This timely comparative study assesses the role of medical doctors in reforming publicly funded health services in England and Canada.
Respected authors from health and legal backgrounds on both sides of the Atlantic consider how the high status of the profession uniquely influences reforms. With summaries of developments in models of care, and the participation of doctors since the inception of publicly funded healthcare systems, they ask whether professionals might be considered allies or enemies of policy-makers.
With insights for future health policy and research, the book is an important contribution to debates about the complex relationship between doctors and the systems in which they practice.
This Introduction defines our research objectives and the key concepts underpinning our inquiry. We look at reforms in contemporary welfare states, which include England and Canada ( Denhardt and Denhardt, 2000 ; Bejerot and Hasselbladh, 2011 ; Ferlie and McGivern, 2013 ) and on their implications for the potential roles and manifestations of the agency of medicaldoctors ( Denis et al, 2016 ).
Setting the scene: reforms in contemporary healthcare systems
The question of healthcare reforms has attracted growing interest among policy analysts and health
The federal context in Canada warrants attention as it influences the negotiating space for provincial governments and medicaldoctors. While healthcare services are mostly under provincial jurisdiction (Section 92, Constitution Act 1867), the federal government plays an important role, particularly by using its spending power to uphold national standards (for example, with respect to insurance coverage for services provided in hospital or by medicaldoctors via the Canada Health Act, 1985). 1 To various degrees and at different times in the history of
The objective of empirically exploring the role of medicaldoctors in healthcare reforms and policy changes raises a number of methodological questions. What data set should be considered? What is the appropriate period of study (that is, when should analysis of reforms start and end our)? What context-specific elements, whether jurisdictional or situational, influence agency in healthcare reforms? What characterises the roles played by various actors in the reform process? With what influence on context and policy outcomes? What methods should be used to
For a better understanding of the historical role played by medicaldoctors in the NHS healthcare reforms, we need a few preliminary words on the process of law-making to reform the healthcare system in England.
Usually, the reformative process is ignited by an inquiry or policy proposal. In the early years of the NHS, the government established Royal Commissions as ad hoc committees ( House of Lords, 2007 ) tasked to lead investigations that triggered reforms. This long and burdensome process later gave way to more targeted inquiries to inform policy changes
As an epilogue, we completed this analysis just before the COVID-19 pandemic. We have since been able to observe the commitment and dedication of front-line clinicians, medicaldoctors and others healthcare professionals and workers in dealing with extraordinary and immense pressure to deliver care, often at considerable risk to their own health. In a sense, the commitment of medicaldoctors confirms one of the key findings of our study: the discrepancy between medical politics and the day-to-day accommodation between the medical profession and the healthcare
This chapter presents the conceptual framework underpinning our research. It looks at elements of the legal and political context that influence the role of medicaldoctors in healthcare reforms. It then analyses scholarly work on the sociology of professions and the interface between professions and organisations in order to better understand the predispositions of medicaldoctors in the context of reforms. The chapter closes with a presentation of the theoretical model that guides our empirical inquiry.
Agency in context: legal and political dimensions
The first digital-only ebook taster of Unequal health: The scandal of our times by Danny Dorling. Competitively priced, it gives a flavour of one of the major themes: public health and contains three chapters from the book, preceded by an all-new introduction specially written by Danny Dorling. This ‘must-read’ will introduce an even wider readership to his work.
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.
Health care support workers (HSWs) play a fundamental role in international health care systems, and yet they remain largely invisible. Despite this, the number of HSWs is growing fast as governments strive to combat illness and address social care issues in a world of finite resources.
This original collection analyses the global experience of HSWs in the UK, Japan, Australia, Brazil, Canada, Portugal, Sweden and The Netherlands. Leading academics examine issues including the interface of HSWs with the health professions, regulatory practice risks, employment challenges and the dilemmas of an ageing population. Crucial future policy recommendations are also made for a world becoming increasingly dependent on HSWs.