THE NEW POLITICS OF MEDICINE
| Date | 01 June 2006 |
| DOI | http://doi.org/10.1111/j.1467-9299.2006.00014.x |
| Published date | 01 June 2006 |
| Author | Rob Flynn |
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© Blackwell Publishing Ltd. 2006 Public Administration Vol. 84, No. 2, 2006 (479–515)
THE NEW POLITICS OF MEDICINE
Brian Salter
Palgrave Macmillan, 2004, 236 pp., £17.99 (pb) ISBN: 0333801121
Health policy and the regulation of the medical profession have been con-
tinuing themes for analysts in different social science disciplines as well as
practical preoccupations for public administration in most welfare states.
Salter has provided an incisive and insightful account of changes in the bal-
ance of power between medicine, civil society and the state. He does this
through a detailed commentary on the recent history of doctors in the
British National Health Service. Salter emphasizes at the outset that medical
power is multi-faceted, operates at different levels, and thus requires a syn-
thesis of different theoretical approaches. While there is some cross-national
comparison with experience in other (mainly European) health care sys-
tems, the bulk of the book concerns the NHS and – to a lesser extent – the
private (for-profi t) health care market, and recent political history since the
1980s. His evidence is drawn almost entirely from documentary and other
secondary sources. The principal claim is that despite many complex struc-
tural and ideological changes, medical power has endured and successfully
re-positioned itself.
The book ’ s fi rst chapter provides a schematic model of relations between
citizenship, the welfare state and medicine, arguing that a triangle of politi-
cal forces results in continuous tensions, especially over the regulation of
professional expertise. It shows how the critical issue of managing ever-
increasing citizen demands, and the state ’ s dependence on the role of doc-
tors in rationing supply, have intensifi ed pressures for closer control of
medical professionals. Chapter 2 reviews the essential features and dynam-
ics of the doctor-patient relationship; it blends several different theoretical
models of the emergence of, and recent challenges to, medical dominance.
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