chapter  15
20 Pages

National Systems of Health Care

ByDouglas R. Mackintosh

Before 1948, most British residents were covered for out-of-hospital medical expenses by the National Health Insurance Scheme. This scheme was administered by local insurance committees and some 1,000 "approved societies" and financed by employers, employees, and the state. The National Health Service (NHS), which was inaugurated in 1948, was a mammoth undertaking, representing, at that time, the tenth largest financial investment in the world. Sociomedical services such as home health care, ambulance services, and services for the handicapped and mentally ill were provided through the health departments of local governing authorities. The NHS has had its problems. The tripartite structure has made centralized overall planning difficult. A gulf developed between hospital and nonhospital practitioners. In 1974, the NHS was reorganized. It was broken into four health services: England, Wales, Scotland, and Northern Ireland, all of which have slightly different characteristics.