P!fSODs, same pension. (ipclqding pension) not lQ £221 per annum gt, aijjOUI\t of basic wage +ol _ wditf pension, after age same amount as ._ "·- ···

1321

53

CoNSPECTUS oF AcTs RELATING To OLD-AGE, INVALIDITY, AND SuRVIVoRs' BENEFITS IN V .A.RIOus CouNTRIEs ...... continued .

.

Country.

Denmark

France

Date of Act and

Method of rganizatlon.

1891 Ministry of the Interior Communal authorities

1905 Ministry of the Interior Departmental authori- ties Communal authorities

Scope of System. Sources ot Income.

C.-NON ·CONTRIBUTORY PENSIONs-continued.

Every person in pos­ session of national rights and resident for five years, if of

good character and not in receipt of

poor relief, nor with income equal to half pension plus 100 krone

Every Frenchman, without permanent resources, who is not in a position to earn a living by

work and is over 70 years of age

The cost of pensions is borne by the communes, but the State Treasury refunds seven-tenths of the expenditure

The payment of pensions depends on the domicile of the pen­ sioner ; generally communes are responsible for it, other·

wise the Departments The State defrays the cost for those who do not belong to a commune or department, sub­

sidizes communes and pays the cost of administration

Benefits.

Old-age pension, at age 65 years, from 1,008 krone to 600

krone per annum, according to the place of residence for a married couple, from 552

krone to 402 krone for a

bachelor and from 505 krone to 300 krone for a spinster 1 krone = 1s. 1 -fd.

Old-age pension, from 5 francs to 20 francs per month. No

deduction made where income is less than 60 francs per

annum or 120 francs if three children have been reared. Whole income, including pen­ sion, must not exceed 475

francs per annum · 1 franc = 9fd.

··-------------I-----------------1-----------------!------------------------I------------------------ Holland 1919 State Bank

New Zealand

Norway

United Kingdom

1898 Government

1923 State Insurance Office Municipal Old-age As-sistance Commis­

sions

1908 Local Government Board with local pension committees

in the larger

Boroughs and Ur­ ban Districts

Every inhabitant, who at the 31st Decem­ ber, 1919, was over age 65, and not in receipt of a pension . and who was not

assessed for pro-perty tax or income

The cost of pensions is defrayed by means of an annual subsidy from the State

tax on 1,200 gulden 1

Old-age pension, 3 gulden per week for single person, 2 ·50 gulden each for a married

couple 1 gulden = ls. Sd.

-----1---------------------I---------------------- Residents of New Zealand for 25 years, of good character, without income ex­ ceeding £78 if single, £130ifmarried,and without property exceeding £390 in value Norwegian citizens, who have resided in the country for one half of the period since attaining the age of 16 years British subjects of ten years' standing, resi­ dent for twelve years before attain­ ing age of 50, or, if naturalised, resident for 20 years, and with income not exceeding £49 l7s. 6d. The cost of pensions is borne by

the State

Pensions are paid by municipali­ ties, the State refunding 50 per cent. up to a maximum of 300 krone for a single person, and 450 krone for a married

couple 1 krone = ls. l!d.

Pensions paid by Government

(a) Old-age pension, at age 65 for males, or age 60 for females, £39 per annum. Total income, including pension, not to ex­ ceed £78 (b) Widow's pension, with one

child under age 14, maximum £39 per annum, plus £19 lOa, for each additional child under age 14

Old-age pension at age 70, an amount corresponding to 60 per cent. of the discrepancy between the income of the beneficiary and a basis secur­ ing 60 per cent. of the necessi­

ties of life

Old-age pension at 70 years, lOs. per week, where income does not exceed £26 5s., reduced by 2s. per week fo11 every £5 5s. in excess

! ---.-------c-'---------------'--------------------·----------C..:.----------------------

Printed and Published for t.he Govrm!'iME:>;T of the CoMMO:--IWEALTH of AuSTRALIA bv H. J. GREEN, Government ·Printer for the State of Victoria. '