TY - JOUR
T1 - A shift in the historical trajectory of medical dominance
T2 - The case of Medibank and the Australian doctors' lobby
AU - De Voe, Jennifer E.
AU - Short, Stephanie D.
N1 - Funding Information:
This work was supported, in part, by a grant from the Rhodes Trustees and Nuffield College, Oxford. Professor Jane Lewis, Oxford University, offered invaluable support and guidance. We would also like to acknowledge our anonymous reviewers and extend a special thanks to the interviewees who graciously gave of their time.
PY - 2003/7
Y1 - 2003/7
N2 - During the twentieth century, episodes of major health policy reform were relatively rare. These rare episodes were pivotal 'critical junctures' in determining the paths taken by modern health systems and in creating a unique health policy arena. A pivotal 'turning point' in Australia came in the form of national health insurance. Introduced in the early 1970s, Medibank (universal, compulsory national health insurance) was the first significant structural health policy change in Australia during the twentieth century. When Medibank health insurance proposals were presented in Australia, political struggles erupted. Government leaders in Australia faced fierce opposition from key players within the health policy arena. Prior to this turning point, one of the key health policy players - the Australian Medical Association (AMA) - had developed a corporate partnership with the non-Labor government. When the Medibank proposal emerged, power structures in the health policy arena were re-aligned. The political role of the AMA shifted from a corporate partner to a pressure group. Examining the political processes surrounding this unique episode of major health policy change helps to illuminate the dual and dynamic nature of the doctors' lobby. Our study aims to demonstrate empirically Day and Klein's proposition that the doctors' lobby operates as a pressure group, rather than as a corporate-style partner, during periods of structural reform in health care [Political Studies, 40 (1992) 462]. This case study of the doctors' lobby during Medibank negotiations represents a rare break in the tradition of ultimate medical professional veto power in health policy decision-making and provides empirical evidence that challenges a widely held perception about an inevitable historical path of medical dominance.
AB - During the twentieth century, episodes of major health policy reform were relatively rare. These rare episodes were pivotal 'critical junctures' in determining the paths taken by modern health systems and in creating a unique health policy arena. A pivotal 'turning point' in Australia came in the form of national health insurance. Introduced in the early 1970s, Medibank (universal, compulsory national health insurance) was the first significant structural health policy change in Australia during the twentieth century. When Medibank health insurance proposals were presented in Australia, political struggles erupted. Government leaders in Australia faced fierce opposition from key players within the health policy arena. Prior to this turning point, one of the key health policy players - the Australian Medical Association (AMA) - had developed a corporate partnership with the non-Labor government. When the Medibank proposal emerged, power structures in the health policy arena were re-aligned. The political role of the AMA shifted from a corporate partner to a pressure group. Examining the political processes surrounding this unique episode of major health policy change helps to illuminate the dual and dynamic nature of the doctors' lobby. Our study aims to demonstrate empirically Day and Klein's proposition that the doctors' lobby operates as a pressure group, rather than as a corporate-style partner, during periods of structural reform in health care [Political Studies, 40 (1992) 462]. This case study of the doctors' lobby during Medibank negotiations represents a rare break in the tradition of ultimate medical professional veto power in health policy decision-making and provides empirical evidence that challenges a widely held perception about an inevitable historical path of medical dominance.
KW - Critical junctures
KW - Health insurance
KW - Path dependence
KW - Pressure group politics
KW - Professional dominance
KW - Punctuated equilibrium
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U2 - 10.1016/S0277-9536(02)00362-3
DO - 10.1016/S0277-9536(02)00362-3
M3 - Article
C2 - 12765713
AN - SCOPUS:0038293290
SN - 0277-9536
VL - 57
SP - 343
EP - 353
JO - Social Science and Medicine
JF - Social Science and Medicine
IS - 2
ER -