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The Doctor's Changing Role in Allocating U.S. and British Medical Services

Published online by Cambridge University Press:  29 April 2021

Robert G. Lee  and
Frances H. Miller
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Extract

Until the fourth decade of this century, British and American patients who could afford physician services paid for them out of their own pockets; those who could not relied on charity care or simply went without. Doctors functioned as independent contractor private practitioners in both Great Britain and the United States, allocating medical services in response to paying-patient demand — and their own consciences.

Beginning in the 1930s, health care financing on both sides of the Atlantic was restructured in dramatically different directions, and physicians’ allocational roles in their respective countries began diverging. Under the National Health Service (NHS), British general practitioners became essentially gatekeepers to health services, funneling patients to appropriate hospital and specialist care. As time went by they came more to resemble lockkeepers, regulating the queue for secondary and tertiary treatment resulting from governmental limits on health care spending — and from the limitations and inefficiencies of a system of rationing by waiting. In the U.S., on the other hand, efficiency was not at first a concern.

Type
Article
Information
Law, Medicine and Healthcare , Volume 18 , Issue 1-2 , Summer 1990 , pp. 69 - 76
Copyright
Copyright © 1990 American Society of Law, Medicine & Ethics

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