Crosfill M
Vesalius. 1996 Dec;2(2):118-25.
The Highlands and Islands of Scotland cover a large area of the country and are sparsely populated. A series of man-made and natural disasters ensured that, early in the nineteenth century, they were also poverty stricken. It was gradually recognised that the degree of social deprivation was too severe for self-help and could only be alleviated from outside the area. This paper traces the use of State funds to support a medical service, from the first payments under the new Poor Law until the outbreak of war in 1939. Improvement was at first very slow but a turning point came with the establishment in 1913 of the Highlands and Islands Medical Service Committee. The committee was given a free hand to expand or retain its annual grant as it saw fit; the way in which the money was used to develop first a comprehensive primary care service and then the nucleus of an integrated hospital service is revealed in the annual reports. The success of this local scheme may have made easier the later introduction of a national health service.
苏格兰高地和岛屿覆盖了该国的大片区域，且人口稀少。一系列人为和自然灾害致使在19世纪早期，这些地区也陷入贫困。人们逐渐认识到，社会贫困程度过于严重，无法依靠自助解决，只能从该地区以外获得缓解。本文追溯了从新济贫法下的首次拨款到1939年战争爆发期间，国家资金用于支持医疗服务的情况。起初改善非常缓慢，但1913年高地和岛屿医疗服务委员会的成立成为了一个转折点。该委员会被赋予自行决定扩大或保留年度拨款的自由裁量权；年度报告揭示了这些资金如何首先用于发展全面的初级医疗服务，进而用于发展综合医院服务的核心部分。这个地方计划的成功可能为后来引入国家医疗服务体系提供了便利。
