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State medicine

Folders for Patients Records, London, England, 1996

Folders for Patients Records, London, England, 1996

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While early hospitals were associated with charity and religious orders, governments across the world soon took an interest in how they were operated. In Italy some of the first Renaissance hospitals were organised by confraternities, religious brotherhoods that carried out a variety of social functions. Their range of charitable activities included homes for orphans and general welfare, as well as hospitals. In most cases cities and governments eventually took over the responsibility for charitable institutions established by religious orders.

Increased government control over hospitals from the 1500s

The tendency for state control over hospitals increased in Europe after the Reformation of the 1500s. Central state governments focused primarily on control of the unemployed, whether or not they were sick. Many state governments organised, paid and provided housing in the form of hopitaux generaux, or workhouses. In the 1720s the Prussian and Austrian governments also became involved in the care and cure of the poor and sick. In Austria the result was the establishment of the Allgemeines Krankenhaus in 1784.

European governments, funding by individuals and medicine in the military

Increasingly, European governments sought to control medical education, and to provide a strong military medical service. Private funding supported hospital development in many countries. In Britain this took the form of voluntary hospitals, whose governors regularly appealed to the public for financial support. This type of hospital also became dominant in the United States and in the British colonies. As hospitals began to modernise in the 1900s, most voluntary institutions began to run into financial difficulties.

State control - the creation of the NHS in 1948

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The solution lay in state intervention or the development of business strategies, which might involve private insurance schemes. State control in Britain became a reality with the creation of the NHS in 1948. Central to the provision of health care in Britain, the hospital system was rebuilt extensively under a plan put forward by Enoch Powell in the 1960s. Other state schemes were introduced under socialist governments in Russia and China.

The transformation of a country’s health - the People’s Republic of China

With the formation of the People’s Republic of China in 1949, the country’s health was transformed. There had been a limited number of missionary hospitals and dispensaries since the 1800s. Some consisted of a few beds in a back room, others were purpose-built buildings. Modernisers decided that well-equipped hospitals should form the nucleus of a new health-care system for China.

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By the 1990s the country supported a grid of modern hospitals. Originally funded by the state, hospitals in China no longer receive all of their funding from the government. As a result of reforms introduced after 1979, hospitals now receive two-thirds of their funding from user fees. Ironically the New Economic Policies of 1979 have established a new market for traditional Chinese medicines. In order to reduce the growing imbalance between urban and rural health services, traditional Chinese medicine hospitals have been set up in every county in China. These institutions are intended to provide cheap medicine to the majority of the country’s inhabitants.

European and local medicine in African and Asian countries

The European model of the hospital spread with European imperial and colonial expansion. While often similar to Western hospitals in appearance, hospitals outside the West have differed in the ways they developed in several important respects. Many were commenced in a colonial context, which saw alternative methods of funding and administration. They also supported different professional hierarchies and medical practices. Though the rise of the hospital in many African and Asian countries was often part of a self-conscious effort to emulate the West, local cultures and traditions have always modified the development of hospital services. The adoption of modern biomedicine has not necessarily led to the rejection of local medical traditions.

The Sri Lankan government’s support of health care

For instance, in Sri Lanka hospitals were a Western import, but their design and the medical services they offered were shaped by local influences. By the time of independence in 1948 (when Ceylon became Sri Lanka), hospitals in the country had multiplied, numbering more than 200. They had become an essential part of the new nation’s modern identity. Sri Lanka’s medical service, however, was never exclusively European, as was reflected in hospital architecture, the composition of medical staff and the medicine they practised. Consuming a fifth of the national budget, health care demonstrated the government’s commitment to its citizens. Although the welfare state was undermined by reforms in the late 1970s, the health of inhabitants remains strong. Despite the existence of a long-running war and low per-capita income, Sri Lanka has life expectancy and infant mortality rates that mirror those of much wealthier nations.

The vision of a hospital

Across the globe, governments have increased their involvement in the provision of medical services, including hospitals. While the hospital has come to symbolise biomedicine, it also serves as a focal point for local culture and a symbol of community pride.

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Bibliography

M Harrison and M Jones (eds), From Western Medicine to Global Medicine: The Hospital Beyond the West (New Delhi: Orient Longman, 2008)

M Jones, The Hospital System and Health Care in Sri Lanka (New Dehli: Orient Longman, 2008)

M Renshaw, Accommodating the Chinese: The American Hospital in China, 1880-1920 (London: Routledge, 2005)

G Risse, Mending Bodies, Saving Souls: A History of Hospitals (Oxford: Oxford University Press, 1999)

Glossary:

Biomedicine

The name given to the medical practice that is based on the sciences of the body, such as physiology (the functioning of the body).