History of hospital care in São Paulo: State grants to the misericórdia charitable associations. / História da assistência hospitalar em São Paulo: a subvenção do Estado às misericórdias paulistas.

This article investigates how the santas casas de misericórdia charitable associations in the state of São Paulo were subsidized by the municipal, provincial, and state governments at the turn of the twentieth century. Budget appropriations from 1838 to 1915 were examined to evaluate these charitable grants as well as the growth in funding during this period. While a care network created with strong state backing, it was put into action by philanthropic assistance. This network of hospital care retained the same format until at least the first third of the twentieth century, and included misericórdia establishments created within the interior of the state of São Paulo.

O artigo analisa como as santas casas de misericórdia do estado de São Paulo foram subvencionadas pelos governos municipais, provincial e estadual na passagem do século XIX para o XX. Para tanto, são discutidas as dotações orçamentárias realizadas de 1838 a 1915, com o fim de avaliar o repasse e a ampliação de verbas nesse ínterim. É possível notar que foi criada uma rede de assistência fortemente apoiada pelo Estado, mas efetivada pela assistência filantrópica. Essa rede de atendimento hospitalar permanece com o mesmo formato até pelo menos o primeiro terço do século XX, contexto em que se incluíam as misericórdias criadas pelo interior do estado paulista.

História da assistência hospitalar em São Paulo: a subvenção do Estado às misericórdias paulistas / History of hospital care in São Paulo: State grants to the misericórdia charitable associations

Resumo O artigo analisa como as santas casas de misericórdia do estado de São Paulo foram subvencionadas pelos governos municipais, provincial e estadual na passagem do século XIX para o XX. Para tanto, são discutidas as dotações orçamentárias realizadas de 1838 a 1915, com o fim de avaliar o repasse e a ampliação de verbas nesse ínterim. É possível notar que foi criada uma rede de assistência fortemente apoiada pelo Estado, mas efetivada pela assistência filantrópica. Essa rede de atendimento hospitalar permanece com o mesmo formato até pelo menos o primeiro terço do século XX, contexto em que se incluíam as misericórdias criadas pelo interior do estado paulista.

Abstract This article investigates how the santas casas de misericórdia charitable associations in the state of São Paulo were subsidized by the municipal, provincial, and state governments at the turn of the twentieth century. Budget appropriations from 1838 to 1915 were examined to evaluate these charitable grants as well as the growth in funding during this period. While a care network created with strong state backing, it was put into action by philanthropic assistance. This network of hospital care retained the same format until at least the first third of the twentieth century, and included misericórdia establishments created within the interior of the state of São Paulo.

[Hospital Panorama in Zamora at the middle of the XVIIIth Century]. / Panorama hospitalario de Zamora a mediados del siglo XVIII.

The XVIIIth century was an era of reforms in multiple fields, including healthcare. To advance in its study, the present article delves into the knowledge about the hospital network in the middle of said century within the territories which integrate the current province of Zamora. Accordingly, the type of establishment, its funding, organisation and operation are analysed. As a result, a panorama dotted with numerous rural refuges and some hospitals in the centre of certain built-up areas is drawn, dedicated, basically, to the reception and religious assistance of poor vagrants. Such establishments were funded, above all, by agricultural income and by census rents. They counted , moreover, on a notable, ecclesiastic presence.

Staying the course.

Much has been written about public hospitals relative to their mission to care for the underserved, their role in medical education, and the continuous financial challenges that they encounter. But, despite doubts about their viability, public hospitals have not only withstood the test of time, but have thrived and have evolved into a new entity, i.e., the safety net hospital. Like with any long-standing institution, the development of public hospitals holds valuable lessons that provide insight into how they will continue to evolve and potentially strengthen, even in the face of adversity. Their rich heritage includes many medical "firsts" in the United States such as the first municipal ambulance service, first blood bank, first trauma center(s), first cardiac catherization, and first civilian burn center. If safety net hospitals care for their communities and continue in their educational mission, they will thrive in the tradition of service.

Do mergers really reduce costs? Evidence from hospitals.

In this paper, we compare potential and realized cost savings from hospital mergers. Our approach isolates changes in realized cost savings due to different output mixes from systematic changes due to time and also provides a measure of the potential cost savings due to scale economies. Our findings suggest that economies of scale are present for merging hospitals and they realize these cost savings immediately following a merger. However, we also show that over time, cost savings from the merger decrease and the proportion of hospitals experiencing positive cost savings declines.

Hospital contributory schemes and the NHS debates 1937-46: the rejection of social insurance in the British welfare state?

This article considers the discussion and rejection of social insurance model of funding for the British National Health Service. Specifically it asks why the hospital contributory scheme movement had so little impact on policy debates in the 1940s. We argue that at the start of the policy-making process serious consideration was given to the incorporation of this mode of funding, not least because the contributory schemes, with some ten million members, played a major role in financing existing voluntary hospital provision. Early sections describe the growth and nature of the schemes, noting that, despite their large working-class constituency and the presence of labour movement representatives amongst their leadership, they remained peripheral to discussion of reform in the interwar period. We then trace the emergence of the proposal for an insurance-based 'hotel-charge' in civil servants' discussions about hospital funding the Beveridge Report. Officials, however, remained sceptical about the contributory schemes' capacity to deliver a comprehensive and efficient funding mechanism, given their lack of uniformity, the gaps in their coverage, and the limited progress of reciprocal arrangements between them. Finally, we note the ineffectiveness of the British Hospital Contributory Schemes Association as a player in the policy community. Its leadership had no clear strategy for influencing events and was reluctant to deploy pressure group tactics such as lobbying through the press or parliament. Crucially, the movement was divided internally between those members who supported the voluntary system and others who welcomed a publicly funded health service.

The contribution of the Hospital Saturday Fund to nursing history: evaluation of a primary source.

The Hospital Saturday Fund was established as a means of providing much-needed contributions to the voluntary hospitals. Subscribing to the Fund ensured the contributor's care, but, additionally, they could sponsor a 'deserving object'. The annual reports of the Fund provide a number of insights in relation to the social, economic and political history of Liverpool. The reports also provide some insights into nursing in the city during the period 1888-1927. Following documentary analysis, the paper discusses some of these findings, namely district nursing, services for women and convalescence, and evaluates how useful this source may be to nursing history.

[The century-long trends of the French hospital system: an analysis in terms of regulation]. / La dynamique séculaire du système hospitalier français: une analyse en termes de régulation.

This article is an inquiry about growth of hospitals expenses. The analysis is founded on the long term construction of monetary series. These series show evidence of three characteristics: growth of hospitals expenses between 1815 and 1993, development trough a succession of stages, existence of long term cyclic fluctuations contrary to the Kondratieff's movements.