Co-optation, commodification and the medical model : governing UK medicine since 1991
By: HARRISON, Stephen
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ArticlePublisher: Malden : Wiley-Blackwell, June 2009Public Administration: An International Quarterly 87, 2, p. 184-197Abstract: Self-regulation and autonomy are traditionally treated as distinctive elements of how professions are governed in contrast to other occupations. For medicine, these elements provide a collective medium of governance (through the institutions of professional self-regulation) and an individual medium (through the practice of 'clinical autonomy'). Both are reinforced by the intellectual dominance of the so-called 'biomedical model' of health and illness. Analysts generally agree that, in many countries, both self-regulation and clinical autonomy are under significant challenge. But it is less obvious that, in the UK at least, the biomedical model has effectively been co-opted for managerial purposes to support the commodification of medical care. Thus ideas that have traditionally been considered as supporting medical dominance have transpired to be a source of weakness for the profession.
Self-regulation and autonomy are traditionally treated as distinctive elements of how professions are governed in contrast to other occupations. For medicine, these elements provide a collective medium of governance (through the institutions of professional self-regulation) and an individual medium (through the practice of 'clinical autonomy'). Both are reinforced by the intellectual dominance of the so-called 'biomedical model' of health and illness. Analysts generally agree that, in many countries, both self-regulation and clinical autonomy are under significant challenge. But it is less obvious that, in the UK at least, the biomedical model has effectively been co-opted for managerial purposes to support the commodification of medical care. Thus ideas that have traditionally been considered as supporting medical dominance have transpired to be a source of weakness for the profession.
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