Health Professions and Health Practitioners’ Regulation after the Neo-Liberal Era: A Theoretical Framework for Analysis

The paper will set out a preliminary outline of a theoretical framework to analyse health practitioners’ regulation and its evolution in a comparative perspective. Developing from Giarelli and Saks (2023), it will combine a theoretical framework and concepts drawn from the neo-institutionalist theory, as used in comparative health policy, and from the sociology of professions, especially the Neo-Weberian theories. Neo-institutionalist theory explores institutional conditions and policy developments by analysing the interaction between institutions and actors in comparative health policy. The methodological and conceptual tools used to reconstruct policy-making in a multi-level perspective may be adopted to analyse the policy of health practitioners. In this context, professions are interest groups or stakeholders competing for power and social position in the political and social arenas.This approach is consistent with the Neo-Weberian theories of professions. These use concepts such as social closure, exclusion, usurpation and jurisdiction to analyse how professions defend or improve their position in the social stratification, in terms of income, status and power. Contributions of these two approaches are integrated by that of industrial relations, in order to study the characteristics and strategies of social mobility adopted by the health support workers.

This framework may be tested in the study of health workforce policy, and particularly of health practitioners’ regulation, after three decades of neo-liberal and globalisation policies. Marketisation, managerialisation and labour market liberalisation have significantly affected health policy and, directly or indirectly, health professions and their regulation. In particular, they altered the distribution of power among the actors in the policy arena, changed the relationship between State and professions, and challenged the traditional mechanisms of labour regulation in the health sector, which were focused on the ideal-type of professionalism and on the medical dominance. The paper is aimed at discussing the proposed framework and its empirical use.