Distribute Public Benefits within and Outside Public Hospitals: Healthcare Professionals' Practices and Social Justice

Professionals in the public medical sector are key actors in the distribution of public resources. Beyond caring and curing services provided within the hospital and the medication, they can deliver certificates, sick-leave certification, prescriptions of spa treatments, and reimbursements of transportation fees… The increased need for profitability of social and health services combined with the “migrant crisis” leave them in the position of gatekeepers of the public spending. It has also transformed their conditions of work.

My proposal is based on an ethnographic fieldwork (mixing observations and interviews) led during six months in two university hospital centers in Paris and its near suburb (France). I will discuss the ways healthcare professionals, especially but not only doctors, construct the frontier between the legitimate and illegitimate recipients of social security benefits in their daily practice. Thus, they build and apply local representations of social justice.

Medical observance is then constructed as a citizenship issue, especially for patients from minorities and/or lower classes, suspected of looking for “secondary benefits”. The range of services or care proposed and furnished by the professionals is directly impacted by the evaluation of patients’ compliance. The necessary tasks (to fill out forms, certificates, etc.) are also seen by the physicians as a specific type of dirty work, boring, repetitive and time-consuming. Finally, healthcare workers build their solidarity across gap between occupations in what we can see as a professional ethos of the public service, based on principles of hard-working, devotion, but also awareness of cost and realities of the health system but also of the entire welfare system.