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The political economy of health careWhere the NHS came from and where it could lead$
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Julian Tudor Hart

Print publication date: 2010

Print ISBN-13: 9781847427830

Published to Policy Press Scholarship Online: March 2012

DOI: 10.1332/policypress/9781847427830.001.0001

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(p.112) (p.113) Five Ownership
The political economy of health care

Julian Tudor Hart

Policy Press

Before the NHS came into being, virtually all hospitals were built and funded either by the state or local government, or by various charities. The dominant medical culture has encouraged doctors to think and behave as if they owned the hospitals in which they worked, and as if all other staff within them were their servants. Contemporary ideas of ownership played a major role in disputes between doctors and the state, at the birth of both National Insurance in 1912 and the NHS in 1948. In both cases, doctors serving affluent populations feared degradation of their work if it escaped their ownership and control. Though some of these fears were justified, state funding opened free access to care for all. State funding in fact expanded professional ownership as social responsibility with new possibilities for developing primary care came further than anyone had previously imagined.

Keywords:   NHS, hospital ownership, medical culture, National Insurance, state funding, doctor ownership

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