title: Between professional autonomy and economic orientation - The medical profession in a changing health care system.
abstract: The current discussions surrounding the German health care system are being determined and defined by the concepts of "profitability", "efficiency" and "saving". These concepts also determine the demands made on this system and have had an effect on the medical profession. The economy's growing influence on physicians' decision-making and the increasing necessity to look at and regulate services under economic aspects arising from the need to save costs are seen by the medical profession as a threat to its autonomous conduct and freedom to make decisions, in other words it sees it as a danger to its medical orientation. Conflicts between medical autonomy and economic orientation in physicians' conduct are therefore already foreseeable, as are conflicts between medicine and economy in regards to who has the power to define the terms of the public health system.
  
  
  OBJECTIVE
  This article will outline the area of conflict based on the available literature. It will discuss how the political and economic regulatory attempts affect the medical profession's autonomous conduct. It will also discuss which conflicts of conduct emerge for physicians, what types of solutions the medical profession tends to develop as a reaction, and whether or not this tension between medical and economic orientation can be resolved in an acceptable way.
  
  
  METHODS
  This article should first outline the changed economic and political basic conditions and the attempts to reform the German health care system, using this as a starting point. Following this, it will explore the significance professional autonomy acquires within the concept of profession from the point of view of the sociology of professions. With this in mind, the third part of this article will describe and analyze the effects of advanced economization on the medical profession's autonomous conduct, which has long been regarded as uncontested. This part of the article will also describe and analyze the medical profession's strategies it uses to defend its autonomy. Finally, this article will discuss whether or not a stronger integration of medical and economic responsibility is possible. Conclusion and summary: The conclusion that will be drawn from this discussion is that the medical profession can only avoid the pending loss of its autonomy (deprofessionalization) if it is able to combine cost efficiency and quality (and integrate economic aspects into its actions). If it is unable to do so, it will lose more and more control over the public health system to the state, economy, and management.
authors.affiliation: Albert-Ludwigs-University Freiburg, Department for Medical Sociology, Freiburg, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Kälble