The Evolution of British General Practice 1850-1948

By Anne Digby | Go to book overview

12
National Health Insurance

THE connection between the individual's health and that of the body politic was given a new political imperative in 1904, when the findings of the Interdepartmental Committee on Physical Deterioration suggested that the vigour of the imperial state depended upon the physical health of the citizen. The creation of the national health insurance (NHI) scheme seven years later was related to German precedents, and in this way great-power competition reinforced domestic pressures to achieve a healthy and economically productive people.1 Through its response to a complex of wider concerns in society-notably those of labour efficiency and citizen's rights -- the scheme provided a major and largely exogenous shock to general practice. Although attempting to meet wider social needs the scheme also recognized some of the incipient requirements of doctors then engaged in general practice. Indeed, the BMJ later commented that it had 'had a profound influence on general medical practice'.2

Earlier, the Victorian state's relationship with health and with individuals' access to health had been complex, usually being of an implicit rather than explicit character. Compared to welfare, health did not have a high profile, being the junior partner in an overlapping set of concerns. The negative right to refuse health-related measures (as in smallpox vaccination), or healthrelated topics which impinged on property rights (as in doctors' right to sell their practices), were much more clearly articulated than an individual's positive private right to health. Public health interventions drew on the traditional (collectivist) right of the community to safety, but in certain circumstances might be contested by (individualistic) claims to defend the integrity or autonomy of the human body -- as in the furore over the Contagious Diseases Acts. This tension between collectivism and individualism was not resolved by the time of the national insurance scheme of 1911,

____________________
1
E. P. Hennock British Social Reform and German Precedents. The Case of Social Insurance, 1880- 1914 ( Oxford, 1987), 20. The scheme differed in important respects from the German one, especially in its uniform, rather than graduated, contributions and benefits ( E. P. Hennock "The Origins of British National Insurance and the German Precedent, 1880-1914", in W. J. Mommsen (ed.), The Emergence of the Welfare State in Britain and Germany, 1850- 1950 ( 1981), 84-109).
2
"The Profession of Medicine", BMJ, ii( 1933),411.

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The Evolution of British General Practice 1850-1948
Table of contents

Table of contents

  • Title Page iii
  • Acknowledgements vii
  • Contents ix
  • List of Plates, Maps, and Figures xi
  • List of Tables xiii
  • Abbreviations xiv
  • 1 - Constructing General Practice 1
  • PART I - Careers 21
  • 3 - Recruitment, Education, and Training 40
  • 4 - Reinventing Roles 66
  • PART II - In Practice 91
  • The Medical Market 93
  • 6 - Organizing A Practice 126
  • 7 - Women Practitioners 154
  • 8 - Medical Investigation and Treatment 187
  • 9 - Patients 224
  • PART III - A Wider World 257
  • 10 - Public Duties and Private Lives 259
  • 11 - Generalists, Specialists, and Others 287
  • 12 - National Health Insurance 306
  • 13 - The National Health Service 325
  • Select Bibliography 343
  • Index of Medical Names 365
  • General Index 369
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