The organisation of services

The establishment of the National Health Service was part of moves across Western Europe and Australasia in the period 1945–64 to extend the role of the state in the provision of health care. Most systems were based on compulsory social insurance with direct links between payments and benefits and a higher degree of bureaucracy and decentralisation. In France, payment was on a fee for service basis through a mixture of social security and insurance benefits. In the United States, a large proportion of the population was privately insured, with inadequate reimbursement for some of the remainder (Baggott, 1994). Suggestions that British post-war welfare policy drained resources away from the modernisation of industry and technology underplayed the extent to which these developments were a Western European rather than a peculiarly British phenomenon (Barnett, 1986). However, the principles of unconditional relief of poverty and equality of access were more strongly built into the British health system than elsewhere. The British system was also unusual in being centrally funded out of taxation, which helped to secure the political ideal of a free and equal service for all to a degree unmatched in other Western European countries. Nevertheless, the NHS also had its structural and financial deficiencies from the outset, as discussed in the previous chapter. The circumstances of the service's inception and the various strategies adopted to secure the support of the medical profession ensured that decisions had been taken which led directly to some of its later problems.