Summary: In the context of developments in health care arrangements over the late nineteenth and twentieth centuries, change in the voluntary hospitals is not normally regarded as a major theme. Yet in their relations with each other, with external authorities, and in patterns of funding the hospitals were subjected to change. In particular, the growth of hospital contributory schemes enabled renewed hospital expansion to occur and established a quasi-insurance basis to hospital activity in place of the earlier, largely philanthropic approach. The schemes also involved additional market mechanisms and promoted reorganization, including a degree of co-ordination of hospital services, felt at the local level before the growth of policy making bodies on a national scale and largely independent of central or local government. Focusing upon East Anglia but including other examples, the article examines the growth of hospital collections, the emergence of contributory schemes and their consequences for popular access to hospital facilities. A 'grass roots' approach is adopted, using annual reports of several hospitals and contributory schemes and local Insurance Committee minutes. It appears that the size and impact of the schemes in East Anglia has been understated, though this may not be typical of the situation nationally. The local evidence is also examined in the light of other recent research on the themes of popular participation, employer interest and social control aspects in health care provision at hospital levels.