From Hospital Contributory Schemes to Health Cash Plans: The Mutual Ideal in British Health Care after 1948

Abstract

The article traces the post-war history of the British hospital contributory schemes, which had developed during the inter-war years to the point where, through the accumulation of small weekly contributions from a mass membership, they provided substantial proportions of hospital income. A minority of contributory schemes remained in existence post-1948, but their subsequent development has received little attention. Some evolved into provident associations offering private health insurance; others remained committed to the provision of low-cost benefits to a blue-collar clientele, and continued to be known as hospital contributory schemes. This article outlines the principal features of the contributory schemes' contemporary history. We first explore why many schemes decided to continue in existence. The next section uses national and individual scheme records to delineate the market niche which they captured and to investigate their role in post-war health provision, relative to the state system. In particular we trace the decline of convalescent home benefit, and the gradual trend towards a more uniform benefit package, of which optical and dental grants were the most popular. We then survey patterns of membership and account for the main trends in support for cash plan products since 1950. Finally, we ask to what extent the schemes were able to retain their character as a ‘movement’ with distinctive mutualist and charitable features, particularly in the more competitive environment of the later twentieth century.