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Publication abstract

Voluntarism, municipalism and welfare: the geography of hospital utilization in England in 1938

This paper provides a comprehensive analysis of the pattern of hospital utilization (rather than provision) in England prior to the establishment of the NHS, showing the extent to which the probability of obtaining hospital treatment was a function of residence. Access to hospital care depended on the vigour of voluntarism and the political priorities of local governments. The paper draws upon the wartime Hospital Surveys which contained, for each hospital, a breakdown of the number of patients by local authority. It therefore analyses the geographical areas of origin of some 2 million hospital inpatients. The pattern of voluntary hospital utilization is shown to have been markedly unequal, with significant variations -- at least fivefold -- between the most advantaged areas and those with least access to hospital provision. Analysis of comparable statistics for the public sector demonstrates that the effect of municipal provision was to reduce disparities in access to services. The paper demonstrates variations in hospital utilization and discusses contemporary assessments of the situation. This work contributes to debates about the efficacy of non-profit forms of welfare delivery; it provides a novel British study to complement American work in this field. It also raises questions about the contemporary vogue for partnerships in health care delivery between the public and private sectors, arguing that such proposals rest on an optimistic view of history.

Since the paper was written, further work has been done to combine the statistics on hospital utilisation presented therein, with data on hospital expenditure from the hospitals database, to provide regional and local estimates of per capita levels of hospital expenditures for 1938. This is as yet unpublished but further details are available from John Mohan.

GeoData Institute