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.

1 Payment in the history of healthcare ‘The voluntary hospital system is not dead’, declared one delegate at the 1938 annual conference of the Incorporated Association of Hospital Officers; ‘It may be changing, it may eventually become something other than a voluntary hospital system, but it is not dead.’ 1 Ten years later it would be brought to an abrupt end, nationalised and integrated almost wholesale into the new

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simple switch from medical charity to private healthcare – a reformulation rather than a rejection of philanthropy. Philanthropy reformulated The voluntary hospitals underwent a great many changes during the interwar years. Those in the medical technology they employed were matched by changing dynamics in relations with the local and national state, while new styles of fundraising fostered a more democratic relationship with the local community. 7 As far the terms

in Payment and philanthropy in British healthcare, 1918–48

2 Medicine and charity in Bristol Before the NHS, British healthcare had no national system. 1 While policies could be agreed and pursued by the Ministry of Health, the British Medical Association (BMA), the Institute of Hospital Almoners or any other national body, decision-making was distinctly local. For public hospitals this meant either the poor law union or the municipal authority. In the voluntary hospital

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, 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
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Interpreting Violence on Healthcare in the Early Stage of the South Sudanese Civil War

Introduction 1 On 15 December 2013, only two and a half years after the Republic of South Sudan had become an independent state, the long-simmering tensions between President Salva Kiir and his former vice-president, Riek Machar, erupted into armed clashes in the capital, Juba. War soon broke out. This article seeks to document and analyse violence affecting the provision of healthcare by Médecins Sans Frontières (MSF) and its intended beneficiaries in the early stage of the current civil war in South Sudan. 2 It focuses on the first few months of the war and on

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is here recognised and characterised as a shift from a moral to an economic code of conduct. Yet it is argued that new systems of class division merely replaced old ones, ensuring such distinctions remained at the heart of the hospital system and serving to mitigate and mediate the rise of universalism in British healthcare. Charity and change There have only been three decades in British history (at the time of writing) when it was the norm

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hospital could no longer be a site for the medical care of the poor exclusively, but rather that it must be a resource for all classes. This line of argument seems to have had some purchase in the municipal sector. Indeed, two emergent principles of healthcare were promoted by Section 13 of Health Minister Neville Chamberlain's 1929 Local Government Act. One was universalism, by means of granting local authorities the power (if securing Ministry of

in Payment and philanthropy in British healthcare, 1918–48

advice and guidance of real value.’ 87 To this end, ‘home visits’ also featured as part of the almoner's after-care work in her reports. 88 By the late 1920s, the practice had developed whereby subscribers to convalescent homes would send their recommendation tickets to her for use in the after-care referral of hospital patients. 89 In this respect, she was part of the wider network of voluntary healthcare and

in Payment and philanthropy in British healthcare, 1918–48
Staff Security and Civilian Protection in the Humanitarian Sector

heart of its mandate, the role of public statements has been contested among the senior management, and MSF mostly undertakes its medical work without making public statements about abuses in its zones of operations ( Weissman, 2011 ). Both the ICRC and MSF have also run global campaigns concerned with attacks on medical missions and healthcare facilities. 2 While framed primarily in terms of protecting people’s access to medical and healthcare services, the absence of campaigns of a comparable scale concerned with attacks on other civilians is notable. While most

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