One Voice: Friendly Societies
One matter that had grown from a state-sized irritation to a nation-sized problem concerned contracts between doctors and the friendly societies that governed terms and conditions – capitation rates, for example – for the very many doctors providing medical services to society members.
Friendly societies were extremely popular throughout most of the 19th and well into the 20th century. Among their other services, they provided health coverage for (often less well-off) members and their families for discounted rates determined annually between doctors and societies. About the time that BMA branches were being formed in the States, about a third of all doctors were thought to be involved in these arrangements. By the time World War I was declared, the number of participating doctors had risen to 50 per cent or more – almost all the doctors in South Australia, according to some reports. The reason for the popularity of these arrangements was that the annual capitation rates very often represented steady annual income for the doctors. But, in the pre-war period, as the societies grew and became more commercially sophisticated, they became more inclined to press down on capitation rates. Not only that, but it was strongly suspected that societies were fiddling their members’ income levels so as to force rates down. Doctors and their organisations became alarmed at, in effect, being forced to act as sweated labour for the societies.
The issue was on the agenda for the first meeting of the new branch in South Australia. Doctors in New South Wales published black lists of the worst offenders and even the doctors who continued to provide services to them. Some doctors in Queensland wanted strike action, but the BMA branch there refused to countenance it. Negotiations between the BMA branches and the societies were going nowhere. Shortly before the Federal Committee was formed, the NSW branch designed a model contract that specified minimum rates, income ceilings for society members receiving medical benefits and extra fees for specific services. The Federal Committee took up the running, using the NSW model as a basis for agreement. By the time war was declared in 1914, the societies had agreed to the BMA’s terms in New South Wales, Queensland and Western Australia. But in Victoria and South Australia agreement was not reached until after the war, when government at the national level was well ahead with its thinking on a national health insurance scheme – a deeply concerning prospect for doctors in Australia. They had heard all about the uproar in the UK a few years earlier about the compulsory scheme established by the Lloyd George Government, a scheme so contentious that the argument over it led eventually to reform of the House of Lords.