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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.

Religious culture and civic life in medieval northern Italy

Most people would agree that the hospital functions as one of the 'first duties of an organized society' as a public service for those members of the community who are in need. In the thirteenth century, hospitals represented a nexus of exchange between church officials, the community, the needy, and the pious or ambitious individual. This book presents a survey that offers an overview of the role of the hospital in affairs of the urban community, suggesting how changes within that community were reflected in the activities of the hospital. It locates the rise of the hospital movement in northern Italy within the context of the changing religious, social, and political environment of the city-states. The book introduces the hospital's central function in the distribution and administration of charity. It illustrates how the hospital and other charitable organizations played a role in the appropriation of power and influence by urban citizens. A comprehensive investigation of twelfth and thirteenth century hospitals' foundational charters follows. The book then delves into a detailed description of the physical plant of the hospital, the daily life of individuals, and rules and statutes followed by its members. It considers the social composition of donors, workers, and recipients of hospital services. Jurisdictional disputes among the city leaders, the community, individual religious orders, ecclesiastical authorities, and larger political forces. Finally, the book explores the process of consolidation and bureaucratization of hospitals in the fifteenth century and the emergence of state control over social services.

Open Access (free)
George Campbell Gosling

commonly excluded from accessing hospital services through the mechanisms described in the previous chapter. 3 It was only by charging higher rates to this separate class of patient that the hospitals stood any chance of turning a profit. This new category of patient would be accommodated not in the usual dormitory-style wards, but in a separate one- or occasionally two-bed room, domestic in style. These private wards would be physically separate, sometimes

in Payment and philanthropy in British healthcare, 1918–48
Martin Gorsky
,
John Mohan
, and
Tim Willis

hospital services. These various analyses permit a fuller evaluation of how successful the schemes were in enhancing the financial position of the hospitals. The nature of the contributory schemes in the inter-war years The sheer diversity of the hospital contributory schemes often attracted comment. Some schemes were administered directly by hospitals themselves, while others were operated by separate organisations, sometimes pre-existing Saturday funds, but also newly constituted bodies. There were in addition substantial variations with respect to internal

in Mutualism and health care
George Campbell Gosling

public hospital service. 152 In Bristol this meant the sick wards of the workhouses (rebranded as public assistance institutions following the 1929 Local Government Act) at Stapleton and Eastville. A Ministry of Health survey in the early 1930s judged that Stapleton was essentially a public asylum, with fewer than one in five of its 796 patients not certified. 153 Meanwhile, a great many of its patients were ‘aged and infirm persons, who are mostly bedridden’. 154

in Payment and philanthropy in British healthcare, 1918–48
The Emergency Hospital Services in Second World War Northern Ireland
Seán Lucey

debates, especially after the publication of the 1942 Beveridge Report which recommended widespread reform of social welfare and formed the basis of the post-war welfare state. The state's obligation to provide medical attention to a civilian population suffering from exogenous threats of aerial attacks led to the inauguration of the Emergency Hospital Services (EHS) – later the

in Medicine, health and Irish experiences of conflict 1914–45
Barry M. Doyle

In the latter part of the nineteenth century, and especially in the first third of the twentieth century, the urban hospital saw its purpose move from the protection and care of patients to their diagnosis and cure. As a result of this process, the numbers and types of patients entering hospitals in England and France, and the funding structures supporting those admitted, underwent a substantial change. These changes were underpinned by new ways of accounting for treatment which saw starkly different approaches adopted by institutions in the two countries. Drawing on evidence from the hospital services of Leeds and Sheffield in England and Lille, Rouen and Le Havre in France, this chapter explores those differences. It utilises a range of sources, including hospital annual reports, financial returns, and internal enquiries, to examine the development of the daily rate – prix de journée – calculated for patient treatment by hospitals in France and the growth of block grants provided by working-class mutual societies in England. It shows that the daily rate, which initially emerged as a way to charge external organisations for using community funded hospitals, became a highly contested site in which accounting practices were deployed to police the boundaries of permissible costs. In contrast, the block grant was adopted, in part, to minimise accounting complexity and administrative costs, but more importantly to shore up the residual charitable elements of the ‘voluntary hospital’ system and impose strict financial discipline. Each of these approaches fed into postwar socialised hospital services, shaping accounting and financial practices for decades to come.

in Accounting for health
Membership, reciprocity and integration
Martin Gorsky
,
John Mohan
, and
Tim Willis

contributions in rural areas. The latter difficulty arose because most schemes were tied to a particular hospital and those seeking admission to other institutions risked incurring charges for maintenance. More generally, schemes did not operate over defined territories and there were several boundary disputes concerning whether large, multi-hospital funds had the right to encroach on what local schemes saw as their catchment area. Third, the role of the schemes in the integration of hospital services is explored. Historians have argued that, in the first half of the twentieth

in Mutualism and health care
George Campbell Gosling

before and after 1948 is likely to be an oversimplification. This is true in the case of payment. While the interwar period's fledgling municipal hospital services anticipated the NHS in other ways, they also operated effectively the same payment system as the voluntary hospitals. Legislation in 1879 and 1885 had already empowered poor law guardians to recover ‘the cost of maintenance’ from those who were deemed able to

in Payment and philanthropy in British healthcare, 1918–48
The state and hospital contribution, 1941–46
Martin Gorsky
,
John Mohan
, and
Tim Willis

would be taken over ‘by agreement’.33 Brown’s statement and policy discussions, 1941–42 The government formally signalled its intention to reform the post-war health service on 9 October 1941, in a parliamentary statement by the Minister of Health, Ernest Brown. A ‘comprehensive hospital service … available to every person in need of it’ would be established, administered in partnership by local authorities and voluntary hospitals. It would not be free, however, and patients would be expected to meet the costs of their care, ‘either through contributory schemes or

in Mutualism and health care