Age-based rationing of medical care in nineteenth-century England

Abstract

This article questions whether indoor medical care for the elderly provided under the poor law and by voluntary hospitals during the second and third quarters of the nineteenth century was rationed on the basis of age and, given that the elderly were discriminated against compared with other age groups, how their ability to secure medical care changed over time and between providers.The research was motivated by the current debate on the allocation of scarce health care resources in the British National Health Service. This debate has contrasted the traditional approach of doctors who ration care on the basis of medical need, that is through clinical assessment of a patient's state of health, with new solutions developed by health economists and medical ethicists who seek to maximize the health care outputs society can buy or the welfare individuals can achieve over their lifetime.I use admission and discharge registers from two case studies – a voluntary hospital in Bristol and a workhouse infirmary in East London – to test the following hypothesis: that during the period medical resources, as defined by admissions and hospital days, were allocated according to the medical need of age groups. Differential access to medical and nursing staff, to remedies or interventions, and standards of hygiene or diet are not considered. Although these care components were clearly important, and some aggregate indicators may be calculated for the two providers, the available sources do not allow comparison of the allocation of these components between age groups.Section II outlines the theoretical framework underpinning this article and Section III introduces the historical context. The sources of data are described in Section IV and the evidence is presented in Section V. The final section contributes to the historiography of old age for nineteenth-century England by suggesting ways in which to interpret the findings.