Doctors And The State

All advanced health care systems face severe difficulties in financing the delivery of today's sophisticated medical care. In this study David Wilsford compares the health systems in France and the United States to demonstrate that some political systems are considerably more effective at controlling the cost of care than others. He argues that two variables--the autonomy of the state and the strength and cohesiveness of organized medicine--explain this variance. In France, Wilsford shows, the state is strong in the health policy domain, while organized medicine is weak and divided. Consequently, physicians exercise little influence over health care policymaking. By contrast, in the United States the state is weak, the employers and insurers who pay for health care are fragmented, and organized medicine is strong and well financed. As a result, medical professionals are able to exert a greater influence on policymaking, thus making cost control more difficult. Wilsford extends his comparison to health care systems in the United Kingdom, West Germany, Italy, Canada, and Japan. Whether the private or public sector finances health care, he discovers, there is now an important trend in all of the advanced industrial countries toward controlling escalating costs by curbing both the medical profession's clinical autonomy and physicians' incomes.

Published in 1999, the main aim of this text is to examine the nature of professional control, medical practice and the state of health services in a post-colonial state and the medical profession in Zimbabwe since 1980. The text reviews the theories of professions and professional control and medical practice, it concludes by examining the nature of the Zimbabwean state. The chapter on methodology highlights some of the ethical dilemmas of carrying out research in developing countries. The book then goes on to review health services and policies of both the colonial and post-colonial governments in Zimbabwe. Three chapters discuss the nature of medical practice and the constraints encountered by doctors in their work, the terms and conditions of service under which doctors work, and the nature of medical regulation of education, licensing and discipline including issues such as malpractice and litigation. Throughout the book, comparisons are made with situations in other countries, both developed and developing, and the main conclusions of the book are that medical doctors in Zimbabwe have minimal administrative restrictions on the type of treatment which they can carry out but the unavailability and breakdown of essential equipment, shortages of essential drugs and staff limit the doctors' autonomy to carry out the treatment that they consider necessary.

Published in 1999, the main aim of this text is to examine the nature of professional control, medical practice and the state of health services in a post-colonial state and the medical profession in Zimbabwe since 1980. The text reviews the theories of professions and professional control and medical practice, it concludes by examining the nature of the Zimbabwean state. The chapter on methodology highlights some of the ethical dilemmas of carrying out research in developing countries. The book then goes on to review health services and policies of both the colonial and post-colonial governments in Zimbabwe. Three chapters discuss the nature of medical practice and the constraints encountered by doctors in their work, the terms and conditions of service under which doctors work, and the nature of medical regulation of education, licensing and discipline including issues such as malpractice and litigation. Throughout the book, comparisons are made with situations in other countries, both developed and developing, and the main conclusions of the book are that medical doctors in Zimbabwe have minimal administrative restrictions on the type of treatment which they can carry out but the unavailability and breakdown of essential equipment, shortages of essential drugs and staff limit the doctors' autonomy to carry out the treatment that they consider necessary.

Looking at health service institutions in the Soviet Union, this book looks particularly at the role of doctors and their recruitment, pay and administrative duties. The book also studies entrepreneurial medicine, material resources and the decline of the general practitioner.

Collaborations of physicians and researchers with industry can provide valuable benefits to society, particularly in the translation of basic scientific discoveries to new therapies and products. Recent reports and news stories have, however, documented disturbing examples of relationships and practices that put at risk the integrity of medical research, the objectivity of professional education, the quality of patient care, the soundness of clinical practice guidelines, and the public's trust in medicine. Conflict of Interest in Medical Research, Education, and Practice provides a comprehensive look at conflict of interest in medicine. It offers principles to inform the design of policies to identify, limit, and manage conflicts of interest without damaging constructive collaboration with industry. It calls for both short-term actions and long-term commitments by institutions and individuals, including leaders of academic medical centers, professional societies, patient advocacy groups, government agencies, and drug, device, and pharmaceutical companies. Failure of the medical community to take convincing action on conflicts of interest invites additional legislative or regulatory measures that may be overly broad or unduly burdensome. Conflict of Interest in Medical Research, Education, and Practice makes several recommendations for strengthening conflict of interest policies and curbing relationships that create risks with little benefit. The book will serve as an invaluable resource for individuals and organizations committed to high ethical standards in all realms of medicine.

First published in 1998. Routledge is an imprint of Taylor & Francis, an informa company.