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    "source_key": "britannica_1926",
    "source_title": "Encyclopaedia Britannica (1926)",
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    "chunk_id": "1926:insurance social:0bd4176ab3a3",
    "title": "INSURANCE, SOCIAL",
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    "verified_text": "social insurance is the name given to the arrangements, whether provided by the state or private agencies, whether voluntary or compulsory, for paying a certain sum of money, or goods and services in kind, as compensation for the loss resulting from certain kinds of emergencies which in their nature lead to diminished capacity to earn or to an increase of expenditure. the object of all branches of social insurance is to protect the workman against the fact and fear of insecurity and its accompaniments—the exhaustion of savings, a lowered standard of living and recourse to public or private charity. this device gives him a legal right to a definite sum. the causes which may reduce the work- man to want are of two kinds: those which are unexpected, catastrophic and undesired emergencies, and which entail a lowered capacity to carn or an inability to earn; and those which are desired and normal happenings, but entail an increase in expenditure even where the income has not diminished. in the former class should be included industrial accidents and occu- pational diseases, non-industrial accidents, ill health, invalidity, blindness and unemployment, burial, unprovided widowhood and unprovided orphanhood and, in the latter, old age, maternity and provision for growing children. in order to deal with these problems modern states have created new institutions, assumed control of existing machinery and provided subsidies, and their legislation on the subject constitutes in its totality a veritable code guaranteeing the workman a minimum of security in all his emergencies. i. general introduction origin of social insurance.—social insurance began as a device employed voluntarily by workmen to protect themselves against 488 emergencies. trade unions, friendly societies, employers’ wel- fare funds and private insurance companies organised provision for the cost of burial, ill-health and unemployment, and settled the rates of contributions and of benefits. germany, under bismarck, was the first country to realise the value and necessity of the compulsory method of insurance against sickness, indus- trial accidents and old age, which was applied to practically the whole industrial population by the laws of 1883, 1884 and 1889. great britain was the first to experiment (in 1911) witha national compulsory system of unemployment insurance, and possesses the most comprehensive system of pensions for widows and orphans of any country in the world. the schemes first intro- duced in the central and western countries in europe are now being copied by other countries, by the south american repub- lics and japan. since the war new risks have been provided for 1n countries where before only one or two were recognised. classes hitherto excluded from insurance legislation are being brought increas- inglv within its scope. gradually the families of insured members are being recognised as standing in equal need of insurance with the breadwinner. money and service benefits are being added to bring them up to an amount which will give the insured popula- tion a minimum sufficient to maintain them in efliciency. a new factor which is likely to grow increasingly insistent is the effect of compulsory insurance on the costs of production and consequently on international competition. it is in the interest of countries like great britain and germany, which spend heavy sums annually on social insurance, to press for the extension of similar activities in other countries. in 1924 great britain spent an aggregate of some £170,000,000 (contri- buted by employers, workers and the state) and germany some {60,000,000 on the various branches of the social insurance systems. the international labour organisation has adopted at itsannual conferences a number of conventions and recommenda- tions on unemployment insurance, maternity insurance and workmen’s compensation, and the exhaustive studies made by its staff provide an armoury of information. in great britain legislation in connection with provision against social risks, either by way of compulsory insurance, provision by the employer or regulation of voluntary insurance falls under the following heads: compensation for industrial accidents and industrial disease, old age pensions, sickness and invalidity insurance, maternity, unemployment, widows’ and orphans’ pensions, blind persons, family endowment (provision for children under the war pensions and unemployment insurance acts). each of these is dealt with below. grea. britain may claim to have the most comprehensive system of social insurance in the world, but most industrial countries have adopted some schemes covering one or more risks. the two branches most highly developed in the united states of america are workmen’s compensation and pensions for widows and orphans. basis of state action.—why does the state interfere in the matter of social insurance? from the days of the elizabethan poor law the state has been the ultimate resort of those who are destitute. when all other means had failed those in distress, they could turn to their parish for relief, though this relief has generally been inadequate and granted only under deterrent conditions. social insurance reduces the number of those who will become destitute. moreover, unless compulsion is applied, few will make ad- equate provision against these social emergencies. but to the community as a whole, assuming no change in our habits, these risks are unavoidabie, and it is now regarded as the business of the state to contrive that they shall be provided for. even the individual who is fully conscious of the dangers he runs will frequently be unable to make adequate provision, and therefore parliament may decide that the immediate costs should be borne by the employer or by the state itself. another considera- tion has been slowly emerging. only parliament can decide that large bodies of people shall be compulsorily insured. when it has gone so far it cannot allow private organ- insurance, social isations to administer the insurance badly or at too great a cost. since the administration is extremely simple, once the actuary has worked out costs in relation to benefits, there is everywhere a tendency for social insurance to be organised through state- monopolised funds. behind all these arguments of a practical nature lies the consideration that every worker is an asset to the state, and the community as well as the individual suffers when his health or efliciency is impaired. limits of social insurance-—many of the older advocates of social insurance are beginning to be nervous about its colossal growth, and complaints are frequently made of the heavy burden which it imposes on the nation. it is misleading, however, to lump togethers as some critics do, aggregate expenditures on pensions, health and unemployment insurance, workmen’s com- pensation and burial insurance premiums, and bring out a grand total of some two or three hundred million pounds which is called “ national expenditure. ” it is not national expenditure in the sense that it is all provided by the exchequer. on work- men’s compensation and burial insurance the state pays nothing. and its contributions in respect of the three compulsory insur- ance schemes are, of course, only a fraction, even if a substan- tial fraction, of the total cost. the following tables show the respective shares of the workers, the employer and the state in great britain. health, widows and orphans and old age contributory pensions (weekly contributions) worker od. 6d. employer gal. 7c. men women state contribution (a) health: two-ninths of the total cost of benefits (payable on disbursement). (6) pensions: £4,000,000 a year. (there will be a slowly rising additional cost to the exchequer in respect of old age pensions at 70, equal to .£1,700,000 in 1926-7 and £4,700,000 in 1935-6. at the same time there will be a relief to the exchequer in respect of health and unemployment insurance. the #et exchequer charge on all these pensions will, it is estimated, be £5,700,000 in 1926-7, rising to £6,400,000 in 1935-6. the finance of the scheme is complicated; it will be found discussed in detail in the govern- ment actuary’s report on the financial provisions of the widows’ etc., pensions bill, cmd. 1925. unenproyment (weekly contributions) | worker i-mployer men. a 7d. 8d. women ee 6d. 7. boys (16-18). . | 45d. 4d. girls (0618) |) | 3a sa. moreover, it is plain that if the state were not paying these millions which have been reduced by the economy aci of 1926 into the insurance funds, it would be forced to pay as much, or perhaps even more, in other ways—e.g.,in supporting a public health service, in various palliations of unemployment, in extra poor law relief, or some similar form of public assistance. state-aided insurance, in short, is judged to be true economy. so it is that we find extensions and improvements being advocated in all directions. the paradox of social insurance, indeed, is its steady growth in spite of constant attacks upon it and the lack of any visible widespread enthusiasm for it. unification.—parallel with the movement for the extension of social insurance there is a movement for its unification. at present all the emergencies are treated by different administra- live machinery, with different methods for raising funds and different rates of contributions. since the objects underlying all these schemes are broadly the same, the prevention of des- litution, the abolition of the fear of insecurity and the provision of a minimum in all periods of need, it is undesirable that these variations should continue. moreover, the workman, the in- sured person, wishes to be spared the trouble of dealing with 2 host of organisations. however the present medley has been brought about, it is surely desirable that all these different schemes should be unified. and unification must be taken to insurance, social mean not merely the correlating, co-ordinating or riveting together of all the schemes, but their complete amalgamation in respect of finance, administration and underlying principles. the advantages claimed for a unified scheme are:— (1) the problem of social emergencies will stand out prominently and steps for prevention will thus be encouraged. (2) administrative expenses would be very much less and insur- ance could be provided cheaply. the benefits given for the same premiums will consequently be higher. (3) the workman dealing with one body will be more likely tv know his rights and how to claim them. . (4) existing anomalies, such as death by industrial accident re- ceiving different treatment from death through a non-industrial accident, or natural causes, will be abolished. (5) a department of state will be better able to tackle the whole problem than the variety of agencies that now are at work. im- provements will be carried out more easily, investigations will not be hampered by private interests. no doubt such a department of state would be a huge affair. nor would the change over from the present system be easy. vested interests and inter-departmental jealousies would have to be overcome, and the machinery for dealing with every insured workman greatly extended and improved. but that is the direction in which social insurance is tending, and not only in great britain. in some of the more important recent codes of social insurance, those of russia and czechoslovakia, sickness, old age, invalidity and death are treated in unified schemes. the proposed french and australian schemes are also very comprehensive. the unification of social insurance is also being debated in germany. | | il workmen’s compensation in great britain the employers’ liability acts of 1880 and the workmen’s compensation acts of 1897, 1906 and 1923 con- stitute the legislative basis for providing compensation to workpeople who suffer ‘‘ personal injury by accident arising out of and in the course of employment, ”’ or in consequence of one of the industrial diseases brought specifically under the act of 1923. in the act of 1880 negligence had to be proved against the employer. but in the act of 1897 employers were held to be responsible for injuries arising out of work in their establish- ments, even when negligence could not be proved, on the ground that the workman was unable to bear unaided the monetary loss which injuries involved. in 1906 the scope of workmen's compensation was greatly increased. in the workman’s com- pensation acts the individual employer is alone held to be responsible for paying compensation, and neither the worker nor the state makes any contribution towards the cost. it is still open to the employer to choose whether he will insure himself in some private insurance company against the risk of having to meet compensation claims, or pay them himself. the number of workpeople who obtain some measure of protection is estimated at over 17,000,000, but the statistics of its working! relate only to some 8,000,000, to those employed in: shipping, factories (to which the factory and workshop acts apply), docks (including wharves, quays, etc.), mines, quarries, constructional work (not including building construc- tion) and railways. rates of compensation.—the rates of compensation laid down by the act of 1923 are broadly: for partial incapacity, a sum equal to half the difference between the man’s earnings before and after the accident; for total incapacity, half-wages up toa maximum of 30s. a week. compensation is payable from the fourth day of incapacity. where, however, the incapacity lasts for four weeks, the first three days also rank for compensation. thus in addition to the loss of at least half his wages the workman in most cases suffers the joss of the waiting period, the cost of doctors, medicines, artificial limbs, etc., the cost of training for a new job; and in all cases where disputes arise he is lable to meet the costs of litigation. although in theory the employer is liable to bear the total costs of an accident, in practice it is doubtful whether much more than a third of its financial burden is placed upon him, the workman bearing still about two-thirds of the loss. , in fatal cases a sum of between {200 and £300 is paid to the widow, which may be raised by additional allowances for children up to a maximum of £600. it should be observed that whilst some provision is made for dependents in the case of fatal industrial accidents, no provision is made for their needs in the case of non-fatal accidents. the home office has estimted that the total of the charges and expenses for workmen's compensation in the seven great industries was not less than £5,000,000 in 1913 and 1914, {6,000,000 in 1919, £8,500,000 in 1920, 1921 and 1922, £9.000,0¢00 in 1923. but these figures relate only, as we have seen, to about half the industrial popu- lation. assuming that the accident rate in the other occupations is only half what it is in the seven great industries, then in 1923 the cost of workmen's compensation to employers must have been about £13,500,000. since, however, the workman is still made to bear between one-half and two-thirds of the loss resulting from an acci- dent, it has been estimated that the annual loss due to industrial accidents and diseases amounts to between £30,000,000 and {40,000,000 per annum. _ the administrative expense in the case of workmen’s compensa- tion has for many years been about 50% of the premium income. phe holman gregory departmental committee reported in 1919 that ‘ during the last five or six years the employers have had to pay {100 in premiums for every £48 paid out in benefits to insured workmen.’’ the companies agreed in 1923 to confine administrative expenses to within 40° of the premiums they received, with a further reduction to 373° at the beginning of 1927. although employers generally insure themselves against the risk of being called upon to pay workmen’s compensation, they are not bound to do so, and very frequently the smaller employers fail to make any such provision. cases thus arise where the workman is obliged to take less than he is entitled to by law. it has therefore been proposed that employers should be compelled to insure, so that the workers may be certain of receiving compensation. over 30 «diseases have now been scheduled as being due specifically to various industries and in respect of which compen- sation is provided. but in the many kinds of industrial diseases which may also arise apart from the employment—c.g., bronchitis in cotton workers—no compensation under the act is provided. this system is also crilicised as involving frequent litigation and delay in payment. moreover, agents are alleged frequently to induce injured workmen to take smaller amounts than their due. insurance companies, as often as they can, induce the workman to accept a lump sum, since in spite of their heavy cost of administration they have only clumsy machinery for making weekly payments and for the review of benefits as the children grow older or die. lump sum payments very frequently mean the rapid dissipation of benefits. neglect of preventive measures—perhaps the most serious fault is the neglect of preventive measures. there is little evidence of a steady and significant decline in the number of industrial accidents, of which about 400,oo0 occur annually. the neglect of the well-known and fried devices of the “ safety first ’ association, with their educational influence on the workpeople, both by employers and by the insurance companics, is a glaring piece of carelessness. second only to this in import- ance is the scant attention paid to the rehabilitation of injured workmen. it has been suggested that a government fund for insuring employers against the liability to pay compensation could be run at a much lower administrative cost than private insurance. in the united states competitive funds have an administrative expense of 6 to 9°95. another suggestion is the linking up of workmen’s compensation with health insurance and the scheme for widows’ and orphans’ pensions. this might be desirable in itself, but would necessitate compulsory insurance in a state scheme. it would indeed involve altering the whole basis of the present law, the device of workmen’s compensation has been so widely adopted that the international labour organ- isation was able to adopt a convention on this subject at its conference 1n 1925. ii. pensions old age pensions.—old age pensions were first granted in great britain by the act of r908. this act, which was amended in some particulars by the acts of rgrt1, r91t9 and 1924, pro- vided for the payment of pensions to all persons who had reached 490 70 years of age, who had been british subjects for at least 10 years or if natural british subjects had resided in the united kingdom for a period of not less than 12 years since attaining the age of 50. the amount of the pension was to be adjusted to the means of applicants. they must be below a certain standard before they could claim, and the pension was in no case to exceed ios. a week. the scheme was non-contributory in character, and the entire cost of the pensions and of the administration was defrayed out of national taxation. under the existing acts, the application for a pension must be made, in the first place, at the local post office on a ‘‘ claim to pension ’ form. the local excise officers appointed under the acts by the treasury to be pension officers report on the means of the applicant; the pension committee decide on the validity of the report and the rate of pension. the claimant or pension officer, if dissatis- fied with the decision, may appeal to the minister of health within seven days of receipt of the notice of the committee’s decision. if the claim is allowed the applicant obtains his weekly pension at the local post office. the old age pension act of-1908 was the first act to provide permanent public assistance outside the poor law. its advo- cates argued that even if the workman could save enough to provide for ill health or unemployment he could not be expected to save enough to provide both for himself and his wife after 70. the scheme adopted bore signs of its origin in the older system. the pension is granted only to those who are not, it is true, destitute, but necessitous. no one is eligible who has an income of {504 year or over. the amount of the pension varies directly with the need of the applicant. the poverty qualification infringes the idea of social insurance, the essence of which is to grant a legal right to a definite sum. the pensions scheme, it is true, does this, but grudgingly and on conditions which savour of the poor law. it involves vexatious inquiries; it discourages thrift and the aid of relatives; it is unjust. on the other hand, it is the first branch of social insurance in which the state intervened directly. its inquisitorial character was inevitable in a non-contributory scheme. in 1910, the first full year of the working of the old age pension scheme, the cost was {8,468,128. in 1924 it amounted to £24,000,000. in 1965 the government actuary estimates that the same scheme will cost more than double that amount, some £57,000,000. this is attributed to two causes, the growth in the annual number of births between 1850 and 1890 and the decline in the death rate. the cost of granting universal old age pensions without tests or a means limit would an additional {14,000,000 a year, rising to about £19,000,000 in twenty years. the total net cost of administration of the scheme, covering the expenses of the pensions committee, was estimated for the year 1924 at £800,000. this constitutes an administrative expense of 33 %. the operation of the old age pensions scheme revealed an appalling mass of poverty, among those over 70, and it was known that the lot of those between 65 and 70 was little better. the act of 1925 introduced contributory old age pensions at 65, and also abolished the means disqualification for those insured. this act, however, allows the non-contributory pension at 70 to continue until it is slowly absorbed by the contributory insurance scheme. non-contributory old age pension schemes exist in:— (1) australia, denmark, france, great britain, the irish free state, new zealand, norway, in certain of the united states and uruguay. (2) contributory pension schemes have been introduced in rumania, spain, switzerland, belgium, italy, the netherlands, the serb-croat-slovene kingdom, bulgaria, czechoslovakia, and recently in great britain. the act of 1891 passed by denmark for assisting the aged has thus been the forerunner of the modern schemes of old age pensions and insurance which have now been adopted in most industrial countries. old age is assumed to occur at some stated age which varies from 50 to 70 years according to the country. pensions for the blind.—in great britain the blind act of 1920 provided that all blind persons of the age of 50 or over should be granted pensions at the same rates and on the same conditions as those applying to persons of 7o and over. the local authorities are empowered to make provisions for the blind—such as the insurance, social establishment of workshops, assistance to homeworkers, home teaching and assistance in book production—out of the public funds. such provision is aided by a state grant. widows’ and orphans’ penstons.—the contributory old age and widows and orphans act 1925 marked a new development in social insurance in great britain. two methods are open tog government for making provision for widows and orphans, that of compulsory contributory insurance, or as it is termed in great britain, contributory pensions, or that of non-contrib. utory pensions. from january 1926 widows have received a pension of fos, a week, together with 5s. for the first child under 14, or under 16 if the child is still attending school, and 3s. for each of the others. this scheme has been linked with one for providing old age pensions of ios. a week at 65 instead of 70 to all insured men and women with. out inquiry into their means. both these schemes are joined to the existing scheme of contributory health insurance and the non. contributory old age pensions. it has been estimated that the benefits accruing to an insured man and his dependents under the act are roughly equal in value to an endowment assurance for £200 payable at death or at the age of sixty-five. but instead of being entitled to an old age pension, if his income was very restricted, at the age of 70, he will under the new scheme be able to draw his weekly pension of 10s. for the rest of his life on reaching the age of 65, whatever other sources he may possess and whether he gives up work or not. his wife will also be entitled to a pension at sixty-five. the new scheme provides also that on his death—at whatever a —his widow will receive a weekly pension of 10s. until her death unless she marries again; if he leaves children at school under the age of 16, his widow will be entitled to draw 5s. a week for the eldest and 3s. a week for each of the others; and if the children are motherlesg as well as fatherless payments will be made in respect of them until they reach the age ai 14, at the rates of 7s. 6d. a week for the eldest child of a family and 6s. a week for each of the other children. the pension age, it should be observed, is reduced only in the case of those who are insured, and it is only in their case that the existing means disqualification is to be removed. those who have not been insured as workers remain under the existing system. the costs of health insurance may be expected to be lessened by the scheme, because many workers who will be drawing their old age pensions at 65 will no longer be entitled to their invalidity benefits. under the economy act 1926 the government lessened, therefore, the state contribution to health insurance. the first full year in which old age pensions at 65 will be paid will be 1928-9, when the costs will be £12,400,000, from which they will steadily rise up to the maximum in 1965-6, when they will amount to {21,500,000. in that year the total cost of old age pensions will be £85,900,000. in the first complete year (1926-7) the cost of widows’ and orphans’ pensions will be nearly {11,000,000, and the amount will rise steadily until 1965-6, when it will be £38,800,000. in that year the total payment on account of old age pensions and widows’ and orphans’ pensions will be {125,000,000. for many years to come the old age pensions scheme is to be a growing liability and the war pensions scheme a dwindling one. in 1926 these two services cost about {94,000,000. in forty years they will cost about £90,000,000. after that the state grants out of taxes grow less until, as the percentage of those who come in after 1956 increases, the government will be called on to pay less and less, and its liability will gradually dwindle to nothing. the contributions to be paid by the insured persons are 43d. a week ‘by a man and 2d. by a woman, while the man’s employer also pays 43d. and the woman's 2}d. the state also contributes its share under the new scheme. as regards the administration of the scheme, contributions are collected in the same way as in the case of health insurance. in fact, the health and pensions contributions are combined, and the same stamp and the same card serve for both. the approved societies issue the certificates showing that a person is entitled to benefits, but the actual payment is made by the post office. it is calculated that the administrative expense will be no more than 2% of the contributions. germany, czechoslovakia, italy and holland have very inadequate schemes on a contributory basis. new zealand, most of the states of north america and canada have adopted non-contributory schemes of pensions for widows and orphans. iv. industrial insurance abuses of the unreformed system—by industrial life assur- ance or burial insurance the working classes obtain benefits sufficient to cover the cost of burial. this form of insurance is common in great britain because of a very deep and wide insurance, social spread terror of a pauper’s funeral. between 1903 and 1924 the amount spent by the workers on this branch of insurance increased by about 4oo per cent. the great success of the in- dustrial insurance companies is due to the army of some 70,000 agents employed by them to collect weekly the small premiums. burial insurance is brought by them to the worker’s home in such a form and at such a price that he can provide for it out of his small earnings. indeed, the agents have been able to per- suade many working class families, and especially the mothers, to take out one or more policies for each member of the house- hold, so that it is a common thing for a workman to spend between 1s. and 2s. a week for this branch of insurance. it has been claimed that “ there is scarcely a home among the millions of the working classes in this country which is not visited at least once a week by these agents.’ in rg2t it was stated that there were over 50,000,000 “ industrial policies ” in force, for which £35,000,000 was paid annually in premiums. ‘to this should be added the interest on invested capital. it is estimated that expenditure for “ death ” benefits is equal to about twice or three times the amount spent on health, maternity, and dis- ablement taken together. this business has been subjected to very strong criticism. a departmental committee, presided over by lord parmoor, reported in 1920. it was found that some 44% of the premiums went in agency and management charges, proving that this method was needlessly costly. excessive house-to-house can- vassing led to considerable overlapping and wasteful competition. the persistence of the agents led to the purchase of policies by persons who could not afford to pay for them, with the result that some 5,000,000 policies lapsed annually. there had been failures and scandals and the system was full of abuses. three policies were proposed for dealing with the situation: — (1) to nationalise the business and to provide burial benefits compulsorily under the nationa}) insurance scheme. (2) to control it, to remove the more flagrant abuses, and to limit the joint charges of administration and profits. (3) to control it, but to leave the insurance companies to remove the main causes of complaint themselves. the parmoor committee recommended this third policy, which was in effect adopted by parliament. statutory regulation. —the industrial assurance act 1023, the outcome of the report, made the chief registrar of friendly societies the industrial assurance commissioner, with wide powers, and every office, whatever its constitution, which transacts industrial assurance business is now required to make returns to him. ‘the companies are required to make an addi- tional deposit of £20,000 in respect of industrial assurance business, and the collecting socicties have to make a similar deposit. the accounts of the industrial assurance business must be kept separate from other branches of insurance business. the commis- sioner has power to examine into and report upon the affairs of any company or collecting society where an offence has been committed or in his opinion is likely to be committed. every office transacting this business had to have a valuation made by an actuary not later than the end of 1925, and where a deficiency was disclosed the com- missioner might present a petition for winding up the company. attempts are being made to lower the administrative expenses in four ways. the “block system” of canvassing for business, by which a definite area or number of blocks of houses is assigned to one agent, is being substituted for the anarchic method which allowed every agent to canvass where he would. companies will still com- pete with one another, but not the agents of the same company, there is also an increasing tendency to pay agents by salary rather than by commission. this will give the company greater control, and encourage sounder methods of obtaining clients. in the third place, efforts are made to induce regularly employed people to pay premiums monthly. fourthly, higher premiums are canvassed for in order to lower the proportion of administrative expense. one company working along these lines has reduced the expense from 40°, to something below 30%, in a few years, but we are warned that from even this company we must expect no reduction of the rate of administrative expenditure to premiums below 20%. there are strong arguments against allowing the business to remain voluntary. the present method, apart from incidental abuses, is open to objection on the ground of its wasteful administra- tion and the undestrability of continuing the voluntary method when the compulsery is adopted in related branches of insurance. 491 now that we have a system of life insurance endowment policies in the wilows’ pension scheme, it is contended that it is absurd to omit life insurance burial policies. many countries grant this additional benefit in conjunction with their health insurance schemes, an arrangement which keeps administrative expenses low. the state can administer this benefit at an expense below 2° of the premium income. v. health insurance the national insurance act of 1011 constituted in many respects a new departure in british social policy. workmen’s compensation was already in operation, but the judicial justi- fication of the new scheme was entirely different, whilst the state was, and still is, very little concerned in its actual admin- istration. the old age pension act might be regarded as the offspring of the old ideas of poor law, and it was very easy to administer. the device now introduced of contributory insurance conveying a legal right to a definite amount was unknown previously in great britain. ‘the act of torr was in fact a novel experiment, both as regards the health insurance and the unemployment insurance sections. hfealth insurance.—the national insurance act rorr, part i.,, makes provision for insurance against loss of health and for the prevention and cure of sickness. it is compulsory on all manual workers between the ages of 16 and 70 and non-manual workers with incomes under £250 who have not claimed the right of exemption. over 15,000,000 persons are included. the normal benefits provided under the scheme include: — (1) the payment of a weekly benefit of 15s. for men and of 12s, for women for not more than 26 wecks as sick benefit. (2) a disablement benefit after the 26th week of 7s. 6d. per week so long as the beneficiary is incapable of work. (3) a maternity benefit of 40s. to the wife of an insured man, which is raised to £4 when she ts herself an insured person. (4) provision for medical benefits. this medical benefit consists of such medical treatmient as can consistently with the best interests of the patient be properly undertaken by a general practitioner of the usual professional skill. it also includes the provision of medicines and of such medical and surgical appliances as are approved by the regulations issued by the supervising body, the ministry of health. the employer is responsible for the payment of the joint contribution for himself and for the employee, which since january 1926 is od. for cach employed man and 83d. for each employed woman, but he deducts 42d. in the former case and 4d. in the latter case from their wages. but, as shown above, the contributions in respect of pensions are now combined with these, and the actual vajue of the weekly stamp affixed by the employer is 1s. 6d. for men, and 1s. 1d. for women. the pur- chase money of the stamps, which are obtained from the past oflice, is paid into the national health insurance fund. the state adds two-ninths of the cost of the scheme. the benefits are determined actuarially on the basis of the contributions from the employers, the workers and the state. the administration of the scheme is carried out by approved societies and insurance committees. approved societies consist of trade unions and friendly societies, collecting societies and special branches of insurance companies, which are to be “recognised ” if they are democratically controlled and non- profit making. the medical benefits are administered by the insurance committees. these consist of local bodies represent- ing the interests concerned, the insured persons. the doctors and the ministry of health. deposit contributors, of whom there are about 250,000 are persons unwilling or unable to become members of approved socictics. they are entitled to benefits up to the amount of the contributions paid in respect of them. unlike ordinary members, they cannot draw more than that amount if their illness continues, most approved societies have attracted the majority of their members from particular trades. in consequence some have a high sickness rate and some a low one. the latter are in a position to give additional benefits above the normal benefits: the former suffer fram deficits even when they give only the normal benefits. ‘this system involves a certain amount of unfairness, to counterbalance which four devices for securing some measure of equalisation have been introduced: - 492 (1) the system of ‘' reserve values ” to allow for the age distribu- tion of members. (2) the contingencies fund to guard against the probability of an excess of liabilities, or deficiency on valuation of a socicty due to expenditure for benefit being in excess of the expected. (3) the central fund to guard against the probability of a defi- ciency on valuation caused by abnormal rates of sickness due to the nature of the occupation of the members or the environment in which they live, or an epidemic such as iniluenza, or some other cause beyond the control of the society. (4) the women’s equalisation fund to meet the fact that women, especially married women, have a high rate of disability, principally on account of child-bearing. whis fund was withdrawn and a sum added to their reserve value in its place. in spite of these funds, the benefits obtained by clerks and agricultural labourers are very much higher than those obtained by miners, and it has been suggested that the whole of the government grant of two-ninths should be used to guarantee all insured members the same benefits. | proposed amendments.—a royal commission was appointed in july 1924 to inquire into the scheme of national health insur- ance, and to recommend any alterations or improvements that might seem desirable. it reported early in 1926. two reports were issued, both recommending changes and extensions, but, the minority being a good deal bolder than the majority. there was general agreement on the fundamental soundness of the system, on the need for a considerable extension of benefits, and on abolishing the insurance committees and transferring their functions to the local health authorities. the extension of benefits advocated by the majority is, however, to be made only “fas and when funds are available to meet the cost.’”? the minority report, on the other hand, rejects this proviso, and makes definite recommendations in favour of an all round extension of benefits, and especially for (a) the provision of medical treat- ment and attendance for children of school leaving age and for the dependents of insurance; (b) extended provision for child- bearing women before, at and after confinement; and (c) increase of the rates of cash benefit paid under the health insur- ance acts to the present rates under the unemployment in- surance acts—i.e., 18s. a week for men and rss. for women. furthermore, the minority recommended the abolition of the approved societies system. the approved societies, they hold, are a failure. they are not democratically controlled, they are uneconomical, and they are ‘a hindrance to the development of a complete public health policy.” the local authorities, therefore, should take their place. compulsory health insurance schemes are to be found in many european countries, including germany, austria, bulgaria, czechoslovakia, great britain, norway, poland, russia, bel- gium and the serb-croat slovene kingdom. all the states in australia have introduced non-contributory maternity grants. japan introduced a scheme of health insurance in 1922, and chile in 1924. in poland, russia and the serb-croat slovene kingdom the territorial fund has in effect a monopoly of insurance. in germany, austria and czechoslovakia the territorial fund is the leading but not the sole insurance institution. in some countries, e.g., germany, rumania and bulgaria, survivors’ insurance, consisting as a rule of both burial benefits and pensions for their dependents, is attached to the various health insur- ance schemes. unen ployment insurance.—great britain was the frst country to introduce a system of compulsory unemployment insurance. the national insurance act rgir (part ii.), as a first instalment, made provision for insurance against unemployment in certain selected trades. the scheme was extended to include additional groups of workers by the munition workers act of 1916. the act of 1920 brought into insurance all persons of the age of 16 and upwards employed under a contract of service, excepting domestic servants, outworkers, agricultural workers and non- manual workers employed at a rate of remuneration exceeding fasoayear. employees of local authorities, railways and certain other public utility undertakings, members of the police forces, and persons with rights under a statutory superannuation scheme may, in certain circumstances, be excepted. insurance, social as in the case of health insurance, the scheme is contrib- utory, and the stamp and book method is employed ior collecting contributions. every insured person is given an unemployment book, on which his employer fixes a stamp weekly for the amount to be paid in contributions in respect of himself and his employee: the part of the contribution made on behalf of the workman is, of course, withdra‘yn from his wages. | the rates of contribution, as revised in 1926, are, for men, 8d. a week from the employer, 7d. from the employee and 8d. from the state; for women, 7d. from the employer, 6d. from the employee and 6d. from the state. these contributions are paid into the unemployment fund, out of which come all bene- fiis and administrative expenses connected with the scheme. rates and conditions of benefits —the rates and conditions of benefits laid down in the 1924 act are that after three days’ unemployment, provided no suitable work is available, men receive a flat rate of 18s. a week and women 15s. a week, with an additional allowance of 5s. a week for a dependent wife or husband, and 2s. a week for each dependent child. under the act of 1920 one week of benefit was payable in respect of every six contributions, and not more than 26 weeks of benefit were payable in one year. every insured person claiming unemployment benefit must lodge his unemployment book at an employment [:xchange when making aclaim. if the insurance officer is satisfied that no work in his own trade is available, and that the workman is bona-fide unemployed, he will receive his benefit. a workman is regarded as unemployed for the purposes of the scheme when he is able-bodied, efficient and, though willing to work in his own trade at the current rates of pay, is unable to find employment because of lack of work. benefits are not paid to those thrown out of employment through trade disputes. the employment exchange system, with its lists of employers in search of work-people and of workers in search of employment, together with other sources of information available to the officer in charge, en- ables him to judge of the bona fide of applicants for benefit. if they are offered suitable employment and refuse it, the benefit is withheld, courts of referces of employers and cmployees constitute a court of appeal from an insurance officer. he in turn has an appeal against them to an umpire. : vhe total number of insured work-people in great britain and northern ireland has grown to nearly 12,000,000 and the annual receipts of the unemployment fund at the present rate of con- tributions are between £40,000,000 and £50,000,000 per annum. in 1922 the expenditure of the fund was over £58,000,000, and a debt to the treasury was incurred, most of which has since been slowly repaid. the extended scheme of 1926, including also the mass of indus- trial workers (agricultural workers and domestic servants are ex- cluded), was introduced on the eve of the trade depression, so that reserve funds had not been accumulated to mect the great demands. rates of contributions and of benefits have been frequently changed; the unemployment fund instead of being a creditor has become a debtor of the treasury. the administrative checks on applicants originally intended and the limitation of benefits have not been applied. in 1920 there was introduced the system of what was at first called ‘‘ uncovenanted ” henefit, and is now known as “ ex- tended \" benefit. extended benefit is benefit allowed to unemployed persons who have exhausted their “ standard” benefit (z.e., what they are strictly entitled to in respect of their contrihutions); it is granted under certain conditions and at the discretion of the minister of labour. this discretion was taken away in 1924 and extended benefit was made a right, subject only to the fulfilment of the statutory conditions; but it was restored by the act of 1925. all this has led to unemployment insurance being decried as a “dole ’’ system. but dole is clearly a misnomer for the standard benefit. and even as regards extended benefit, the expectation always is that the recipient of it is one who had contributed to the fund, and who will in the future pay the premiums against the bene- at he has drawn in advance. it should be noted that the debt to the treasury is not very large, and is certain to be repaid from the un- employment fund as soon as the volume of unemployment dimin- ishes. during a period of four years from the beginning of the de- pression in 1920 workers’ contributions were £62,000,000; those of employers £71,500,000, and of the state £46,000,000. thus the exchequer provided slightly over a quarter of the total amount spent. taking the whole duration of the scheme, the state has given and lent very little more than was originally intended by parliament. (the economy act of 1926 provided for a reduction of the state grant in respect of unemployment insurance.) nor is it a fact that the same people have remained unemployed all these four years. an investigation made in 1924 into 10,000 claims showed that 47° of the claimants to unemployment benefit had had no insured eniployment from 0 to 29 of the 125 weeks of the period covered, that insurance, social. 22-7°4 had done some insured employment in from 30 to §9 weeks; 23-5%, in from 60 to 89 weeks; and 30°5 “9 in from 90 to 125 wecks. but if it is wrong to say the workman is drawing a “ dole,” it is clear that the nature of the insurance scheme has changed owing to the intensity and continuance of the industrial depression. at present the scheme provides for the insurance of all workers in the insured who are actually employed and not by all those who are insured. since unemployment is a normal feature of industry, there is a prima facie ground for making benefits equal wages. ‘there is indeed a large school which demands “ work or maintenance ”’ for all unemployed, and maintenance at full rates of pay, but the practical difficulties of this are obvious. generally speaking, criticism of unemployment insurance takes the form of suggestions for improving and strengthening the existing scheme, not for abolishing it. jt is proposed that agricultural workers and domestic servants should be included, that greater power should be given to advisory committees of employers and employees in its administration, that parliament should set up a body with authority to advise what political and economic policies will mitigate unemployment, and an interdepartmental body for giving effect to such policies. thirteen years’ experience has demonstrated that compulsory unemployment insurance is entirely practicable, that the british scheme has been conceived on right lines, that it embodies ideas which are socially desirable, that it is actuarially sound, that it is extremely elastic, and that it has been one of the signal successes of british administrative effort. a departmental committee of inquiry into the whole question of unemployment insurance was set up by the british govern- ment in 1925. compulsory unemployment insurance has now been adopted in six other countries. it was introduced in italy by a legis- jative decree in 1919, which was superseded by a decree of 1923. austria introduced it in 1920. queensland adopted it in 1920 and soviet russia includes it in its labour code. poland introduced a system in july 1924. the irish free state is continuing the compulsory system it took over from england. the voluntary system of unemployment insurance supported by state subsidies previously known as *‘ the ghent system, ” is in operation in nime states, but the british method is steadily gaining more adherents. insurance by industry—the proposal to organise insurance by industry has attracted special attention in relation to un- employment. but there is no reason why it should not be considered also in relation to the other branches of social insur- ance. workmen’s compensation in this country is organised in a manner which ought to satisfy the advocates of insurance by industry, and it is possible, if it is desired, to organise unemploy- ment insurance and health insurance in a similar manner. this idea underlies professor commons’ scheme for the american states. | the arguments in favour of this course and against 1t may be briefly summarised as follows:— if the burden of these social emergencies in each industry is placed directly on that industry, a financial incentive will be given to the employers to prevent them in cach industry, and a similar arrangement might even be made for each firm so as to prevent them in cach firm, and so lessen their burden. why not, it is asked, use this obvious instrument for stabilising employment? each industry could forra one representative organisation of all concerned in it, which would attempt to grapple with these social emergencies. experience of working together in this way by employers and workpeople would enable them to face other problems. thus insurance by industry 1s seen to be part of the wider policy of giving the workers some share of control in industry. another argument used is the justice of adjusting benefits to earnings. unfortunately, some of these arguments have little force. thus the money incentive that can be offered would be relatively so small that experience with the rebate system offered under the 1911 act to employers who kept a stable staff proves that it would have little or no effect in inducing employers to seek means to reduce the amount 493 of unemployment. the desire to give the workman and his employer some share in the administration of the scheme can be achieved through increasing the functions of advisory com- mittees both of employersand of work-people. similarly the better | adjustment of benefits to wages can be achieved in other ways. trades by means of premiums paid by or in respect of those alone | there are many difliculties in the way of this proposal. first there is the difficulty of classifying and delimiting indus- tries, though it must be admitted that the same ditticulty will have to be tackled if whitley councils are ever to be made really effective. nor have suggestions been wanting how to dcal with the class of floating labour, especially of unskilled labour which finds employment now in one industry and now in another. it is argued also with force that in case of decaying trades the technical process may become obsolete, but the in- dustry continues, and it is preper for the industry to bear the burden of maintaining those who are too old to adjust themselves to the new conditions. : but there are other serious objections. each industry would have to institute its own system of exchanges, and this would make the administrative expenses of insurance high. besides, workmen might be tempted not to transfer from a high benefit industry to a low one even when it was economically desirable for them to do so. labour would tend to become immobile. moreover, it may be doubted whether it is really unfair for, say, clerks to pay towards the cost of insuring unemployment in the coal industry. they consume coal, the trades in which they are engaged probably use it. shipbuilding is dependent upon the iron and stcel manufacturing industry, engineering, woodmaking and other industries. most industries are depend- ent on coal and transport, and they all use electricity and gas. when industry has grown so interdependent there seems to be no substantial injustice in a ilat rate system. atco.) vi. medical aspects of health insurance insured persons —the number of insured persons in great britain is approximately 15,000,000. they consist of persons under a contract or service, namely all manual workers without any income limit, and nen-manual workers with an income limit of £250 a year. certain other persons, within the same income limit, who have previously been employed insured persons or who have married an insured woman, are allowed to enter the scheme voluntarily. on the other hand some employed persons who have sources of income other than their employment may be exempted, and certain whole classes are excluded from compulsory insurance because they are serving under conditions which provide benefits equivalent to those of the insurance scheme. i 4 lhe medical service.—yhis large proportion of the workers of the country has beer entitled not only to the cash benefits described, but, since january 1913, to such medical advice and treatment as can reasonably be expected from general medical practitioners as a class, other than in respect to a confinement. this 1s a very wide range; and gratuitous service even beyond this range has repeatedly been given. there are about 15,000 medical practitioners engaged in this work. every registered medical practitioner who wishes to do so has the right to take part in the servicc, unless and until he be removed therefrom after due inquiry according to prescribed methods and machinery. yo this provision the medical profession has always attached the utmost importance. equally important are the provisions that every insured person has a free choice of all available dectors, that he may change his doctor at any time, and that the doctor may, with due notice in the case of illness, request his patient to seek other advice. the maximum eifective number of insured persons for whom any doctor may, single-handed, make himself liable is 2,500. with a doctor of quick mind, methodical habits, and considerable ability, who devotes the major part of his lime to insurance practice this number is reasonable, but in an average case where a corresponding amount of private practice is undertaken, this number is probably too large for cfhicient work in times of stress. in some densely populated areas where the number of doctors is relatively [ew and the lists 494 correspondingly large a certain amount of complaint may at times have been justified, but these conditions are, by common consent, adjusting themselves and the service improving. in fact, the number of doctors who have lists effectively exceeding 2,000 is small, the average number of insured persons per doctor being less than a thousand. the aim of all these arrangements is lo make the conditions of insurance practice approximate as nearly as possible to those of private practice. the actual and legal relationship between doctor and patient is the same in both, the only modification of this statement (and that a small one) being that since the whole body of insurance practitioners of an area have undertaken the responsibility for attending all the insured persons of that area, each practitioner must attend any insured person in an accident or other emergency whereas this is merely an obligation of human- ity in non-insurance practice. in addition, the doctor under the insurance system undertakes to give certain certificates with regard to incapacitating illness and to keep certain records and make certain reports as required by the ministry of health. kiffects of the system.—after 13 years of such a system it is true to say, in general, that the incidence of incapacitating ill- ness among the working population has diminished, that whole classes of persons are now receiving a real medical attention which formerly they did not get at all, that the amount and character of that attention is immensely superior to that given under any of the old forms of contract practice, that illness is now coming under skilled observation and treatment at an earlier stage than formerly, and that the bias towards preven- tive rather than mere remedial treatment has been reinforced. good as this is it might yet be better. the existing defini- tion of insured persons includes some—the higher-paid manual workers—who could make the necessary provision for themselves without state aid. equally clearly it excludes many others who urgently need such aicd,—e.g., poor persons not under a contract of service, such as hawkers and small tradesmen. the depend- ents of all the lower-paid insured persons, however defined, manifestly need aid for securing adequate medical attention in some way and might well be brought within the insurance scheme. to make the required adjustments will give rise to some formidable diflicultics but these should be faced and over- come. the difficulty with regard to the inclusion of dependents is almost wholly one of finance. the difficulty of including other poor persons is that of collecting compulsory contri- butions (not necessarily weekly) from those who have no employer. the difficulty of excluding the higher-paid of those now included is that of applying an income limit to the manual worker as well as to the clerk. these difficulties are not in- superable. extension of scope of treatment.—the extension of the scope of the medical advice and treatment available so that it shall include not merely such as can in the best interest of the patient be given by general medical practitioners as a class, but also consultant and specialist services (including dental treatment), and the advantage of pathological laboratories, would not only be of immense advantage to both doctors and patients, but would solve a good many of the minor problems which give rise to daily troubles under the existing system. ‘the expense of such an extension as has been recommended by the royal commission on the insurance acts, to whose reports reference has already been made, would not be prohibitive, and experience already gained would greatly facilitate the necessary working arrangements with the medical profession. a subsequent further extension to cover residential institutional treatment, the provision of nurses, and other ancillary services would be quite practicable and would complete a national system designed to leave no one without the means of readily obtaining adequate medical attention in all forms of illness. (h. b. br.) bibliography.—a selection only of recent official and other publications is given here:— the general problem: report of committee on the co-ordination of administrative and executive arrangements for the grant of assistance from public funds on account of sickness, destitution and unemploy- ment (1924), cmd. 20t1. sir w. beveridge, k.c.b., zastrance for intellectual co-operation all and everything (1924); j. l. cohen, secial insurance unified (1924); a. gordon, social insurance (1924); f. m. rubinow, social insurance: national and international aspects (various), (1913); general problems of social insurance (studies and reports, series m, no. 1), the international labour office (geneva, 1925); see also the international labour review passim for 1924 and 1925. an inter- national zeitschrift fiir sosialversicherung is published in prague; zeitschrift fiir die pesamte versicherungs-wissenschaft, quarterly publ. (igor, etc., berlin). most countries have at least one technical publication on the subject. the monthly labour review of the u.s. dept. of labour. and the american lubour legislation review con- tain useful studies and reports. in great britain, the ministry of labour gazette (1923, etc.) monthly, is the best source of information. workmen's compensation: report of departmental commititee 1922, cmd. 896; workmen's compensation: stutisttes of accidents, annual; annual reports it. m. inspector of factories; compensation for industrial accidents, series m, no. 2 (1925); compensation for occupational diseases, series m, no. 3 (1925) (the international labour office}; j. l. cohen, hworkmen’s compensation in great britain (1923); widows, orphans and old age contributory pensions act, chap. 70 (1925). see also vemorandum and report on scheme by the government actuary, cmd. 2405 and 2406 (1925). national health insurance: report on the administration of national iealth insurance 1914-7, (md. 8890 (1917); appendix to afinutes of evidence tuken before the royal commission on national health insurance, 3 parts (1924 and 192 ey national health insurance in great britain, 1911 to 1921 (u.s. dept. of labour, no. 312, 1923; sickness insurance, studies and reports, series m, no. 4 (the inter- national labour office, 1925); report of the royal commission on national ilealth insurance, cmd. 2596 (1926); widows, orphans and old age contribuiory pensions bill (report by the government actuary), (md. 2406 (1925). unemployment insurance: report on national unemployment insurance to july 1923 (1923), and two reports of investigations into the personal circumstances and industrial i{istery of 10,000 claimants to unemployment benefit (the ministry of labour, lon- don, 1924 and 1925); j. l. cohen, insurance against unemplovment (1921); j. l. cohen, zrsurance by industry examined (1923); f. mor- ley, unemployment relief in great britain; a. 1... bowley, w. t. layton and others: unemployment insurance in great britain (1925). family income insurance: family allowances (the inter-national | labour office, 1924); j. l. cohen, family income insurance (1926): p. h. douglas, wages and the family (1925); e. f. rathbone, the disinherited family (1924). intellectual co-operation, international institute of.— in sept. rg21 the league of nations, on the proposal of m. leon bourgeois, added to its existing technical committees an international committee on intellectual co-operation, made up of distinguished scholars chosen first from 12, afterwards from 14, different countries. its membership included, among others, mme. curie, prof. einstein, prof. gilbert murray, m. jules destree and dr. millikan. m. henri bergson was elected tts first chairman. the task assigned the committee was that of studying the better organisation, through united international effort, of literary, artistic and scientific work. the committee soon became convinced that if it were fully to accomplish its task it must have a permanent administrative organ to prepare its pro- gramme and carry out its plans. in 1924 the french govt. offered to defray for the league the expenses of such an organ, asking only in return that paris be its seat. the league accepted the offer; and in sept. 1925 the international institute for intellectual co-operation opened its offices in paris, at the palais royal. | the institute is divided into seven specialised sections which are as follows:— general section. —this makes a preliminary survey of afl problems submitted to the institute. it draws up an annual set of international statistics on intellectual life and its changes in level. it studies all general problems and suggestions that bear upon the international organisation of intellectual work. scientific relations.---this section deals with specific problems of international scientific organisation. it keeps in touch with the important existing institutions and associations in this ficld, and aids them to co-ordinate their efforts, encouraging the creation of new bodies where these are necessary. it follows closely the powerfu) but still unco-ordinated activity of international scientific congresses. artistic and literary relations —yhese two sections study the organisation, from an international point of view, of literary and artistic production, they prepared in 1926 a plan for an inter- national ofhce for museums. they investigate the question of general protective laws for artists and works of art. university relations.—this section acts as a link between institu- tions of higher education in all parts of the world. to this activity intelligence, animal the committee attached a particular importance from the first. in 1923 they suggested to the council and the assembly of the league the need for an international university information office, since created. in 1925 the assembly decided to refer to the institute for study the question of a general international entente in matters of education. legal.—this section deals with the legal problems raised by plans for international intellectual co-operation. in accord with the inter- national labour office, it studies the economic conditions of intellec- tual workers. information.—this section studies also the means by which the results of intellectual work are diffused, particularly the problems of book production and printing. it secks to co-ordinate the activity of periodical! publications which treat the various phases of intellectual life. the institute is strictly international in character. its officials belong to 20 different nations: the section for general affairs, for instance, had as its first head an englishman; the section for university relations a pole; the information section an italian; the section for artistic relations a belgian; the section for literary relations a chilean, a woman; the section for scientific relations a german; and the legal section a spaniard. the staff, drawn from all parts of the world, represent the most varied intellectual interests. but all of them, from the french director down, are moved by the same desire: to seek in each individual problem submitted to them, with all the exact- ness and modesty of experts who understand the clear limita- tions of a given task, the methods best adapted to reconcile the interests of each nation with those higher interests of the mind that govern the broad sphere of intellectual life. bibliography.—j. luchaire, l'institut international de co- operation (revue bleue, dec. 6 1924); la vie des peuples (oct. 1925); la renaissance politique litteraire et artistique (nov. 1925); minutes of the international committee on intellectual co-operation (league of nations, 1922, etc.); journal of the 6th assembly (sept. 1925). 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