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Part of the book series: Issues in Higher Education ((IHIGHER))

Abstract

According to Newman (2005), the way the state, public and private stakeholders, the health professions and the market connect with each other determines the structure of governance in health care in each particular country. This concept stresses a more complex and diversified set of regulatory mechanisms and practices than those provided by the broad typologies that divide Western health-care systems into national health services (the Beveridge model), social security systems (the Bismarck model) and private health insurance systems (the market model) (see van der Zee & Kroneman 2007 for a synthesis). Countries sharing the same typology may actually reflect different governance arrangements, depending on the threefold articulation between the state, the professions and the market. In some cases, network-based governance has pride of place (the Netherlands or Norway); in others that key position is taken either by the state (the United Kingdom) or health professionals (in which case medicine may stand alone (Germany) or be obliged to negotiate with other health professions (Denmark)) (Burau & Vrangbæk 2008).

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References

  • Bucher, R. & Stelling, J. G. 1969. ‘Characteristics of professional organizations’, Journal of Health and Social Behavior, Vol. 10, No. 1, pp. 3–15.

    Article  Google Scholar 

  • Burau, V. 2005. ‘Comparing professions through actor-centred governance: Community nursing in Britain and Germany’, Sociology of Health and Illness, Vol. 27, No. 1, pp. 114–137.

    Article  Google Scholar 

  • Burau, V. & Vrangbæk, K. 2008. ‘Global markets and national pathways of medical re-regulation’, in E. Kuhlmann & M. Saks (eds.), Rethinking Professional Governance, Policy Press, Bristol.

    Google Scholar 

  • Carapinheiro, G. 1993. Saberes e poderes no hospital [Knowledge and Powers in Hospitals], Afrontamento, Porto.

    Google Scholar 

  • Carapinheiro, G. (ed.) 2006. Sociologia da saúde: Estudos e perspectivas [Sociology of Health: Studies and Perspectives], Editores Pé de Página, Coimbra.

    Google Scholar 

  • Carapinheiro, G. & Page, P. 2001. ‘As determinantes globais do sistema de saúde português [The global determinants of the Portuguese health-care system]’, in G. Carapinheiro & P. Hespanha (eds.), Risco Social e incerteza: pode o Estado Social recuar mais, Afrontamento, Porto.

    Google Scholar 

  • Carvalho, T. 2012. ‘Adapting to a managerial environment: A case from nurses in Portugal’, Journal of Health Organisation and Management, Vol. 26, No. 4, pp. 524–541.

    Article  Google Scholar 

  • Carvalho, T. 2014. ‘Changing connections between professionalism and managerialism: A case study of nursing in Portugal’, Journal of Professions and Organization, Vol. 1, No. 2, pp. 176–190.

    Article  Google Scholar 

  • Chamberlain, J. M. 2009. ‘The changing medical regulatory context: Focusing on doctor’s educational practices’, Medical Sociology Online, Vol. 4, No. 2, pp. 26–34.

    Google Scholar 

  • Clarke, A., Shim, J., Mamo, L., Fosket, J. & Fishman, J. 2010. ‘Biomedicalization: A theoretical and substantive introduction’, in A. Clarke, L. Mamo, J. Fosket, J. Fishman & J. Shim (eds.), Biomedicalization: Technoscience, Health, and Illness in the US, Duke University Press, Durham.

    Google Scholar 

  • Coe, R. 1984. ‘Development of the modern hospital’, in R. Coe (ed.), Sociology of Medicine, McGraw-Hill, New York.

    Google Scholar 

  • Correia, T. 2011. ‘New public management in the Portuguese health sector: A comprehensive reading’, Sociologia Online, No. 2, pp. 573–598.

    Google Scholar 

  • Correia, T. 2012a. Medicina: o agir numa saúde em mudança [Medicine: Acting in a Changing Health], Mundos Sociais, Lisboa.

    Google Scholar 

  • Correia, T. 2012b. ‘Debating the comprehensive basis of Western healthcare systems in the light of neo-liberalism’, CIES e-Working Paper, No. 124/2012.

    Google Scholar 

  • Correia, T. 2013. ‘The interplay between managerialism and medical professionalism in hospital organizations from the doctors’ perspective: A comparison of two distinctive medical units’, Health Sociology Review, Vol. 22, No. 3, pp. 255–267.

    Article  Google Scholar 

  • Correia, T. 2014. ‘Connecting medical professionalism and large bureaucracies in the changing hospital governance’, European Journal of Public Health, Vol. 24, Suppl. 2, pp. 181–181.

    Article  Google Scholar 

  • Davies, C. 2004. ‘Regulating the health care workforce: Next steps for research’, Journal of Health Services Research & Policy, Vol. 9, No. 1, pp. 55–61.

    Article  Google Scholar 

  • Du Gay, P. 2000. ‘Enterprise and its futures: A response to Fournier and Grey’, Organisation, Vol. 7, No. 1, pp. 165–183.

    Google Scholar 

  • Espanha, R., Mendes, R. V., Fonseca, R. B. & Correia, T. 2013. ‘The place and the role of internet use in health: The Portuguese case’, Health by Numbers Portugal, No. 1, pp. 102–110.

    Google Scholar 

  • Evetts, J. 2005. The Management of Professionalism: A Contemporary Paradox, in Changing Teacher Roles, Identities and Professionalism, Kings College, London.

    Google Scholar 

  • Exworthy, M. & Halford, S. 1999. ‘Assessment and conclusions’, in M. Exworthy & S. Halford (eds.), Professionals and the New Managerialism in the Public Sector, Open University Press, Buckingham.

    Google Scholar 

  • Faulconbridge, J. & Muzio, D. 2008. ‘Organizational professionalism in globalizing law firms’, Work, Employment and Society, Vol. 22, No. 1, pp. 7–25.

    Article  Google Scholar 

  • Ferlie, E., Pettigrew, A., Ashburner, L. & Fitzgerald, L. 1996. The New Public Management in Action, Oxford University Press, Oxford.

    Book  Google Scholar 

  • Foucault, M. 1979. ‘La politique de santé au XVIIIe siècle’, in M. Foucault, B. B. Kriegel, A. Thalamy, F. Beguin & B. Fortier (eds.), Les Machines à Guérir. Aux origines de l’hôpital moderne, Mardaga, Brussels.

    Google Scholar 

  • Freidson, E. 1970. Professional Dominance: The Social Structure of Medical Care, Transaction Publishers, New Jersey.

    Google Scholar 

  • Gabe, J. 2004. ‘Risk’, in J. Gabe, M. Bury & M. A. Elston (eds.), Key Concepts in Medical Sociology, Sage, London.

    Google Scholar 

  • Goodall, H. 2011. ‘Physician-leaders and hospital performance: Is there an association?’, Social Science & Medicine, Vol. 43, No. 4, pp. 535–539.

    Article  Google Scholar 

  • Goss, M. 1963. ‘Patterns of bureaucracy among hospital physicians’, in E. Freidson (ed.), The Hospital in Modern Society, Free Press, New York.

    Google Scholar 

  • Gough, I. 1996. ‘Social assistance in Southern Europe’, South European Society and Politics, Vol. 1, No. 1, pp. 1–23.

    Article  Google Scholar 

  • Gruening, G. 2001. ‘Origin and theoretical basis of New Public Management’, International Public Management Journal, Vol. 4, No. 1, pp. 1–25.

    Article  Google Scholar 

  • Harrison, S. 2003. ‘Governing medicine: Governance, science and practice’, in A. Gray & S. Harrison (eds.), Governing Medicine: Theory and Practice, Open University Press, Berkshire.

    Google Scholar 

  • Herzlich, C. & Pierret, J. 1987. Illness and Self in Society, Johns Hopkins University Press, Baltimore.

    Google Scholar 

  • Jespersen, P. & Wrede, S. 2009. ‘The changing autonomy of the Nordic medical professions’, in J. Magnussen, C. Vrangbæk & R. B. Saltman (eds.), Nordic Health Care Systems, Open University Press/McGraw-Hill Education, London.

    Google Scholar 

  • Kuhlmann, E. & Saks, M. 2008. ‘Changing patterns of health professional governance’, in E. Kuhlmann & M. Saks (eds.), Rethinking Professional Governance, Policy Press, Bristol.

    Google Scholar 

  • Kuhlmann, E., Burau, V., Correia, T., Lewandowski, R., Lionis, C., Noordegraaf, M. & Repullo, J. 2013. ‘“A manager in the minds of doctors”: A comparison of new modes of control in European hospitals’, BMC Health Services Research, No. 13, 246.

    Google Scholar 

  • Lopes, N. 2006. ‘Tecnologias da saúde e novas dinâmicas de profissionalização [Health technologies and new patterns of professionalization]’, in G. Carapinheiro (ed.), Sociologia da Saúde: Estudos e Perspectivas, Pé de Página, Coimbra.

    Google Scholar 

  • Mirowski, P. & Plehwe, D. (eds.) 2009. The Road from Mont Pélerin: The Making of the Neoliberal Thought Collective, Harvard University Press, Cambridge, MA.

    Google Scholar 

  • Nettleton, S. 1995. The Sociology of Health and Illness, Polity Press, Oxford.

    Google Scholar 

  • Newman, J. 2005. Modernising Governance: New Labour, Policy and Society, Sage, London.

    Google Scholar 

  • Noordegraaf, M. 2007. ‘From “pure” to “hybrid” professionalism: Present-day professionalism in ambiguous public domains’, Administration Society, Vol. 39, No. 6, pp. 761–785.

    Article  Google Scholar 

  • Nowotny, H., Scott, P. & Gibbons, M. 2001. Re-Thinking Science: Knowledge and the Public in the Age of Uncertainty, Polity Press, Cambridge.

    Google Scholar 

  • Reich, A. 2012. ‘Disciplined doctors: The electronic medical record and physicians’ changing relationship to medical knowledge’, Social Science & Medicine, Vol. 74, No. 7, pp. 1021–1028.

    Article  Google Scholar 

  • Rhodes, R. 1994. ‘The hollowing out of the state: The changing nature of public services in Britain’, Political Quarterly, Vol. 65, No. 2, pp. 138–151.

    Article  Google Scholar 

  • Saltman, R. B., Dubois, H. F. & Durán, A. 2011. ‘Mapping new governance models for public hospitals’, in R. B. Saltman, A. Durán & H. F. Dubois (eds.), Governing Public Hospitals: Reform Strategies and the Movement towards Institutional Autonomy, WHO on behalf of the European Observatory on Health Systems and Policies, Copenhagen.

    Google Scholar 

  • Serra, H. 2008. Médicos e poder: Transplantação hepática e tecnocracias [Doctors and Power: Liver Transplantation and Technocracies], Fundação Económicas/Almedina, Lisbon.

    Google Scholar 

  • Serra, S. 2010. ‘Medical technocracies in liver transplantation: Drawing boundaries in medical practices’, Health, Vol. 14, No. 2, pp. 162–177.

    Google Scholar 

  • Serra, H. 2011. ‘Das tecnologias às tecnocracias: Novos protagonismos emergentes em saúde [From technology to technocracy: New and emerging protagonisms in health]’, in A. Barbosa & J. Silva (eds.), Economia, gestão e saúde, Edições Colibri, Lisbon.

    Google Scholar 

  • Slater, B. 2001. ‘Who rules? The new politics of medical regulation’, Social Science and Medicine, Vol. 52, No. 3, pp. 871–883.

    Article  Google Scholar 

  • Turner, B. S. 2006. ‘Hospital’, Theory, Culture and Society, Vol. 23, No. 2–3, pp. 573–579.

    Article  Google Scholar 

  • Van der Zee, J. & Kroneman, M. 2007. ‘Bismarck or Beveridge: A beauty contest between dinosaurs’, BMC Health Services Research, available online at http://www.biomedcentral.com/1472–6963/7/94 (accessed 17 March 2015).

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© 2015 Tiago Correia, Graça Carapinheiro and Helena Serra

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Correia, T., Carapinheiro, G., Serra, H. (2015). The State and Medicine in the Governance of Health Care in Portugal. In: Carvalho, T., Santiago, R. (eds) Professionalism, Managerialism and Reform in Higher Education and the Health Services. Issues in Higher Education. Palgrave Macmillan, London. https://doi.org/10.1057/9781137487001_9

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