THE ‘HEALTHCARE STATE’ IN TRANSITION

ABSTRACT

The building of a European nation challenges entrenched ties between the state and the professions. Yet, in relation to healthcare, European law is especially weak and professional power is particularly strong. Against this background, the present paper aims to map out the specific configurations of the changing governance of healthcare and the dynamics arising from intersecting contexts of change. We argue that the ‘healthcare state’ is strongly shaped by national regulatory frameworks, while the platform for the power of a self-regulatory medical profession is increasingly international in nature. Across countries managerialism and performance measures together with evidence-based medicine and clinical guidelines are meant to improve the accountability of professionals and the safety of the public. However, the new regulatory tools may also have the opposite effect and indeed serve as a means to reassert professional power; here, the heightened internationalization of healthcare even provides new opportunities. We use material from different countries gathered in a number of research projects to assess the changing governance of healthcare and its contexts. The paper concludes by highlighting the significance of both national regulatory frameworks and (international) professionalism.

Keywords:

• healthcare
• governance
• medical profession
• European convergence

Notes

¹These research projects are ‘Modernising Health Care’, funded by the University of Bremen (ZF 27/820/1; see Kuhlmann 2006) and an international research project on ‘Governing Doctors: A Comparative Analysis of Pathways of Change’, funded by the Danish Social Science Research Council and co-ordinated by Viola Burau. The material used for the case studies has mostly been gathered as part of the latter project, while the Norwegian case study is part of a parallel research collaboration with Simon Neby at the Stein Rokkan Center at the University of Bergen. We are grateful to our colleagues Simon Neby, Brian Salter, Willem Tousijn and Karsten Vrangbæk for allowing us to use material from their country reports.