Dissecting the marketplace: The development of healthcare provision in nineteenth-century Portsmouth
A tri-partite system of healthcare provision prevailed in nineteenth-century England, with treatment available from a range of private, state and charitable providers. Each of these sectors has been studied in depth, but the relationship between them is poorly documented. Current thinking generally accords a leading position to the private sector. Conceptualised in economic terms, the so-called 'medical market' is regarded by historians as the central driver behind the overall development of healthcare provision and responsible for its rapid expansion in this period. Evidence at a national level reinforces this hypothesis. At a local level however, it remains untested. Aspects of the hypothesis are also under-developed. In particular, an understanding of how the market actually worked in practice is lacking. Through a comprehensive reconstruction of healthcare provision in nineteenth-century Portsmouth, this thesis systematically tests the generalisations that underpin the medical market hypothesis. Its findings challenge the simplistic market generally portrayed in the existing historiography. In addition a range of insights are offered into market operation. These include a thorough consideration of how patients engaged with the market; how the market responded to sudden upsurges in demand; and how the market interacted with state and charitable providers. Detailed analysis of Portsmouth Royal Dockyard's archives forms an important component of the thesis. As well as giving an in-depth picture of dockworkers' health, the records show the extent to which factors other than market forces influenced the way local healthcare developed. Rather than provoking a market response, it is discovered that the high levels of occupational ill health generated at this industrial complex led to a substantial enlargement in state healthcare provision. As a result the state sector constrained the growth of the medical market in parts of Portsmouth. Hence, while broadly supporting the medical market hypothesis, this thesis' main contention is that to understand why healthcare provision developed as it did, scholars need to stop focusing on the medical market in isolation and start considering it as part of a wider system of healthcare.
Networked Digital Library of Theses and Dissertations