Open Access Histories of Payment in Healthcare

This year is shaping up to be The Year of Open Access for me. That’s not because open access publishing is new to me. The very first time my scholarly work was published was in an open access postgraduate e-journal, now (*gulp*) a decade ago. But this is proving to be a year where my work is going open access in all kinds of different publications.

mup-2017The year began with the publication of my first monograph – a book detailing the scale and workings of patient payments in British hospitals before the NHS, and asking what it meant to be asked to pay. In particular, it challenges the false assumption that middle-class paying patients crowded out the sick poor and that commercial medicine ended medical charity. These fears, just like hopes that payment would have an empowering or democratising effect, were in fact wide of the mark. Instead, I suggest, payment and philanthropy found a surprisingly traditional accommodation, which ensured the rise of universal healthcare was mitigated and mediated by long-standing class distinctions while financial contribution became a new marker of good citizenship.

This book was based on a PhD funded by the Wellcome Trust. If I was doing that PhD today, it would be a requirement of my Wellcome funding that anything based on that research should be published open access, free for anyone to read. Not so back in my day. But they kindly agreed to apply the principle retrospectively and cough up the 10s of 1,000s to make it happen. At a time when paid services have an increasing place within the NHS, the value of knowing the NHS’s pre-history is hardly restricted to ivory towers. So I’m very happy to say you can read or download it for free over at the OAPEN Library.

I thought one open access e-book was good going. But I was very happy to see a second pop up in my twitter feed, with news that a collection of essays I contributed to a couple of years back has now been published as an open access e-book as well.

Lucey and Crossman 2015 (2)Sean Lucey and I wrote a chapter together for the book he edited with Virginia Crossman on Healthcare in Ireland and Britain from 1850: Voluntary, regional and comparative perspectives. Our chapter compared patient payment schemes in Britain and Ireland during the interwar years. For Ireland, this was the time of the formation of the Irish Free State and saw the arrival of the first Fianna Fáil government, which may well have accidentally created a two-tier hospital system simply by misunderstanding the way these payment schemes worked on the ground.

The book features a whole host of excellent essays offering ‘new perspectives on the central relationship between state and voluntary healthcare provision throughout the constituent parts of the United Kingdom’. It’s one of a number of very good historical edited collections recently made available on an open access basis as part of the Humanities Digital Library – a joint initiative between the University of London’s School of Advanced Studies and two of the its institutes: the Institute of Advanced Legal Studies the Institute of Historical Research. You can read or download the e-book here.

WHR coverAfter which, it almost seems routine to have an article published open access in a journal. The journal in question is the Women’s History Review, an excellent forum for feminist-inspired work on women’s history in modern Britain and beyond. My article extends the analysis in my Payment & Philanthropy book by asking what meaning the handling of money carried, not for patients asked to pay the pre-NHS hospital, but for the medical social workers whose job it was to means-test the patient and collect their payment.

It takes the arrival of the NHS as a ‘free’ health service in 1948 as a case study, asking why a change that robbed them of a major part of the their role – indeed, the very reason for which they had gained entry into the hospital world at all – didn’t cause any sort of identity crisis. Just as being able to sensitively handle payments gained them a professional foothold, distancing themselves from handling payments, I suggest, allowed them to assert an enhanced professional standing for an emergent female profession.

It won’t be out in print until next year, but it’s already available online (open access, of course) via the Women’s History Review.

The only downside to having so many open access publication being made available in such a short space of time is that it really makes those publications not open access stand out.  In fact, along with earlier publications, my entire body of work on the meaning of payment in the pre-NHS voluntary hospitals is now open access… with one exception.

Maybe I’ll have to do something about that.


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