Jr. Barnett et al., DECLINING PROFESSIONAL DOMINANCE - TRENDS IN THE PROLETARIANIZATION OF PRIMARY-CARE IN NEW-ZEALAND, Social science & medicine, 46(2), 1998, pp. 193-207
Citations number
130
Categorie Soggetti
Social Sciences, Biomedical","Public, Environmental & Occupation Heath
This paper explores the relevance of the proletarianisation thesis to
the emergence of new forms of managed primary care in New Zealand. Thi
s concern is of particular interest because the primary care sector ha
s persisted virtually unchanged, since the birth of the welfare state
in 1938, despite numerous past slate attempts at reform. Since 1993 co
llective action on the part of general practitioners has resulted in t
he formation of Independent Practice Associations (IPAs). In terms of
Light's (1993) idea of countervailing trends to proletarianisation, IP
A development represents a pre-emptive strategy designed to prevent th
e introduction of the kind of managerialism imposed on the secondary s
ector where some loss of autonomy has been sustained by health care pr
ofessionals. At the macro-level, therefore, there has been little chan
ge in GP autonomy although at the micro-scale there has been some loss
of freedom as the development of IPAs ironically has meant that the d
egree of control by GPs over the content of their work has changed. Th
e results suggest that the notion of the profession acting as a counte
rvailing force has been borne out. Furthermore, the proposition inhere
nt in modern organisation-environment relations literature, that organ
isations not only adapt to their environment but may actively seek to
change it receives some support. (C) 1998 Elsevier Science Ltd. All ri
ghts reserved.