Mutualism and health care

Hospital contributory schemes in twentieth-century Britain

By Martin Gorsky, John Mohan and Tim Willis

Mutualism and health care


  • eBook

Book Information

  • Format: Paperback
  • ISBN: 978-0-7190-6579-8
  • Pages: 256
  • Publisher: Manchester University Press
  • Price: £17.99
  • Published Date: August 2013
  • BIC Category: Society & social sciences / Cultural studies, Medicine / Health systems & services, POLITICAL SCIENCE / Public Policy / Social Policy, POLITICAL SCIENCE / Public Policy / Social Services & Welfare, Cultural studies, Central / national / federal government policies, Sociology


Mutualism and health care, newly available in paperback, presents the first comprehensive account of a major innovation in hospital funding before the NHS. The voluntary hospitals, which provided the bulk of Britain's acute hospital services, diversified their financial base by establishing hospital contributory schemes. Through these, working people subscribed small, regular amounts to their local hospitals, in return for which they were eligible for free hospital care.

The book evaluates the extent to which the schemes were successful in achieving comprehensive coverage of the population, funding hospital services, and broadening opportunities for participation in the governance of health care and for the expression of consumer views. It then explores why the option of funding the post-war NHS through mass contribution was rejected, and traces the transformation of the surviving schemes into health cash plans.

This is a substantial investigation into the attractions and limitations of mutualism in health care. It is highly relevant to debates about organisational innovations in the delivery of welfare services.


1. Introduction
2. The emergence of hospital contributory schemes
3. Mass contribution and hospital finance in inter-war Britain
4. The geography of hospital contributory schemes: membership, reciprocity and integration
5. Hospital contribution and civil society: humanity not democracy?
6. Contributory schemes, workmen governors and local control of hospital policy
7. The 'impending cataclysm': the state and hospital contribution, 1941-1946
8. The contributory schemes and the coming of the NHS
9. 'Where the shoe pinches': reorientation under the NHS
10. The health cash plans and the new mutualism in health care
11. Concluding comments


Martin Gorsky is Senior Lecturer in the Contemporary History of Public Health at the London School of Hygiene and Tropical Medicine. John Mohan is Professor of Social Policy at the University of Southampton. Tim Willis is a Research Officer in the Department for Work and Pensions

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