The Medical Profession and the Modern State: Socio-Political Diversity and the Public Interest

This paper takes a comparative overview of the regulatory position of the medical profession in relation to the state in a selective range of modern societies – from the more autocratic to the more democratic. Here the regulatory framework of medicine spans from a lack of autonomy in Russia through the close interweaving of the profession and the state in continental Europe to a higher level of independence in the Anglo-American context. At the same time it is recognized that the current spectrum of regulatory positions, which reflect both ongoing and historical socio-political issues in each society, are subject to change – not least in the shifting relationship between the medical profession and other practitioners in the healthcare division of labour. In providing a comparative overview, this paper adopts a neo-Weberian and neo-institutionalist perspective on the medical profession characterized by the concept of exclusionary social closure underwritten by the state in the market and by its place among a number of competing institutions in an ecology of forms. Through these interlinked theoretical lenses, the influence of contemporary trends such as hybridization and corporatization on the position of medicine are considered. The pros and cons of diverse forms of medical regulation involving the state are then finally considered from the viewpoint of health policy and the public interest.