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Week 14: Patient Consumers in Mixed Economies of Healthcare

Lecturer: George Campbell Gosling

The ‘medical marketplace’ may be a useful (if problematic) prism through which to look at the delivery of healthcare in eighteenth- and nineteenth-century Britain, but by the twentieth century it might prove more helpful to think in terms of a ‘mixed economy of healthcare’. This week we’ll be looking at the changing roles of the formal public, private and voluntary sectors, as well as the informal sector of family and community support, and what it meant to be a patient in each over the twentieth century. We’ll also consider what it might mean to describe patients at different points of the twentieth century as ‘consumers’. The lecture will include some comparisons with healthcare systems beyond Britain.


Discussion Questions/Essay Topics:

1. How did the role of the public/private/voluntary sector in the delivery of healthcare in Britain change over the twentieth century?

2. Can patients at any point in the twentieth century be fairly described as medical consumers in Britain?

3. How has the notion of the ‘consumer’ in British healthcare changed over the twentieth century?


Required Readings:

• Steven Cherry, Medical Services and the Hospital Services in Britain, 1860-1939 (Cambridge University Press, 1996), Ch. 4 ‘Medical Services 1860-1914’, pp. 41-53.

• Jane Lewis, ‘Providers, “Consumers”, the State and the Delivery of Health-Care Services in Twentieth-Century Britain’ in Andrew Wear (ed.), Medicine in Society (Cambridge University Press, 1992), pp. 317-345. [e-book]

• Alex Mold, ‘Patient Groups and the Construction of the Patient-Consumer in Britain: An Historical Overview’, Journal of Social Policy, vol. 39, no. 4 (2011), pp. 505-521. [e-journal]

[Recommended but not required]: William Bynum, Science and the Practice of Medicine in the Nineteenth Century (Cambridge, 1994), 'Paying the Doctor', pp.196-202.


Further Readings:

• Brian Abel-Smith, The Hospitals, 1800-1948 (Heinemann, 1964).

• Lucinda McCray Beier, For Their Own Good: The Transformation of English Working-Class Health Culture, 1880-1970 (Ohio State University Press, 2008).

• Paul Bridgen, ‘Voluntary Failure, the Middle Classes, and the Nationalisation of the British Voluntary Hospitals, 1900-1946’ in Bernard Harris and Paul Bridgen (eds), Charity and Mutual Aid in Europe and North America since 1800 (Routledge, 2007).

• Anne Digby and Nick Bosanquet, ‘Doctors and Patients in an Era of National Health Insurance and Private Practice, 1913-1938’, Economic History Review, vol. 41, no. 1 (1988), pp. 74-95.

• Barry Doyle, The Politics of Hospital Provision in Early Twentieth-Century Britain (Pickering & Chatto, 2014).

• Martin Gorsky, John Mohan, and Martin Powell, ‘The Financial Health of Voluntary Hospitals in Interwar Britain’, Economic History Review, vol. 55, no. 3 (2002), pp. 533-57.

• Martin Gorsky and John Mohan with Tim Willis, Mutualism and Health Care: British Hospital Contributory Schemes in the Twentieth Century (Manchester University Press, 2007).

• Martin Gorsky and Sally Sheard (eds), Financing Medicine: The British Experience since 1750 (London: Routledge, 2006).

• Martin Gorsky, ‘The Political Economy of Health Care in the Nineteenth and Twentieth Centuries’ in Mark Jackson (ed.), The Oxford Handbook of the History of Medicine (Oxford University Press, 2011), pp. 429-449.

• George Campbell Gosling, Payment and Philanthropy in British Healthcare, 1918-48 (Manchester University Press, forthcoming as an open access e-book in February 2017).

• Anne Hardy, Health and Medicine in Britain since 1860 (Palgrave, 2001).

• Nick Hayes, ‘Did We Really Want a National Health Service? Hospitals, Patients and Public Opinions before 1948’, English Historical Review, vol. 128, no. 526 (2012), pp. 625-61.

• Nick Hayes and Barry M. Doyle, ‘Eggs, Rags and Whist Drives: Popular Munificence and the Development of Provincial Medical Voluntarism between the Wars’, Historical Research, vol. 86, no. 234 (2013), pp. 712-40.

• Ruth Hodgkinson, The Origins of the National Health Service: The Medical Services of the New Poor Law, 1834-1871 (London: Wellcome Historical Medical Library, 1967).

• Elizabeth Hurren and Steven King, ‘Public and Private Healthcare for the Poor, 1650s-1960s’ in Paul Weindling (ed.), Healthcare in Private and Public from the Early Modern Period to 2000 (Routledge, 2015), pp. 15-35.

• Alysa Levene, Martin Powell, John Stewart and Becky Taylor, From Cradle to Grave: Municipal Provision in Interwar England and Wales (Bern: Peter Lang, 2011).

• Donnacha Seán Lucey and Virginia Crossman (eds), Healthcare in Ireland and Britain from 1850: Voluntary, Regional and Comparative Perspectives (London: Institute of Historical Research, 2015).

• Alex Mold, Making the Patient-consumer: Patient Organisations and Health Consumerism in Britain (Manchester University Press, 2015).

• Glen O’Hara and George Campbell Gosling, ‘Healthcare as Nation-Building in the Twentieth Century: The Case of the British National Health Service’ in Paul Weindling (ed.), Healthcare in Private and Public from the Early Modern Period to 2000 (Routledge, 2015), pp. 123-141.

• John Pickstone, Medicine and Industrial Society: A History of Hospital Development in Manchester and Its Region, 1752-1946 (Manchester University Press, 1985).

• John Stewart, ‘The Mixed Economy of Welfare in Historical Context’ in Martin Powell (ed.), Understanding the Mixed Economy of Welfare (Bristol: Policy Press, 2007), pp. 23-40.

• Steven Thompson, ‘Varieties of Voluntarism in the South Wales Coalfield, c.1880-1914’ in Colin Rochester, George Campbell Gosling, Alison Penn and Meta Zimmeck (eds.), Understanding the Roots of Voluntary Action: Historical Perspectives on Current Social Policy (Brighton: Sussex Academic Press, 2011), pp. 82-94.

• Charles Webster, ‘Conflict and Consensus: Explaining the British Health Service’, Twentieth Century British History, vol. 1, no. 2 (1990), pp.115-151.