ALFORD REVISITED - THE PROFESSIONAL MONOPOLISERS, CORPORATE RATIONALISERS, COMMUNITY AND MARKETS

Twenty years have passed since Alford's publication, The politics of h ealth care, described the relative power of three groups, the professi onal monopolists, corporate rationalisers and community, in his case s tudy of health care in New York. Alford suggested that the hegemony of the professional monopolists was the product of a correspondence betw een their interests and those of society. Neither the corporate challe ngers nor the community were able to change a system heavily influence d by the biomedical model which in turn legitimised the position of th e medical profession - the supreme professional monopolists. In the tw o decades since, concerns about rising costs, inefficiencies in both m arket and planned health care systems and, in the United States, gross inequities of access, have produced changes in both UK and US health care. This article reapplies Alford's model, examining the nature of r ecent reforms and their effects on the professional monopolists, corpo rate rationalisers and community.