Missing in Action? Sociological Analysis and the Provision of Public/Private Healthcare

The sociology of medicine arguably began as a specialty of sociology with a structural functionalist, systems approach to the field, propagated by Carr-Saunders and Wilson, and even more notably by Parsons, between the 1930s and 1950s. Critiques of this approach from Illich and Zola during the 1970s and 1980s made it evident that the very structures and organisation of medicine are crucial determinants of medical practice and medical knowledge. Subsequent studies of the political economy of healthcare in the 1980s and 1990s, particularly the studies of the American healthcare system, pressed home these ideas. Recent decades, in contrast, have seen relatively little theoretically-informed debate in sociology about the healthcare system as a structured field of practices, organisations and institutions. In this paper we report on a context-content analysis of publications from the major journals in the sociology of health, illness and medicine, combined with an analysis from the Thomson-Reuter Web of Science. We find evidence of trends towards the experience of illness; but little theoretically informed debate about the healthcare system as a whole. Our discussion centres on the reasons for this disciplinary lacuna and its implications for the making of sociological knowledge. We argue that such analyses are vital in order to inform public and policy discussions about future directions in healthcare.