Frank Honigsbaum, who has died of a heart attack aged 77, was a passionate advocate of universal health insurance and the general practitioner system. A leading medical historian and expert on the National Health Service, Honigsbaum believed that medical care - if it was to be free and universal - had to be rooted in community-based GP services. Otherwise, hospital utilisation rates would rise and medical costs would inevitably soar.
While to those who did not know him, it might seem odd to hear such convictions being expressed by an American - especially by one who, despite living for more than 44 years in London, never lost his accent - Honigsbaum would not have seen a contradiction.
Born in Boston and raised in Troy, New York, his interest in medical care stemmed directly from his five years as research director of the International Brotherhood of Paper Makers in Albany, New York. There, as an organiser, teacher and negotiator, he saw that the membership's greatest need was for adequate pension and medical provision. It was his interest in establishing a group practice prepayment scheme (now known as a health maintenance organisation or HMO) for the union that brought him to Britain in 1957 on a Fulbright Scholarship and to the London School of Economics.
There, guided by Professor Richard Titmuss, he made a detailed study of the GP complaints procedure for patients. But the more he examined the relationship between GPs, patients and hospital consultants, the more he realised that the separation between generalist and specialist care had its roots in class divisions that predated the NHS. It was this insight that led him to extend his stay at LSE and deepen his studies into the operation of the GP panel system in the critical period between 1911 and 1948, when the foundations of the NHS were being laid under Lloyd George's National Health Insurance Act.
Honigsbaum saw himself an "archaeologist of history", digging for the truth. In his effort to write the definitive account of the NHS, he consulted countless journals, newspapers and private documents. The result was two seminal works, The Division In British Medicine: a history of the separation of general practice from hospital care, 1911-1968 (1979) and Health, Happiness And Security: the creation of the National Health Service (1989).
But while these books were to take him 30 years, a lifetime's work, he did have other interests. The son of third-generation Jewish immigrants, he was a natural athlete and played quarterback for his college football. He developed a passion for tennis and was playing at his London club, Queen's, shortly before his death. He was equally enthusiastic about 1920s and 1930s jazz.
After graduating with distinction from Harvard Business School in 1950, he travelled to New York to meet Sidney Bechet, and briefly flirted with the idea of becoming a record producer. He was an optimist with an infectious laugh, so loud that it could startle the academics, medical professionals and politicians he dealt with - and they were many.
In 1969, at the request of Professor Titmuss, he prepared a paper for Richard Crossman, the then Labour social services minister, on the history and operation of the GP complaints service. Four years later, he found himself sitting alongside Barbara Castle on a Labour party working group drafting opposition proposals on health care reform.
His commitment to policy making and public service continued through the 1980s and 1990s, first as a member of the Westminster Association for Mental Health, and later as chairman of the Riverside Community Health Council CHC) and as a member of Riverside District Health Authority (DHA).
As cost pressures on the NHS intensified, Honigsbaum turned to a study of Oregon's controversial health rationing plan and priority setting in countries such as Sweden, the Netherlands and New Zealand. Honigsbaum brought a historical perspective to these issues and a keen actuarial brain - he had been destined for a career in his father's retail business before he went into union work - and his views were widely canvassed.
In 1991, the King's Fund commissioned him to write a report on the Oregon plan, Who Shall Live? Who Shall Die? Then, in 1992, Chris Ham invited him to join Birmingham University's Health Services Management Centre, where together they co-authored a series of papers for the NHS Management Executive looking at the purchasing plans and priority-setting across several British health authorities.
Honigsbaum had long harboured a desire to make a similar contribution in the US. In 1977, he wrote to Ramsay Clark, the new president Jimmy Carter's attorney general, seeking a post at the Department of Health, Education and Welfare. Honigsbaum argued that the US had much to learn from the NHS and that, if it wished to develop a more "humane" and cost-effective health care system, it needed to foster a similar community-based primary care corps.
"But that, in turn, requires the creation of a public system," he warned Clark, "as medical men, general practitioners, cannot survive in the market place. Competition forces them to become specialists and it is only with the helping hand of the state that they can provide the kind of care the nation so desperately needs".
The message fell on deaf ears. Between 1996 and 1998, when Bill and Hillary Clinton put forward proposals to reform Medicaid and Medicare, Honigsbaum renewed his contacts in Washington, but once again US moves towards a fairer and more cost-effective health care system were frustrated.
Nevertheless, he never gave up hope that his compatriots would see the benefits of health reform and up until his death was corresponding with a former colleague of the late Paul Wellstone, the Minnesota senator and champion of reform.
Ironically, on the day that Honigsbaum was rushed to hospital, the California State Assembly passed a single payer health bill, the first step on what he would have viewed as the long road to universal coverage in the US.
He is survived by his wife Naomi and his son and daughter.
· Frank Honigsbaum, campaigner, born January 30 1927; died, June 23 2004
