Transforming the Bonds Between Governance and Professions: Health Reform in Germany, Sweden and Turkey

Governance and professions are bond in complex ways. As policy experts, organizational managers, lawyers, and providers of a wide range of services from teachers, doctors and carers to social workers the professions are serving as mediators between the state and the citizens, while professionalism is oiling the machinery of organizations and service provision. Over recent years, new health policies have challenged these relationships. This paper aims to reveal the contingencies of the bonds between professions and governance and the institutional pathways that create variety of transformations. In terms of method, we use healthcare reform in Germany, Sweden and Turkey as case studies drawing primarily on document analysis and research carried out by the authors. In Germany, the implementation of governance changes depends on negotiations between doctors and sickness funds and new forms of skill-mixes are therefore poorly developed. The Swedish case shows stronger integration and increasing involvement doctors and nurses in management. In Turkey, a mixed model of governance is creating new bonds among the state, the medical professions and the market. One important conclusion drawn from our case studies is that the goals and the toolbox of governance may be similar across healthcare systems while the impact in the relationship between the state and the professions as well between the professions and organizations may take different forms.