Contrasting Accounting Practices in the Urban Hospitals of England and France, 1890s to 1930s

Barry Doyle

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


In the latter part of the nineteenth century, and especially in the first third of the twentieth century, the urban hospital saw its purpose move from the protection and care of patients to their diagnosis and cure. As a result of this process, the numbers and types of patients entering hospitals in England and France, and the funding structures supporting those admitted, underwent a substantial change. These changes were underpinned by new ways of accounting for treatment which saw starkly different approaches adopted by institutions in the two countries. Drawing on evidence from the hospital services of Leeds and Sheffield in England and Lille, Rouen and Le Havre in France, this chapter explores those differences. It utilises a range of sources, including hospital annual reports, financial returns, and internal enquiries, to examine the development of the daily rate – prix de journée – calculated for patient treatment by hospitals in France and the growth of block grants provided by working-class mutual societies in England. It shows that the daily rate, which initially emerged as a way to charge external organisations for using community funded hospitals, became a highly contested site in which accounting practices were deployed to police the boundaries of permissible costs. In contrast, the block grant was adopted, in part, to minimise accounting complexity and administrative costs, but more importantly to shore up the residual charitable elements of the ‘voluntary hospital’ system and impose strict financial discipline. Each of these approaches fed into postwar socialised hospital services, shaping accounting and financial practices for decades to come.
Original languageEnglish
Title of host publicationAccounting for health
Subtitle of host publicationCalculation, paperwork and medicine, 1500–2000
EditorsAxel C. Hüntelmann, Oliver Falk
Place of PublicationManchester
PublisherManchester University Press
Number of pages23
ISBN (Electronic)9781526135179
ISBN (Print)9781526135162
Publication statusPublished - 12 Jan 2021

Publication series

NameSocial Histories of Medicine
PublisherManchester University Press


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