The state, the market, and general practice: The Australian case

This article examines the development of general practice in the latter hal f of the 20th century, documenting the issues of concern to both the profes sion and the state. General practice developed hand in hand with the welfar e state in Australia. As the structural changes associated with restructuri ng of the welfare state have advanced, so have the fortunes of general prac tice declined, despite significant attempts in the 1970s and 1980s to "save " general practice by both the profession and the state. These structural c hanges have operated on two fronts, the economic and the cultural. On the e conomic, changes to the employment of general practitioners clearly indicat e ongoing proletarianization, particularly in a changing environment of lab or-capital relations. At the cultural level, development of the self-help a nd the women's movements and the elective affinity of these groups with the individualism of the new right are leading to deprofessionalization. The a uthor advances this argument in a review of general practice over the fast 40 years and in a case study of community health services. Theoretically he argues for a combination of the proletarianization and the deprofessionali zation theses.