Coburn D
Department of Behavioural Science, University of Toronto, Canada.
Soc Sci Med. 1993 Oct;37(7):841-50. doi: 10.1016/0277-9536(93)90137-s.
The relationships amongst the health professions and between them and the state are rapidly changing. I argue that analysis of these relationships has to take into consideration: the fact that medicine played an intermediary role (through medical dominance in health care) between the state and the other health occupations; the permeability of the boundaries of the state and the professions; and the dual nature of professional organizations (as sites of intra-occupational conflict and as possible vehicles of extra-occupational control). In Ontario the medical profession partially 'mediated' the relationships between 'non-physician' health occupations and the state through medical control over other health care occupations. National/provincial health insurance brought the state into the health care system as an actor and forced a reconsideration of its relationships with medicine and with the other health care occupations. The state came to be directly involved in 'rationalizing' health care. This involvement meant curbing the power of medicine and modifying the relationships between medicine and the para-medical occupations. State influence is partly constructed through a particular kind of professional organization, namely, the professional College. These changing relationships are illustrated by historical and recent developments regarding medicine, nursing and chiropractic in Ontario.
卫生专业之间以及它们与国家之间的关系正在迅速变化。我认为，对这些关系的分析必须考虑到以下几点：医学在国家与其他卫生职业之间扮演了中介角色（通过医疗在医疗保健中的主导地位）；国家与专业之间界限的渗透性；以及专业组织的双重性质（作为职业内部冲突的场所和可能的职业外部控制工具）。在安大略省，医学专业通过对其他医疗保健职业的医疗控制，部分地“调解”了“非医师”卫生职业与国家之间的关系。国家/省级医疗保险使国家作为一个行为主体进入了医疗保健系统，并迫使人们重新审视其与医学以及其他医疗保健职业的关系。国家开始直接参与医疗保健的“合理化”。这种参与意味着抑制医学的权力，并改变医学与辅助医疗职业之间的关系。国家的影响部分是通过一种特殊的专业组织，即专业学院构建的。安大略省关于医学、护理和脊椎按摩疗法的历史和近期发展说明了这些不断变化的关系。
