1723: Cuckfield doctor's payment by results


For reasons not difficult to understand, doctors have never favoured payment by results, where the magnitude of their fee, if any, proportional to their success or otherwise in curing the patient.


But 'payment by results' contracts were not unknown in England between the sixteenth and eighteenth centuries, sometimes being imposed on unwilling physicians, surgeons, or apothecaries by cost conscious parish churchwardens responsible for disbursing poor rate moneys for the treatment of the tick, the "deserving" poor.


Here, for example, is a payment by results agreement, dated 1723, found among the miscellaneous documents in the parish chest at Cuckfield:


MEMORANDUM

An Agreement made between We whose names are underwritten all inhabitants of the parish of Cockfeild and George Mace of Cockfeild Apothecary this 27th day of December 1723.


First We the Inhabitants have agreed to pay George Mace the sum of Four Pounds four shillings in case he makes a perfect Cure of Thomas Bashford’s Legg and Foot before Easter next.


In Case the sd George Mace does not make a Cure of the said Thomas Bashfurds Legg and Foot before Easter next. Then we agree to pay him Four Pounds and Four Shillings within a yr after he shall have made a perfect Cure of the sd Bashford’s Legg and Foot.


But in Case the said George Mace shall make a Perfect Cure of the said T Bashfords legg and Foot before Easter next and shall have reced the Four Pounds and four shillings for so doing and the said T Bashford's Legg and Foot shall happen to grow bad againn within a year of the same then It is agreed that the sd George Mace shall repay the said Four pounds four shillings into some of the parishioners hands for the parish Use


Witness our Hands

Robt Norden Chartes Savage Berd Heasman

Mich Field - Churchwardens


Walter Gatland William Anscomb - Overseers

George Mace


NOTE: Sadly there is no record of whether Bashford's leg recovered or not. Could performance-related payment be something that today's private health companies might consider adopting perhaps? No chance!

Source

Policy Tools for Allocative Efficiency of Health Services

By Xingzhu Liu · 2003 Google Books.


Andrew Allen is a research biologist at Montpellier University.


British Medical Journal: volume 312, No. 7044, 8 June 1996 P1453

Can be found at: https://www.jstor.org/stable/29731897


Illustration

A female patient dying in the arms of her family, an unhappy doctor leaves the room realising it is his final payment. Aquatint by T. Rowlandson, 1786. Wellcome Library, Creative Commons.


Contributed by Malcolm Davison.