The long shadow of charity in the Spanish hospital system, c. 1870-1942

Abstract

[Abstract]: One of the key historical changes related to the increase in overall welfare for the population of Europe was the provision of sickness coverage. Public and private hospital charity was focused almost exclusively on the poor and marginalized until well into the nineteenth century. In the late nineteenth century, in most industrialized countries, the coverage of social risks in general and the risk of sickness in particular came from four basic sectors with different weighting according to country: the state, the market, the traditional family network (which was less robust in urban areas), and solidarity among workers. Historians have shown that, across time, hospital systems tended to be created in developed countries where at least one of these public or private elements was prominent. Spain provides an excellent case study of how a country in Western Europe made modest progress with respect to its hospital system between the 1880s and 1930s in a context of low coverage capacity in all four of the areas that comprise the mixed economy of welfare. Changes to the hospital map occurred above all during the 1920s and 1930s with the emergence of new actors responding to new demands: companies that created hospitals for workplace victims; friendly societies; insurance companies; and medical specialists who set up clinics and polyclinics to attend to an emerging middle class. Despite this, the majority of the working population lacked hospital coverage due to the state’s inability to establish a health insurance scheme in a country with a predominance of agricultural workers without regular work or wages