Doctors in the Crisis and the Crisis of Doctors: The Case of the Italian NHS

The economic crisis and the related austerity policies are promoting a trajectory of change in the Italian NHS, slowly transforming its universalistic and public nature into a more privatized healthcare system. This institutional change has been brought about by the weakening of the main veto players (doctors’ associations and unions, trade unions, Regional governments), which had previously acted as “NHS defenders”.

Given this picture, described at the beginning of the paper, our focus is on the weakening of doctors’ associations and unions, which may be attributed to two broad sets of reasons. First, the economic and financial crisis severely constrained the traditional capacity of doctors to negotiate and affect public spending policies, because national governments were often pushed to assume tough and quick decisions to confront the turbulence of financial markets and EU pressure. Moreover, the loss of influence on policy making reflects a more general decline of the “medical dominance” (Freidson, 1970) exerted within the healthcare system.

In the second part of the paper we will investigate the causes and the extent of the decline of professional dominance of doctors in Italy, with some reference to other national cases, concentrating on three components: the effects of managerialization, the assertion of other health professional groups and the impact of technology (especially ICT) on medical practice and the medical labor market, depicting new scenarios for single practitioners and the professional group. Final remarks will end the contribution.