イギリス医療保障構想の形成過程

概要

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The past century has been years of very great progress in the medical and health services in Britain. The second half of the nineteenth century was marked by the development of environmental health services providing basic conditions for healthy living. The early twenties century saw the start of State aid to medical research and, in the medical benefit of National Health Insurance in 1911, the beginning of a State-aided general practitioner service outside the Poor Law. Problems of public health came under serious consideration during the last century because of great epidemics of cholera and typhus which swept cities, especially poor quarters with thier unpaved streets and their crowded ill- entilated dwellings. The great social reformer, Edwin Chadwick, presented his famous "Report on the Sanitary Conditions of the Labouring Population of Great Britain" to Parliament in 1842, showing how closely ill health was bound up with poverty and with evil sanitary conditions. The Public Health Act of 1848, and the setting-up of a Board of Health were the results of his revelations. Chadwick had insisted that the expense for public drainage would be offset by the diminishing social cost of illness, and gradually many measures were, passed dealing with such matters as water supply, sewerage, inspection of fpod, removal of refuse, and so on. In 1875 health laws were codified under a consolidating Health Act; a local Government Board was set up which continued to administer these measures until the creation of the Ministry of Health in 1919. Like all social reform in England, the improvement in matters of health, came about gradually, for different reasons and in various ways. The Boer War revealed a startlingly low level of fitness among the recruits, of whom nearly half had to be refused on medical grounds. The high death-rate of infants and the great amount of illness among people in general, led to a new concern about health services. In 1911 a Liberal Government enacted the first National Insurance Act. This was "an Act to provide for Insurance, Laws of Health, and for the Prevention and Care of Sickness, and for Insurance against Unemployment, and for the purpose incidental thereto." By this Act Lloyd George, following Bismarck's example, introduced into Great Britain the device of paying for social reform mainly out of the pockets of the poor. And in doing this, he spiked the Socialist's gun. The National (Health) Insurance Act was an answer, and politically an effective answer, to the Minority Report of the Poor Law Commission, which,, appointed under the Conservatives, only finished its tasks in 1909. On one main issue the Majority and the Minority of the Commission agreed. They both held that the Poor Law, as it stood, was obsolete, and that the ad hoc Boards of Guardians ought to be abolished and their functions handed over to the town and county councils. But the. Minority Report-the work chiefly of the Webbs-went much further than this, proposing a complete "break-up" of the Poor Law, and the institution under the local authorities of a complete public health service without any taint of pauperism. The Health Insurance Act was Lloyd George's essentially conservative answer to these demands. Not only did he institute the contributory system: he also firmly entrenched it against attack by handing over the administration of health insurance to a list of "Approved Societies"- friendly societies and insurance companies in the main, but also trade unions, who chosed to set up special machinery for the purpose - and by instituting the system of "panel practice", whereby the medical profession, which used its chance to drive a remarkably hard financial bargain, came to regard the insurance system as its guarantee against nationalization through a State Medical Service.
慶應義塾大学の論文
1962-02-28

著者

藤澤益夫
慶應義塾大学商学部

イギリス医療保障構想の形成過程

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