source and the way in which Finzel recorded the payments he received. In the following section, I will highlight the striking religious elements and connotations of his Rationarium and will place them into the context of his strong Protestant faith. My chapter will conclude with an analysis of the economics of Finzel's practice and of the relative importance of the payments he received from patients of different social and economic status.
Hiob Finzel, or Iobus Fincelius as he latinised his name, was born around
Accounting is about ‘how much’ and is usually assumed to be about money. It is viewed as a financial technology related to the administration of finances, costing, and the calculation of efficiency. But this book suggests a broader understanding of accounting, linking related perspectives and lines of research that have so far remained surprisingly unconnected: as a set of calculative practices and paper technologies that turn countable objects into manageable units, figures, and numbers that enable subsequent practices of reckoning, calculating, valuing, controlling, justifying, communicating, or researching and that generate and appear in account- or casebooks, ledgers, lists, or tables. And Accounting for Health involves both money and medicine and raises moral issues, given that making a living from medical treatment has ethical ramifications. Profiting from the ‘pain and suffering of other people’ was as problematic in 1500 as it is in today’s debates about the economisation of medicine and the admissibility of for-profit hospitals. In current debates about economisation of medicine, it is hardly noticed that some versions of these patterns and problems has been with health and medicine for centuries – not only in the modern sense of economic efficiency, but also in a traditional sense of good medical practice and medical accountability. Spanning a period of five centuries (1500–2011) and various institutional settings of countries in the Western world, Accounting for Health investigates how calculative practices have affected everyday medical knowing, how these practices changed over time, and what effects these changes have had on medicine and medical knowledge.
economy that, after 1900, professionalised as ‘hospital economics’. I argue that all of these different economies were linked together, and that health and accounting have long been deeply entangled with one another. At least since the eighteenth century, paperwork had been an indispensable precondition for all of these economies and involved extensive bookkeeping. I will demonstrate this by focusing especially on inmates’ food and diet: in the hospital's Ökonomie , the production and supply of food was registered and balanced against consumption; daily consumption
before the NHS. An overview of the British
situation is given in chapter 1 ,
locating the hospitals within both the domestic social and political context,
before taking a wider international view. Chapter 2 sets up the city of Bristol as a case study to
explore the operation and meaning of hospital payments on the ground. It places
the hospitals firmly within the local networks of care, charity and public services,
shaped by the economics and politics of a
This book examines the payment systems operating in British hospitals before the National Health Service (NHS). An overview of the British situation is given, locating the hospitals within both the domestic social and political context, before taking a wider international view. The book sets up the city of Bristol as a case study to explore the operation and meaning of hospital payments on the ground. The foundation of Bristol's historic wealth, and consequent philanthropic dynamism, was trade. The historic prominence of philanthropic associations in Bristol was acknowledged in a Ministry of Health report on the city in the 1930s. The distinctions in payment served to reinforce the differential class relations at the core of philanthropy. The act of payment heightens and diminishes the significance of 1948 as a watershed in the history of British healthcare. The book places the hospitals firmly within the local networks of care, charity and public services, shaped by the economics and politics of a wealthy southern city. It reflects the distinction drawn between and separation of working-class and middle-class patients as a defining characteristic of the system that emerged over the early twentieth century. The rhetorical and political strategies adopted by advocates of private provision were based on the premise that middle-class patients needed to be brought in to a revised notion of the sick poor. The book examines why the voluntary sector and wider mixed economies of healthcare, welfare and public services should be so well developed in Bristol.
and expenses in a private practice (see Rieder's Chapter 2 and/or Stolberg's Chapter 1 ), but instead highlights the accounting and similar calculative practices used in treatment and research. Because accounting can be defined as a ‘systematic process of identifying, recording, measuring, classifying, verifying, summarizing, interpreting and communicating financial information’
and in view of Michael Powers's statement that accounting isn't necessarily subordinate to economics,
The working lives of paid carers from 1800 to the 1990s
Anne Borsay and Pamela Dale
a concern with social welfare, class and gender issues, scientific
innovation, medical change, the reform of hospitals and the development of a distinct body of nursing knowledge.14 Such analysis,
in the UK, tends to prioritise the experiences of the general nurse
in institutional and community settings with special status conferred on military nurses and the religious.15 It also foregrounds
the goals elite nurses pursued through nursing organisations that
claimed jurisdiction over rank-and-file practitioners but whose
Mental health nursing
Victorian medical men could suffer numerous setbacks on their individual paths to professionalisation, and Thomas Elkanah Hoyle's career offers a telling exemplar. This book addresses a range of the financial, professional, and personal challenges that faced and sometimes defeated the aspiring medical men of England and Wales. Spanning the decades 1780-1890, from the publication of the first medical directory to the second Medical Registration Act, it considers their careers in England and Wales, and in the Indian Medical Service. The book questions the existing picture of broad and rising medical prosperity across the nineteenth century to consider the men who did not keep up with professionalising trends. Financial difficulty was widespread in medical practice, and while there are only a few who underwent bankruptcy or insolvency identified among medical suicides, the fear of financial failure could prove a powerful motive for self-destruction. The book unpicks the life stories of men such as Henry Edwards, who could not sustain a professional persona of disinterested expertise. In doing so it uncovers the trials of the medical marketplace and the pressures of medical masculinity. The book also considers charges against practitioners that entailed their neglect, incompetence or questionable practice which occasioned a threat to patients' lives. The occurrence and reporting of violent crime by medical men, specifically serious sexual assault and murder is also discussed. A tiny proportion of medical practitioners also experienced life as a patient in an asylum.
Explaining how leprosy was considered in various historical settings by referring to categories of uncleanliness in antiquity, is problematic. The book historicizes how leprosy has been framed and addressed. It investigates the history of leprosy in Suriname, a plantation society where the vast majority of the population consisted of imported slaves from Africa. The relationship between the modern stigmatization and exclusion of people affected with leprosy, and the political tensions and racial fears originating in colonial slave society, exerting their influence until after the decolonization up to the present day. The book explores leprosy management on the black side of the medical market in the age of slavery as contrasted with the white side. The difference in perspectives on leprosy between African slaves and European masters contributed to the development of the 'Great Confinement' policies, and leprosy sufferers were sent to the Batavia leprosy asylum. Dutch debates about leprosy took place when the threat of a 'return' of leprosy to the Netherlands appeared to materialise. A symbiotic alliance for leprosy care that had formed between the colonial state and the Catholics earlier in the nineteenth century was renegotiated within the transforming landscape of Surinamese society to incorporate Protestants as well. By 1935, Dutch colonial medicine had dammed the growing danger of leprosy by using the modern policies of detection and treatment. Dutch doctors and public health officials tried to come to grips with the Afro-Surinamese belief in treef and its influence on the execution of public health policies.
The evolving relationship between infection and length of stay in antibiotic-era hospitals
hernias from 7.3 to 4.9 days. 18
The impact of new surgical techniques such as keyhole surgery in the 1980s facilitated shorter lengths of stay and more day surgery. Its widespread adoption also forced changes in hospital practices: patients now required tuition in changing dressings and domestic wound care.
In the US, where a significant percentage of the population have traditionally relied on private health insurance, there was an earlier and more proactive engagement with health economics. This reflected the marketised nature of the healthcare business, in