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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.
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.
Unlike many other Western countries, Russia has never had an independent medical profession in classic neo-Weberian terms. Under the 1917 Provisional Government before the Russian Revolution, doctors came close to gaining an autonomous, self-regulating medical profession. However, the emerging profession was rapidly disestablished when the Bolsheviks came to power. This position was eased following the demise of socialism in Eastern Europe and the breakup of the USSR when a certain amount of reprofessionalisation began to take place as incipient independent professional bodies re-emerged in a more market-based economy. Despite this, they have yet to gain state underwriting as medicine has remained more a case of ‘professionalisation from above’ than ‘professionalisation from below’. This state autocracy stands in a long stream of Russian history, going back to the Tsars. It does not imply, however, that doctors have been uninfluential in Russia or that they have lacked regulation – it has simply not taken the same professional form as in countries like the United Kingdom and the United States. As this chapter underlines, the nature and implications of regulatory patterns in Russia remain very significant in terms of both physicians and the public alike.
Scandinavian health systems have traditionally been portrayed as relatively similar examples of decentralised, public integrated health systems. However, recent decades have seen significant public policy developments in the region that should lead us to modify our understanding. Several dimensions are important for understanding such developments. First, several of the countries have undergone structural reforms creating larger governance units and strengthening the state level capacity to regulate professionals and steer developments at the regional and municipal levels. Secondly, the three Nordic countries studied experienced an increase in the purchase of voluntary health insurance and the use of private providers. This introduces several issues for the equality of users and the efficiency of the system. This paper will investigate such trends and address the question: Is the Nordic health system model changing, and what are the consequences for trust, professional regulation and the public interest?
It has been argued that the health system in India appears to be systematically falling short in achieving equitable improvements in health status, quality of care, and social and financial risk protection. The poor performance of the health system is to a large extent due to the failure of the state regulators and of the professional associations to uphold their mandates, which in turn appears to be related to a broader and more fundamental failure of ‘trust’ in the expert systems that deliver health care and in institutions that are mandated to oversee this ‘entrustment’. This chapter attempts to identify the sources of this erosion of trust by analysing the regulatory and stewardship arrangements of the health system in India