Medical dominance and strategic action: the fields of nursing and psychotherapy in the German health care system.
The paper seeks to identify and explain shifts in dominance relationships between the medical profession and allied health professions in Germany, taking the occupational fields of nursing and psychotherapy as examples. It suggests an actor-based perspective which focuses on the strategic interplay between collective actors in the fields in question, namely professional associations and unions, state actors, sickness funds, universities, polytechnics and associations of work organisations. It considers the context of governance of the German health care system and an awareness of a changed demand. The thesis is that the interplay between the actors has led to a small reduction of medical dominance. It is examined whether changes in governance structures of the health care system have led to a more favourable context for shifts in the dominance relationships. Moreover, the possible effects of the recent re-organisation of health provision are considered. Based on an empirical investigation using the method of document analysis, the paper shows that there has been a small reduction of medical dominance which is essentially the outcome of the interrelated strategic actions of various collective actors in the fields. A public perception of a new kind of health care demand has facilitated this development.
Department of Sociology, University of Göttingen, Göttingen, Germany. gluzio@uni-goettingen.de
Gaia
G
di Luzio
D003695:Delivery of Health Care / Q000639:trends*; D005858:Germany; D006801:Humans; D007400:Interprofessional Relations; D010819:Physician's Role; D011568:Psychiatric Nursing; D011613:Psychotherapy