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State authority, medical dominance, and trends in the regulation of the health professions: The Ontario case

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  • Coburn, David

Abstract

The relationships amongst the health professions and between them and the state are rapidly changing. I argue that analysis of these relationships has to take into consideration: the fact that medicine played an intermediary role (through medical dominance in health care) between the state and the other health occupations; the permeability of the boundaries of the state and the professions; and the dual nature of professional organizations (as sites of intra-occupational conflict and as possible vehicles of extra-occupational control). In Ontario the medical profession partially 'mediated' the relationships between 'non-physician' health occupations and the state through medical control over other health care occupations. National/provincial health insurance brought the state into the health care system as an actor and forced a reconsideration of its relationships with medicine and with the other health care occupations. The state came to be directly involved in 'rationalizing' health care. This involvement meant curbing the power of medicine and modifying the relationships between medicine and the para-medical occupations. State influence is partly constructed through a particular kind of professional organization, namely, the professional College. These changing relationships are illustrated by historical and recent developments regarding medicine, nursing and chiropractic in Ontario.

Suggested Citation

  • Coburn, David, 1993. "State authority, medical dominance, and trends in the regulation of the health professions: The Ontario case," Social Science & Medicine, Elsevier, vol. 37(7), pages 841-850, October.
    • Handle: RePEc:eee:socmed:v:37:y:1993:i:7:p:841-850
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    Cited by:

    1. Martin, Graham P. & Currie, Graeme & Finn, Rachael, 2009. "Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the 'modernization' of the medical workforce," Social Science & Medicine, Elsevier, vol. 68(7), pages 1191-1198, April.
    2. Benoit, Cecilia & Zadoroznyj, Maria & Hallgrimsdottir, Helga & Treloar, Adrienne & Taylor, Kara, 2010. "Medical dominance and neoliberalisation in maternal care provision: The evidence from Canada and Australia," Social Science & Medicine, Elsevier, vol. 71(3), pages 475-481, August.
    3. Toth, Federico, 2015. "Sovereigns under Siege. How the medical profession is changing in Italy," Social Science & Medicine, Elsevier, vol. 136, pages 128-134.
    4. Ivy Lynn Bourgeault & Michel Grignon, 2013. "A Comparison of the Regulation of Health Professional Boundaries across OECD Countries," European Journal of Comparative Economics, Cattaneo University (LIUC), vol. 10(2), pages 199-223, August.

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