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  • Financing Medicine: The British Experience since 1750
  • Deborah Levine
Martin Grosky and Sally Sheard , eds. Financing Medicine: The British Experience since 1750. London: Routledge, 2006. xiv + 258 pp. ISBN 0-415-35025-5, $125.00.

To what extent is a society responsible for providing health care to its members? What is the best manner for funding a sustainable health care system? This new volume of loosely connected essays attempts to answer these lofty questions through close examination of critical moments within the British medical experience over a 225 year period.

The works are arranged chronologically and by subject, tracing the origins of the current British National Health Service from voluntary hospitals of the mid-eighteenth century through the period immediately following World War II. Throughout, the pieces relate to one another in their consideration of several main themes, outlined by the editors in a helpful and engaging introduction. Nearly every author outlines a period of some type of transition in approach to funding—whether it is the true role of music festivals as fundraisers for Birmingham's voluntary hospitals in the nineteenth century, or [End Page 437] the funding implications of the British National Health Insurance Act of 1911. Also, each of the fourteen articles discuses the problem of geographical diversity within the National system, and several of the essays address these larger questions about the National Health Service: How much uniformity of care can be expected in a society where local variations are so extreme? And, with so much localized variation, why was a program of local governmental healthcare provisioning never pursued? Finally, several of the essays in the last third of the volume focus on the problem of evaluating and improving efficiency in the National Health Service based on historical evaluations of twentieth-century events.

The collection includes fourteen brief, dense but ultimately quite readable studies of the effect of a variety of funding issues on the development of health care systems in British society. The volume itself grew out of a Wellcome Trust Research Symposium on Financing Medicine in 1996. The contributors range from economists and historians to physicians and public health professionals. Editors selected essays that use historical research methods to consider the complicated web of economic imperatives that has shaped the development of Britain's current National Health Service scheme. Most of the works successfully utilize the methodologies associated with classical economic history, providing valuable data (especially Mohan, Waddington, Sheard, and Cutler) to buttress the otherwise sometimes less-than-innovative arguments about the essentially timeless, problematic relationship between those with money and those who provide healthcare.

The most successful essays in this collection are those which treat British medicine during the nineteenth century. Keir Waddington's case study of London's Whitechapel Union under the Victorian Poor Law is an innovative study of the well-known Whitechapel Union during a period of mid-nineteenth century legal transition. Sally Sheard's contribution, "Reluctant providers? The politics and ideology of municipal hospital finance, 1870-1914," offers an original and sophisticated take on inpatient medical care during this transitional period in medical science. Sheard's approach, in which she considers municipal hospitals to be active participants in the medical marketplace, opens up valuable lines of inquiry for future research on the period.

The essays that constitute Financing Medicine are stimulating, rigorous, and insightful. Nearly all of the chapters offer exhaustive references to primary sources as well as secondary works, which will prove tremendously valuable to future researchers. Still, a more comprehensive look at the major themes that link the essays, perhaps [End Page 438] in a concluding piece, would have improved the cohesion of this volume. Patient experience of disease, arguably an important aspect of any healthcare system, is scarcely mentioned, and the role of philanthropy should have been more seriously considered in several of the essays. This collection of essays, though, goes a long way toward shedding light on the many significant ways financial structures have shaped the medical establishment. This volume will probably be most useful for specialists seeking to understand very specific information about healthcare funding in Britain in a particular time and place, but the general student of the history of medicine...

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