The Business of Medicine [electronic resource] : Private Health Care in Britain

## Tables vn I was born just 21 days before it carne into being and was one of its first customers for 'free' services. My parents both worked in it all their lives. I share the view of Richard Titmuss that its creation was 'the most unsordid act of British social policy in the twentieth century ' (1973, p. 254). This book is written for all the people who have worked in the NHS (especially my parents and friends) and all who have benefited from its services. I trust that the developments described in these pages will never weaken the principles upon which the Service was founded and that the generation which saw its flowering will not see its demise. JOAN HIGGINS 2 THE BUSINESS OF MEDICINE market once controlled by the Church, the small entrepreneur and the British businessman. The consequences of these changes may be far-reaching, especially in their impact upon the National Health Service. ## Definitions This book looks at the growth of profit-seeking in medicine and at changes in private health care in Britain since the inception of the NHS. It is specifically concerned with the acute sector and not with long-stay residential care nor with other contemporary issues such as the 'privatisation' of ancillary services in the NHS. As the Royal Commission on the National Health Service discovered in 1979, defining 'private practice' or 'private health care' is not a simple task. This book is concerned with four main areas of activity: private practice by hospital doctors and general practitioners; charges for health care within the NHS; private acute hospital provision outside the NHS; and private health insurance. It will become clear that the private sector itself is not a unified whole and there are many differences in aims, style and outlook, especially between the for-profit corporations and the not-for-profit groups. What unites these different organisations and practitioners is that access to the care they provide is governed primarily by the ability to pay and not medical need. ## Themes This book explores a number of themes and questions. Why was the public/private mix which preceded the creation of the NHS regarded as unsatisfactory? What were the goals of the architects of the new service and why was private practice allowed to continue? Why did the controversies about NHS pay beds and charges remain a running sore in the post-war decades? Why was there such a tremendous boom in private health insurance and hospital and nursing home care in the 1. Public and Private Front Matter....Pages i-ix Introduction....Pages 1-5 Public and Private Medicine in the 1940s....Pages 6-44 Paying for Medicine Inside and Outside the NHS: 1948–78....Pages 45-83 The Boom Years: The Private Market After 1979....Pages 84-123 A Taste of American Medicine....Pages 124-162 Winners and Losers....Pages 163-197 Trends and Issues in the Private Sector....Pages 198-226 Conclusions....Pages 227-239 Back Matter....Pages 240-260 Joan Higgins. Includes Bibliographical References (p. 240-247) And Index.