THE INSTITUTIONALIZED FOUNDATIONS OF PROFESSIONALISM: INDUSTRY AND THE HEALTH CARE SYSTEM.
Item
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Title
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THE INSTITUTIONALIZED FOUNDATIONS OF PROFESSIONALISM: INDUSTRY AND THE HEALTH CARE SYSTEM.
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Identifier
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AAI8119664
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identifier
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8119664
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Creator
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LEYERLE, BETTY JO.
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Contributor
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Joseph Bensman
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Date
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1981
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Language
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English
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Publisher
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City University of New York.
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Subject
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Sociology, Social Structure and Development
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Abstract
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This study analyzes the effects on professional authority and autonomy of developments in the American health care system during the last ten to fifteen years. It starts with the theoretical assumption that professionalism, like other social forms, such as bureaucratic organization, exists not only because of its own inherent features but because it is supported by other established social institutions. The dominance claims of the medical profession, for example, are supported by the legal system, which licenses professional practice, and by the education system, which legitimates the license, as well as by institutionalized interactions at the micro-level, such as the perception that the doctor-patient relationship is special, confidential, and provides the patient with a service he actually needs. At a more extended and complex level, the medical profession is also supported by the American system of third party reimbursement, both public and private, by government regulations of various sorts, and by the American hospital system.;Professionalism, like bureaucratic organization, continuously supports and recreates itself through the manipulation of certain "structural mechanisms" associated with these institutional arrangements. The term "structural mechanisms" refers to strategic techniques for accomplishing goals which are effective because they are integrated interactions with powerful, existing elements of the larger social environment.;This study describes briefly the ways in which these structural mechanisms have historically supported professional dominance within the health care system. These developments were most salient from about the turn of the century, with the acceptance of germ theory and the development of laboratory medicine, until the mid 1960's, when passage of Medicaid and Medicare marked the zenith of the socialization of medicine in this country. At that time public and political acceptance of the ideal that health care services are a right of all citizens and should be offered in some form to everyone, as is education, was at its height.;During this period the health care sector experienced enormous growth. It became the third largest industry in the United States, following only construction and food production. Until the early 1970's, physicians maintained almost total control over this vast new empire.;This study focuses on developments after the mid 1960's, specifically on efforts by major U.S. corporations to reverse some of the developments of the last 55 years in an attempt to contain health care costs in this country. Those efforts have been directed toward three major areas. First, corporations have attempted to restructure and control third party reimbursement arrangements both public and private. Second, they have increasingly participated and intervened in the government regulatory process. And third, they have attempted to create health care delivery systems which are alternative to traditional, physician controlled systems. These alternative systems include various kinds of out-patient treatment programs, industrial health programs and health maintenance organizations.;An inherent feature of this process is that the structural bases of professional organization and authority have been undermined, perhaps fatally, while the bureaucratically controlled organization of health care delivery systems has been supported and enhanced. The result has been a movement toward the dominance of bureaucratic authority within the health care sector and of the bureaucratization of professional work itself. That is, diagnostic and treatment procedures are increasingly based on bureaucratic exigencies rather than professional knowledge, service, or even self-interest. Bureaucratic accountability, rather than professional service and knowledge thus becomes the legitimating basis for authority in the health care system.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
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Program
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Sociology
