Elsevier

Social Science & Medicine

Volume 55, Issue 5, September 2002, Pages 733-741
Social Science & Medicine

Medical dominance in Italy: a partial decline

https://doi.org/10.1016/S0277-9536(01)00199-XGet rights and content

Abstract

In the last three decades, a number of changes in health systems has been challenging medical dominance in many countries. It has been widely debated whether the medical profession has been able to cope with these changes and maintain its power or, rather, has been deprofessionalised or proletarianised. In this paper, the effects of these changes in Italy are examined, by using a multi-dimensional concept of medical dominance. As a result of this analysis, medical dominance in Italy is depicted as declining on some dimensions while changing its nature on others. The final part of the paper discusses some current explanations of this trend and suggests that the transition to post-modern society and the “late modernity” argument (Giddens 1990; The consequences of modernity, Polity Press, Cambridge, 1990; Beck, 1992; Risk society: towards a new modernity, Sage, London, 1992) may provide an entry into more adequate explanations.

Section snippets

Changes in health systems

Since the 1960s, in Western industrialised countries, a number of important changes in health systems has been challenging medical dominance, which had been established long before and had lasted for many decades. Two attitudes to the nature of these changes emerged: some believe that medical dominance has undergone a process of decline, often labelled as deprofessionalisation or as proletarianisation, others believe that the medical profession has been able to cope with change and eventually

The effects of change on medical dominance

An evaluation of the effects produced by the changes described above on medical dominance should take into account the several aspects or dimensions that make medical dominance a complex concept. One problem in the medical dominance debate is that many of the contenders disagree on which dimensions should be included in the concept and on how to define them. In this analysis, I will draw on some previous works (Starr (1996), Tousijn (1999)) and use a five dimensions concept. The five dimensions

A partial decline

In the early 1990s, Eliot Freidson intervened once more in the endless debate over medical dominance, which he himself had originated some 20 years before. He noted that it was an issue bound to remain without a final answer because of two reasons: partly because it was a “half empty/half full cup” issue, and partly because of “the absence of common criteria by which to select systematically and analyse the data” (Freidson, 1993, p. 55). This paper has tried to solve the second problem, by

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