desire of the medical profession the Medical Benefit Regulations provide for the control of prescribing being left primarily in the hands of the local panel committees, composed of representatives elected by the insurance practitioners in each insurance committee area from amongst themselves. The procedure ordinarily adopted by panel committees is to call upon practitioners to explain the circumstances under which they wrote any prescription which appears abnormal in character or in quantity of ingredients, and to which attention has been drawn by the Central Checking Bureau in the monthly reports. In the case of practitioners whose costs are shown by the quarterly statistical analysis prepared by the Central Checking Bureau to be exceptionally high, the prescriptions issued are scrutinised and attention is drawn to possible economies. Where costs are found to be in excess of what is considered reasonably necessary for adequate treatment, the panel committee are empowered to recommend that the practitioner concerned should be surcharged the whole or part of such excess. During the year some 40 out of the 2,000 practitioners in insurance practice were so surcharged, the amount involved aggregating approximately £700. The surcharges have been imposed mainly in respect of the following:-unnecessary and excessive prescribing of flavouring and sweetening agents; undue frequency due to repeating a prescription before the previous supply has been exhausted or to lack of care as regards size of bottle and dosage; disregard for the incidence of dispensing fees; unnecessary elaboration of ingredients in prescriptions; and routine use of expensive ingredients where cheaper ingredients of equal therapeutic value were available. Ten practitioners appealed against the surcharges imposed, eight of these being in one area and lodging a joint appeal. In one case the appeal was withdrawn; in eight cases the insurance committee's decision was found to be justified and was upheld; the remaining case had not been decided at the end of the year.

It has been found that in the majority of cases, panel committees fulfil their obligations in regard to the control of prescribing, though some still show marked aversion to taking action against their colleagues. Complaint has been received that the failure of these areas to deal adequately with the position is making it increasingly difficult for contiguous areas to maintain the strict supervision for which the position calls. Where the panel committee fails to exercise control the Regulations provide for action by the insurance committee, and in cases where extravagance in prescribing appears to exist an endeavour has been made to impress upon insurance committees, as trustees of public monies, their duty in the matter of the conservation of their Drug Funds. The Scottish Association of Insurance Committees has again taken an active part during the year in suggesting methods of minimising the unnecessary expenditure which undoubtedly still persists. In addition to keeping in touch with the Association in this matter, reports have

been consistently called for concerning local action, and suggestions have been made as to the cases in which investigations appeared to be indicated. In certain cases an informal scrutiny of prescriptions was undertaken and a report furnished to the insurance committee.

(e) Check of Title to Benefit of Persons receiving Prescriptions.-Correspondence has taken place during the year with the National Insurance Audit Department and the Association of Insurance Committees on the subject of instituting a regular check as to the title to medical benefit of persons receiving National Health Insurance prescriptions. In the past the action taken by insurance committees for this purpose has not in the majority of cases been sufficiently comprehensive, and as a few cases of irregular issue of prescriptions have recently come to notice, it has been decided to adopt a uniform scheme whereby a sample check of the prescriptions issued will be made by insurance committees on a scale which will enable them to cover all practitioners in the area in from one to three years according to the number of doctors concerned. The results of the test will be recorded by the insurance committee for audit purposes. The scheme will be put into force early in 1928.

(f) Testing of Drugs and Appliances.-The adoption of a scheme for testing the accuracy of the dispensing by chemists of National Health Insurance prescriptions has for some time been under consideration. As such a scheme required the cooperation of insurance practitioners for the purpose of issuing test prescriptions, action was delayed pending arrangements to this end. A provision has now been inserted in the agreement entered into by practitioners undertaking insurance practice whereby such practitioners at the request of the insurance committee will furnish prescriptions for the purpose of the scheme. It is hoped to have the scheme in operation at an early date. In the meantime provisional arrangements have been made with certain analysts in the larger centres to furnish to insurance committees an analysis of any sample medicament forwarded to them under the scheme.

13. Exempt Persons.-The total number of certificates of exemption from National Health Insurance in operation on 31st December, 1927, was 3,910; 2,847 were held by men and 1,063 by women. With the exception of ten granted on the ground of limited and intermittent insurable employment, these certificates were valid also for Unemployment Insurance exemption purposes and 2,382 were so applied.

Of the 796 claims received during the year, the majority were based on the ground of dependence upon some other person, and in all 716 certificates were issued. The number of certificates cancelled during the year was 773. Of this number 312 were cancelled on the ground that the holders had ceased insurable employment, 221 because the holders had become fully insured, 88 because the holders had ceased to be entitled to exemption, and the remainder on various other grounds.

14. Exempt Persons entitled to Medical Benefit. The number of exempt persons entitled to medical benefit at 31st December, 1927, was 3,899, of whom 230 were persons who had ceased to hold certificates owing to cessation of insurable employment, but who were entitled to continue in benefit for a limited period after the cancellation of their certificates; 297 persons whose certificates had been cancelled on attaining the age of 70 are entitled to medical benefit for the rest of their lives, provided that they regularly intimate their desire to remain so entitled. During the year 501 persons, in respect of whom liability for the provision of medical benefit existed, failed to qualify for the benefit by reason of insufficiency of contributions. or by failure to furnish evidence of age or employment.

Despite the issue of informatory leaflets, many exempt persons appear to be under the impression that in addition to medical benefit, i.e., free medical treatment and drugs, they are entitled to the sickness and additional benefits (dental and ophthalmic) applicable to fully insured persons, and numerous enquiries were received regarding the payment of expenses incurred by exempt persons for private dental and ophthalmic treatment.

15. Medical Benefit Regulations.—(a) Consequent on the passing of the Contributory Pensions Act, in terms of which exempt men are compulsorily insurable for widows' and orphans' pensions, revised Regulations regarding the title to and provision of medical benefit in the case of exempt persons are at present under consideration.

(b) Appeals under the Medical Benefit Regulations.-Nine appeals were presented by medical practitioners against the decision of insurance committees to surcharge them for excessive prescribing. Eight of the appeals were dismissed and the other is pending.

An appeal was presented by a medical practitioner against the decision of an insurance committee that he was in breach of his terms of service, in continuing to consult in premises occupied by a chemist, on the ground that the waiting-room accommodation was not proper and sufficient. The appeal was allowed.

Two appeals were presented by medical practitioners against the decisions of insurance committees, finding that the appellants were in breach of their terms of service. The appeals have not yet been determined.

An appeal was presented by an insured person against the decision of an insurance committee dismissing her complaint that a medical practitioner had refused to grant her medical certificates of incapacity for work either prior or subsequent to confinement. The appeal was dismissed.

An appeal was presented by the representative of a deceased insured person against the decision of an insurance committee dismissing his complaint that a doctor had failed to provide adequate medical attendance and treatment to his father. The appeal was dismissed.

16. Relation of Exempt Persons to the Contributory Pensions Act. As already stated, exempt men are compulsorily insurable for widows' and orphans' pensions only. Many enquiries were, however, received from exempt men regarding insurance for old age pension purposes, but comparatively few actually surrendered their exemption certificates to qualify for this pension by becoming fully insured persons. In the case of exempt men of 45 years of age and over, the reduced rate of old age pension payable acted as a deterrent to the surrender of their certificates. for the purpose of becoming fully insured, and generally they preferred to continue as exempts and to remain insured for widows' and orphans' pensions only.

Exempt men who had been sick or unemployed during the year were in general fully aware of the necessity of submitting adequate proof of such sickness or unemployment in order to be credited with contributions for pensions' purposes, and many medical certificates and explanatory letters were received with the unstamped and partially stamped half-yearly exemption contribution cards.

The right of exempt men, whose certificates had been cancelled on the ground that they had ceased to be insurably employed, to become voluntary contributors was not exercised to any considerable extent during the year, although leaflets. defining the benefits to be derived from voluntary insurance were sent to all exempt men on the cancellation of their certificates.

Miscellaneous enquiries relating principally to old age pensions were also received from exempt women who are not insured for any of the purposes of the Contributory Pensions Act.

17. Unemployment Insurance Exemption.-Under the liaison arrangements with the Ministry of Labour, 899 claims were referred by the latter Department for investigation. Of this number 200 were from seasonal fish-workers. Appropriate recommendations were sent to the Ministry, and intimation was received that 612 certificates had been issued, 32 refused and the remainder otherwise disposed of. At 31st December, 1927, the total number of Unemployment Insurance Exemption Certificates in operation in Scotland was 3,087.

18. Exempt Persons: General.-The majority of the claims to exemption received during the year were from professional apprentices, i.e. apprentices in accountancy and legal offices, &c. Many claims were received also from students employed during the summer vacation only, as pursers, &c. The opportunity afforded to widows in receipt of pensions under the Contributory Pensions Act to claim exemption by reason of the receipt of the pension has not been widely used. Apparently the knowledge that by remaining fully insured persons they are entitled to all the benefits of Health Insurance despite the receipt of widows' pensions has induced the majority of these widows to continue the full insurance.

19. Contributory Pensions Act, 1925: Contributions of Em

ployed Persons over 65.-On and after 2nd January, 1928, the ordinary contributions under the Health and Pensions Scheme and Unemployment Insurance Scheme cease to be payable in respect of persons aged 65 and over who are employed within the meaning of the National Health Insurance Act, 1924, and the Unemployment Insurance Acts, 1920-26, and special rates of contributions require to be paid on and after that date in respect of such persons.

These contributions, payable by employers only, are as follows:

No part of these contributions may be deducted from the wages of the employed persons.

Pensions contributions as above are payable notwithstanding that the person may be in receipt of an old age pension or that Health and Pensions contributions may have been discontinued before 2nd January, 1928, on the employed person attaining the age of 70. There is thus no age limit to the payment of these contributions so long as the person is employed. Similarly, the special rates of Unemployment Insurance contributions as above are payable notwithstanding that the employed person is over 70 or in receipt of an old age pension. As before, however, Unemployment Insurance contributions are not payable in respect of employments specially excepted from the scope of Unemployment Insurance, e.g. agriculture and private domestic service.

20. Issue of Special Contribution Cards.-Special arrangements have been made for the payment of these contributions on special Pensions and Unemployment Insurance Cards. In cases where persons had been awarded old age pensions, steps have been taken to issue these cards direct to the pensioners, and over 50,000 cards (Class P(A) and P(E) for a man and woman respectively) were prepared and despatched prior to 31st December, 1927. Persons who for any reason had not claimed pensions were required to obtain a special card (Class P(X)) at post offices throughout the country.

Arising out of the cessation of ordinary Unemployment Insurance contributions and unemployment benefit in respect of persons aged 65 and over on and after 2nd January, 1928, and with a view to providing an additional safeguard against the irregular payment of unemployment benefit to such persons, steps were taken to secure, on behalf of the Ministry of Labour, the return of regular and exempt persons' unemployment books held by these persons and the endorsement of them as belonging to old age pensioners prior to their return to the Ministry.

21. Special Position of Superannuated Members of Police Forces. Provision had to be made to deal with the special position

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