The state and the medical profession : A cross-national comparison of the health policy arena in the United Kingdom and Sweden 1945 - 1985

Abstract: The present study analyses the relationship between the State and the medical profession in the United Kingdom and Sweden in the period 1945 to 1985. They are nations which have adopted similar principles for providing health services to the population in the post-war period. The State control of health provision will most certainly affect the interaction between the State and the medical profession, a key group in the health care system. In order to make the system function, public authorities have to find a working relationship with bodies representing the medical profession. From the point of view of the profession it is important to direct constant attention towards what is happening in the health policy arena. The relationship is examined by way of five areas of potential dispute: the consultative process at the national level, the scope for private practice, the medical advisory machinery, the licensing system and the disciplinary machinery. The intention is to select areas covering the professional participation in national policy-making and in health care administration. The focus is on the right of professional bodies to participate, and on the formal and informal structure of actual participation. Three areas of potential dispute are concerned with the autonomy of the medical profession. In order to explain the process of interaction in the health policy arena the study takes up both countryspecific macrosocial factors and ones that are specific to the particular policy sector: the tradition in the field of health care, the post-war health care system, the national policy style, the party-political scene and the organized medical profession.The study shows that the interface between government and the medical profession has differed considerably in the two countries. In Britain a client relationship between government and important professional associations has developed, while in Sweden public actors have dominated the health policy arena. The national policy style, reinforced by characteristics that are specific to the policy sector, has determined the consultative pattern in both nations. The delimitation of professional autonomy, however, has been affected by the tradition in the field of health care, but also national policy style and occasionally the party-political scene are important factors in this respect.