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"Can you afford to be ill?": paying for treatment

Can you afford to be ill?Ill health was feared by many for financial as well as medical reasons. Medical fees, combined with the loss of the income of wage earners unable to work, could lead to destitution. Benefit societies and insurance policies were established to provide medical care for payers of subscriptions, provided that certain conditions were met. A system of National Health Insurance was established as part of the National Insurance Act in 1911, which used deductions from wages to fund a state insurance scheme. For those unable or unwilling to pay subscriptions, there was a possibility of free healthcare provided by charities (if the applicant was seen as a suitable candidate for assistance), or, if all else failed, the Poor Law Union workhouse.

Our digital collection contains various documents which relate to medical insurance, benefit society and charity schemes. A selection of these are linked to below.

National Insurance:

Subscriptions and private insurance:

  • Rules and regulations of the United Brothers' Birmingham Benefit Society, 1908. The local society was formed to financially "assist its members in sickness, and to provide for the payment of a sum of money at the death of a member or for the funeral expenses of a member's wife".
  • Rules of the Sunlight Sick, Funeral and Medical Aid Society, [1909]. The scheme was open to employees of Messrs. Lever Brothers Limited, Port Sunlight, and "provided medical attendance (when in the Medical Officer's district), medicine, sick allowance, and payment on death of members, their wives, and children under fourteen years of age". Subscribers could be refused benefit if, whilst being ill, they visited a pub or a place of entertainment, or left their home during the hours of darkness or without telling people where they were going.
  • Leaflet for the Manor House Hospital, Golders Green, London, undated. The leaflet was issued by the Industrial Orthopaedic Society, and sets out the rates and benefits for subscribing members (e.g. free access to orthopaedic care "subject to local rules and conditions").
  • The "Anchor" Doctors' Bills Policy at Lloyd's for persons between the ages of 2 and 50, 1927. Rules and summary of press coverage of "the only insurance protection for the family against the financial terrors of serious illness". Middle class families were particularly targeted - "a most important class of the community which has in sickness neither the support of riches nor of the State".
  • National Eye Service, National Ophthalmic Treatment Board, [1929]. Brochure which provides an outline of the service and explains some of the reduced financial charges for members of different societies.
  • Leaflets from the Incorporated Association of Assistant Masters (a trade union for teachers) on the health insurance scheme available to its members: After X weeks - what then? and Good health: one friend's wish to another, [1930?].
  • Memorandum on the Hospital Savings Association, 6 October 1932, circulated within the Trades Union Congress. It includes information about rates and benefits for subscribers to the HSA, formed "following the report of the Cave Committee, which recommended that the voluntary system of financing hospitals should be preserved".
  • 4 good reasons why, October 1938. Pamphlet issued by the Royal Infirmary, Leicester, appealing for subscribers to the Saturday Hospital Society to increase their weekly contributions, so that the hospital can build a casualty department and buy new x-ray equipment.
  • Can you afford to be ill?, 1945-1946. Leaflets which explain the Hospital Service Plan of the London Association for Hospital Services Ltd. One leaflet addresses the issue of the planned National Health Service directly - arguing that as the NHS won't be in place until 1948, readers should still insure their families against medical bills.


  • Regulations for the admission of out-patients, confidential inquiry sheet and voucher for the Great Northern Central Hospital, London, 1896-1902. The hospital was "intended for the relief of the Sick Poor only". The regulations set out how prospective patients were financially assessed before receiving treatment; the voucher was to be signed by the patient's doctor or employer, declaring them to be "a fitting case for gratuitous relief".
  • The hospital almoner, September 1904. Article from the magazine 'Our Hospitals and Charities', September 1904, which outlines the role and responsibilities of the almoner (a precursor to the social worker). "The almoner's duty is systematically to interview the applicants for out-patient relief, "with a view to eliminate from among them those whose circumstances do not seem to entitle them to treatment, or who might be better provided for by a provident dispensary or by the Poor Law authorities.""
  • Summaries of cases visited by the almoner, 30 December 1901. Report of some of the almoner's visits to assess the income and moral standards of applicants for free treatment at the Great Northern Central Hospital, London.
  • Summaries of cases visited by the almoner, 28 September 1903. Report of some of the almoner's visits to assess the income and moral standards of applicants for free treatment at the Royal Free Hospital, London.
  • Friendly visiting and partial enquiry, 1902. Recommendations of the Administrative Committee of the Charity Organisation Society for methods of assessing the eligibility of applicants for free medical treatment. Reports on the assessment of patients by Miss Brimmell, almoner at the Royal Free Hospital, London, are included as an appendix.
  • Whitechapel Charity Organisation Committee: mock application for welfare on behalf of Jesus Christ, c.1886. Satirical send-up of the Charity Organisation Society's assessments of the suitability of candidates for charitable assistance. In this case the applicant (Jesus Christ) "was rebuked for his utter want of thrift, industry, temperance, and for the bad company he kept" and turned down by the Society.
  • Memorandum by Mr. Sheppard respecting almoner's work from January to June 1903 at the Royal Free Hospital, London. It includes comment on the "earnest attempts... to encourage thrift and providence among the poorer classes" to relieve "the already over-crowded Out Patients Department" and argues that "indiscriminate Medical relief is an open door to pauperism".
  • Supplement to the Charity Organisation Review, July 1915. It includes appeals from local committees of the Charity Organisation Society for charitable donations to pay for the treatment of particular patients.
  • The Fraud, Futility and Hypocrisy of Charity for the Blind, [1923?]. Leaflet produced by the London District Council of the National League of the Blind of Great Britain and Ireland. It attacks fraud and the amount spent on the salaries of charity officials, whilst "hundreds of of our Blind are incarcerated in London Workhouses, hundreds more are condemned to beggary, and those who are employed are compelled to work piece work".