British hospital contributory schemes in the twentieth century

This book presents a comprehensive account of a major innovation in hospital funding before the NHS. The voluntary hospitals, which provided the bulk of Britain’s acute hospital services, diversified their financial base by establishing hospital contributory schemes. Through these, working people subscribed small, regular amounts to their local hospitals, in return for which they were eligible for free hospital care. The book evaluates the extent to which the schemes were successful in achieving comprehensive coverage of the population, funding hospital services, and broadening opportunities for participation in the governance of health care and for the expression of consumer views. It then explores why the option of funding the post-war NHS through mass contribution was rejected, and traces the transformation of the surviving schemes into health cash plans. This is a substantial investigation into the attractions and limitations of mutualism in health care. It is relevant to debates about organisational innovations in the delivery of welfare services.

Membership, reciprocity and integration
Martin Gorsky, John Mohan and Tim Willis

This chapter considers geographical variations in the membership of hospital contributory schemes in Great Britain and the associated issue of variations in the resources generated by the schemes. It offers a geographical disaggregation of membership and finance, as well as a discussion of one of the key problems facing the schemes, namely the extent of cooperation and the demarcation of territory. The analysis reveals that the growth of the contributory schemes was uneven and the resources they generated varied substantially. This chapter suggests that the schemes therefore never attained comprehensive coverage, and a key factor in this was the question of attachments to individual hospitals. It also explains that the schemes played their part in regionalisation initiatives, and reciprocal arrangements were developed to facilitate the availability of services, but the process was not without dissension.

in Mutualism and health care
Humanity not democracy?
Martin Gorsky, John Mohan and Tim Willis

This chapter investigates the role of hospital contributory schemes as mediators of popular participation in health provision in Great Britain. It presents empirical evidence on the scope for grassroots or local involvement in decision-making and explores the structures and procedures of representation. It examines how active contributors were in the movement, in terms both of attendances in democratic forums and of the nature of the leadership which the movement selected to represent it. The analysis reveals that contributory schemes took their role as bastions of worker democracy very seriously.

in Mutualism and health care
Martin Gorsky, John Mohan and Tim Willis

This chapter examines whether contributor participation affected decision-making and signalled a genuine shift in control of institutions and made them more responsive to the needs of local users. It describes the routine work of the administrators of hospital contributory schemes and evaluates whether they expressed patients’ concerns about services. The analysis reveals two areas in which contributors successfully asserted their wishes. These are the rejection by schemes in Scotland and the North East of the hospital means test and the retention of convalescence benefits.

in Mutualism and health care
The state and hospital contribution, 1941–46
Martin Gorsky, John Mohan and Tim Willis

This chapter examines the development of the official policy towards the idea of voluntary contribution within the health service in Great Britain. It discusses the perception of the hospital contributory schemes from the perspective of those responsible for translating general plans for an extension of health care into practical proposals. It investigates at what point the elimination of the contributory schemes from the structure of the National Health Service (NHS) became inevitable. This chapter suggests that the final shape of the NHS was not the outcome of an unproblematic consensus but a product of negotiation between the interested parties.

in Mutualism and health care
Martin Gorsky, John Mohan and Tim Willis

This chapter explores the responses of both the British Hospitals Contributory Schemes Association (BHCSA) and individual hospital contributory schemes to plans for the creation of a new health service. It describes BHCSA responses to the policy process during the periods between Ernest Brown’s parliamentary statement of October 1941 and the 1944 White Paper, and between the White Paper and the National Health Service (NHS) Bill of 1946. This chapter also analyses the failure of schemes to influence events related to the creation of the NHS in the context of the literature of pressure group politics.

in Mutualism and health care
Reorientation under the National Health Service
Martin Gorsky, John Mohan and Tim Willis

This chapter considers the response of the hospital contributory schemes to the establishment of the National Health Service (NHS) in Great Britain. It describes the attitudes of the schemes towards the 1946–48 debates when they had to decide whether or not to continue in existence. This chapter traces the success of the surviving schemes to develop a market niche and discusses these developments in relation to socioeconomic changes in post-war Britain and to the evolution of policy towards the NHS.

in Mutualism and health care
Martin Gorsky, John Mohan and Tim Willis

This chapter traces the history of medical charity and the emergence of hospital contributory schemes in Great Britain. The idea of a British hospital system funded by its users is one which began to emerge only in the late nineteenth century. There were two main channels for popular contribution. These were the organised collections of the Hospital Saturday and Hospital Sunday funds and the local subscriptions taken in the work-place, firm and community. This chapter considers the funding crisis which followed War World 1 and describes the evolution of mass contribution into a financial mainstay of the hospital system.

in Mutualism and health care
Martin Gorsky, John Mohan and Tim Willis

This chapter explores the development of hospital contributory schemes in Great Britain during the interwar period and evaluates their overall impact on hospital finances. It discusses the growth of membership and of income, and the developing pattern of benefits paid and other expenditure. It outlines the heterogeneous nature of the schemes, which include single-hospital schemes as well as multi-institutional or city-wide funds. This chapter also examines the extent to which the schemes enabled hospitals to treat more patients and stimulated demand for hospital services and highlights the contribution of schemes in enhancing the financial position of the hospitals.

in Mutualism and health care
Martin Gorsky, John Mohan and Tim Willis

This chapter examines the role of hospital contributory schemes in the British welfare state after 1948. It evaluates the extent to which the schemes have retained their distinctive orientation and social purpose since 1948 and analyses the impact of social and economic change on the schemes. This chapter shows that after 1948 some schemes found a new role as providers of health cash plans or low-cost insurance products dealing with services either not easily available on the NHS or with issues where NHS services were perceived to offer little consumer choice.

in Mutualism and health care