Healthcare before Welfare States: Hospitals in Early Twentieth Century England and France

Abstract

Following the Second World War, many west European nations developed welfare states to enhance the health and security of their populations, but the systems that were created differed significantly in form and function. This article will provide a comparative overview of the development of hospital services in urban England and France in the first forty years of the 20th century using evidence from two case study cities to enhance our understanding of how these welfare systems developed. It will consider the structure of the two hospital systems; governance and accountability; institutional finance; patients; and the role of the central and local state to argue that the maintenance of two separate providers and the exclusion of hospitals from state health insurance in England prompted a different set of responses to the delivery of hospital care compared to what was found in the unified and increasingly state-funded French system.