[...]... the State: The Politics of Health Care in France and the United States, Durham, NC: Duke University Press Part II Health professions and the state in Britain 3 State control and the health professions in the United Kingdom Historical perspectives Gerry Larkin Approaches to the analysis of professions in the general sociological literature and within medical sociology in the case of health professions. .. controversy in the sociology of the professions regarding the source and degree of professional autonomy in the face of state intervention The autonomy/intervention controversy in the sociology of the professions arises, it will be argued, only insofar as the relationship between state and professions is misconceived as one existing between two subjects FREIDSON AND FOUCAULT: TWO VIEWS OF THE STATE The dominant... original treatise on the dynamics of countervailing power in oligopolistic markets, ‘creates both the need for, and the prospect of reward to the exercise of countervailing power from the other side’ In those states where the government has played a central role in nurturing professions within the state structure but has allowed the professions to establish their own institutions and power base, the professions. .. as the state apparatus and in the agents of institutionalized expertise, the professions In short, the state, as the particular form that government has taken in the modern world, includes expertise, or the professions The duality, profession /state, is eliminated To return to Freidson, the continued commitment to such dualism in his work inhibits our capacity to think an empirical reality in which these...Part I Professions and the state: theoretical issues 1 Governmentality and the institutionalization of expertise Terry Johnson What is happening to the professions? In both Europe and the United States there exists the growing certainty that those occupations that established such high-status, independent and privileged locations in the division of labour from the midnineteenth century onwards... the profession as a whole is still dominant even though the rank and file increasingly must follow clinical protocols and guidelines, because doctors play central roles in developing those protocols and in running the delivery systems This internal differentiation is certainly growing, but it does not contribute to maintaining dominance, because those doctors work for and develop the goals of the state. .. this stage of the argument we continue to insist on the dualism, state/ profession, the word juggling becomes extreme For we are forced to conclude not only that the independence of the professions depends on the interventions of the state, but that the state is dependent on the independence of the professions in securing the capacity to govern as well as legitimating its governance The obvious implication... one end and state employed professionals at the other as in Figure 2.1 This follows the lead of Larkin (1988:128), that state involvement need not preclude professional dominance and that relations between state and profession involved ‘countervailing pressures’ The following paragraphs develop the indicated end points of the horizontal and vertical axes Professional dominance, in Freidson’s original... the centre These brief examples illustrate the usefulness of the model, even though the exact placement can be debated EXPANDING THE MODEL TO MULTIPLE PARTIES What makes the current era interesting is that the era of professional dominance in Western European countries and the United States, and of state dominance in Eastern European countries and the ex-Soviet Union, has come to an end In most Western... point as the forces and location of market expansion changed As both bureaucratic and technological change intensified, occupational survival required a place within the expansion of state influence in health care THE MEDICO-BUREAUCRATIC COMPLEX The transformation of the nineteenth-century profession and the extension of the state shelter are linked in the later conversion and reconstruction of the health . between health professions and the state in Britain and a number of other European countries—Spain, Belgium, the Netherlands, Scandinavia and the Czech. of the volume by examining the relationship between health professions and the state in a number of other countries in Europe including Spain, Belgium, the