Series: Sociology of Health Professions
Series Editors: Mike Saks, University of Suffolk, UK and Mike Dent, Staffordshire University, UK
This series centres on the production of high quality, original work in the sociology of health professions with an innovative focus on the likely future direction of such professions.
Books in the series cover a wide range of associated health professional areas, and encompass interrelated health fields such as social care, as well as medicine, nursing and the allied health professions.
Sociology of Health Professions
Sociological research on the governance of complementary and alternative medicine (CAM) in Western societies has vastly increased in the last decades. Yet there has been a less marked expression of qualitative studies which put such governance into comparative perspective. Furthermore, research has shown that CAM regulation in Western countries has been very diverse, and so is probably best conceptualised on a spectrum containing several regulatory models. This chapter investigates CAM’s modes of governance in two historically, culturally and politically related countries, Brazil and Portugal. It analyses the extent to which CAM governance has changed over time in these two countries, the main modes of CAM governance in these same countries, and the implications of these modes of CAM governance for CAM professionals themselves and the public. It is concluded that Brazil and Portugal present some similar patterns in the way they govern CAM, but also contrasting differences, particularly in relation to the status of these therapies within the public and the private health care systems, and the implications of this status for CAM professionals themselves and the wider public.
This chapter reviews recent developments in user involvement practices across a range of European health care systems in terms of their implications for the medical profession and regulation of its practitioners. It will review the dominant models of user involvement, from Arnstein (1969) ‘ladder of participation’ onwards within Europe. The chapter will be particularly concerned with the growing linkages between user involvement in its various guises and the governance and regulation of European health care and medicine. The analysis will critically examine the variations in user involvement from ‘choice’ to ‘co-production’ and the range of ways they have been implemented in various European countries, with particular attention to England, Italy and Denmark. The discussion will focus on the implications for the medical profession as much as for the patients themselves.
This chapter describes health complaints entities in Australia and New Zealand, with an analytical focus on the ways in which they do, or do not, serve the public interest. The concept of public interest is explored with reference to the aims and functions of these entities, and the competing interests at work in their design, establishment, administration and operation. We also examine significant events and social movements that have created the impetus for health complaints system reform, and examine the impact and effectiveness of these. We examine the evidence, as well as the lack thereof, regarding the extent to which current complaints commissioners achieve their stated goals. Finally, the chapter identifies emerging challenges with implications and opportunities for the contribution of health complaints entities to the public interest.
Seeking to illustrate the usefulness of Eliasian approaches for debates on health care professional regulation, this chapter examines how long-term social processes have transformed the character of health care professional-patient interactions in the United Kingdom in recent decades, rendering them more informal and less asymmetric. The chapter goes on to consider three key implications and challenges of such transformations for regulatory design and practice, first exploring how performances of compassion and care have become more central to understandings of ‘quality’ health care practice. Secondly, these less asymmetric and structured interactions are also less stable, posing problems for quality assurance and regulation. Finally, informalisation processes are bound up with moves away from a more blanket profession-based trust towards a more critical, interaction-won trust. The chapter concludes by considering the implications of new trust dynamics for regulating quality care amid the processes of informalisation, and how heightened demands for reflexivity may open new possibilities for cultivating (professional) virtue through a dialogue between social research and health care practice.
This chapter provides a commentary on, and introduces, the collection of papers in this volume. It begins by outlining how professional forms of health care expertise have become increasingly subject over the last four decades to third-party scrutiny, as well as how we have witnessed greater public involvement in the monitoring and quality assurance of healthcare work, particularly in Western neo-liberal societies. It then discusses how these changes have led the ‘social closure’ model of professional work to become revised, and in doing so how this raises concerns regarding academic engagement with members of the public as part of a broader patient advocacy and policy reform agenda focused on the promotion of the public interest. This discussion helps set the scene for subsequent chapters, which together seek to unpack the complex relationships that exist between health care practitioners, civil society, the state and professional groups in a variety of different international borders and regulatory jurisdictions. In doing so, each author seeks to explore critically how calls for increased efficiency and cost effectiveness in healthcare are balanced with the need to promote the public interest through providing citizens with essential health services.
This chapter explores the medical licensure and specialty certification environment in United States and examines the persistent difficulties with ensuring that all physicians keep up with the changing demands and advances in medicine. Government agencies (state and federal legislatures, departments and courts), multiple medical organisations, and market bodies (consumers and insurance companies) are intertwined in complex and conflict-prone interactions. This chapter critically explores if the United States can continue to leave it to medical professionals or local state legislatures to oversee maintaining competency and licensure. States currently vary as to the strategy they adopt, the preferred method reflecting local traditions and physician practices, leaving gaps in standards. Anti-regulation sentiments have been on the rise, with the result that efforts by some medical organisations to nudge others toward greater oversight have been stymied by others which launch legal and political challenges against regulatory changes. The diversity of institutions with a stake in the regulatory process complicates the matter. The chapter concludes that what tends to get lost in this state of affairs is the ‘public interest’.
Regulation of the medical profession has a long history in the United Kingdom but a number of high profile failures of National Health Service (NHS) organisations to deliver safe health care and the unlawful killing of more than 200 patients by one rogue doctor have led to a clamour for change. Many of these tragedies have been the subject of public inquiries and have created significant public disquiet about the role and effectiveness of the medical regulator. United Kingdom governments have responded to these inquiries by means of a combination of strengthening professional regulation and the introduction of new mechanisms of appeal against the sanctions imposed on doctors by tribunals. The historical development of medical regulation is reviewed and the more recent changes to address the public interest and crises in the confidence in the regulation of health care are described.
Physicians in Canada are entrusted with one of the highest degrees of self-regulatory privilege of medical professionals, associated in neo-Weberian terms with exclusionary social closure in a competitive marketplace. To protect the public, though, such power must be accompanied by structures which successfully ensure that standards of professional quality are well defined and rigorously implemented. Yet little is known about the performance of presently implemented regulatory structures in medicine in Canada in terms of quality definition and assurance. Drawing on original research, this chapter provides an overview of the standards and regulatory goals and the various formal mechanisms for implementing these in Canada. As such, it will outline how provincial and territorial medical colleges explicitly and implicitly understand, describe, and put into practice their own standards of performance. Appropriate alignment of the colleges with quality assurance in this respect is considered vital in terms of the wider public good.
There are significant variations in how healthcare systems and health professionals are regulated globally. One feature that they increasingly have in common is an emphasis on the value of including members of the public in quality assurance processes. While many argue that this will help better serve the public interest, others question how far the changing regulatory reform agenda is still dominated by medical interests.
Bringing together leading academics worldwide, this collection compares and critically examines the ways in which different countries are regulating healthcare in general, and health professions in particular, in the interest of users and the wider public. It is the first book in the Sociology of Health Professions series.
In the United Kingdom reforms to professional regulation have been introduced to enhance public protection. This chapter accounts for changes from 2002 to 2016 with the introduction of a meta-regulator to oversee nine statutory professional Councils. It examines the expansion of the role of the meta-regulator and reforms within the professional councils themselves. It draws on data collected to show increases in costs and activity and explains the shift from self-regulation to top-down governance using corporate management techniques of audit and review. It demonstrates that the reforms have been evolutionary and that further reform is ongoing.
