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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.

Open Access (free)
George Campbell Gosling

, founder of the King's Fund, 1879 There was only one area of the pre-NHS hospital system which genuinely saw private healthcare operating on a commercial basis. This was the parallel provision made for middle-class patients, the likes of ‘George’ from Your Very Good Health , in the British hospital of the early twentieth century. Since admission of middle-class patients was commonly seen as a threat to

in Payment and philanthropy in British healthcare, 1918–48
Open Access (free)
George Campbell Gosling

charity, even as these underwent significant changes over the early twentieth century. The previous two chapters examined the arrival in the hospital of patient payments and the almoner, contributory schemes and the middle-class patient, and how they became commonplace in the interwar years. It is typically assumed that these changes undermined or even ended philanthropy as the organising principle of the voluntary hospitals. 1 Yet, as we have already seen

in Payment and philanthropy in British healthcare, 1918–48
Open Access (free)
George Campbell Gosling

idea that the working classes should pay in to the system, the various schemes that facilitated this in the community and the almoner who policed it in the hospital, as well as the idea of opening up the hospital to middle-class patients, were all inventions of the nineteenth century. Yet it was not until the interwar years that any of them became the norm, or even commonplace. In both principle and practice, the change brought about was more complex than a

in Payment and philanthropy in British healthcare, 1918–48
Open Access (free)
George Campbell Gosling

wealthy southern city. The options, obligations and experiences of Charley are considered in chapter 3 and then those of George in chapter 4 ; with particular attention to how the hospital payment schemes they would have navigated were introduced in our case study city. Treating the two in separate chapters 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

in Payment and philanthropy in British healthcare, 1918–48
Author:

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.

Barry M. Doyle

number of lower middle-class patients sought free treatment through membership in contributory schemes. 45 Although there was a trend to admit patients on medical grounds and then to seek payment, universal admission was still opposed, especially by the medical profession, that saw the potential for loss of income, and hospital administrators, who feared free-riders accessing services underpinned by charity. 46 The increase of non

in Accounting for health
George Campbell Gosling

choice between free or fee-paying services meant the middle-class patient had more choice under the NHS than before. Rejection or culmination? With the transition from a diverse patchwork of providers to a comprehensive and universal service as the dominant teleological narrative in the history of British healthcare, change looms large. Yet there is no consensus on the cause, or even the chronological scope

in Payment and philanthropy in British healthcare, 1918–48
Valérie Leclercq
and
Veronique Deblon

provided for its part a means of social isolation. Usually built far from the wards, private rooms for ‘paying patients’ were a rare luxury reserved for a class of people that would not have tolerated being associated with the general population (see Chapter 6 , pp. 220–4). Since the law on public charity did not explicitly forbid it, the presence of middle-class patients in publicly funded

in Medical histories of Belgium
Donnacha Seán Lucey

excluded from the Anglo-Irish charitable donations that Protestant hospitals benefited from. In turn, the nursing congregations became ‘unlikely entrepreneurs’ and catered for middle-class patients who were able to pay medical fees. Irish Catholic voluntary hospitals were at the forefront of the establishment of private nursing homes on existing voluntary hospital sites, although fee-paying wards existed across inter-war Irish and British hospitals. In Belfast, for example, the fee-paying Musgrave Hospital was not developed by the Royal Victoria Hospital until the late

in The end of the Irish Poor Law?