Professional Health Regulation in the Public Interest by Chamberlain John Martyn Dent Mike

Author:Chamberlain, John Martyn, Dent, Mike [Chamberlain, John Martyn, Dent, Mike]
Language: eng
Format: epub
ISBN: 9781447335337
Barnesnoble:
Publisher: Policy Press
Published: 2018-06-06T00:00:00+00:00

Conclusion

The continuance of state control in the regulation of doctors is highlighted by the State Nomenclature of Doctors and Pharmacists' Specialties, as inclusion on this list gives rights to use public consulting rooms and to provide medical care free of charge on medical referral (Yurchenko, 2004). This represents a form of social closure, as also indicated by state-led restrictions on the disbursement of research funding and the content of the medical curriculum. However, it is not the type of self-regulatory exclusionary closure that has underpinned medical professionalisation in modern Western societies, especially in the Anglo-American context. This is underlined by the fact that doctors only serve as advisers on state accreditation boards that register doctors (Yurchenko and Saks, 2006). Accordingly, there are real limits on the extent to which physicians can be said to have reprofessionalised in the current ever-more directly managed market under Putin, in which state-owned companies constitute the majority of the economy and state and private insurance foundations are growing in control (Sakwa, 2014). To be sure, the life expectancy of the population is again increasing with more consistent medical accreditation and growing funding of the more technologically sophisticated health system through taxation, social contributions and direct payments – despite ongoing issues related to insurance coverage, the quality of pharmaceutical provision, access to medical care and the strategic leadership of health services (OECD, 2012). However, the prospects for medical professionalisation in neo-Weberian terms remain in the balance moving forward.

In terms of current trends in the reprofessionalisation of medicine, recent statements from the Ministry of Economic Development of the Russian Federation suggest that the state would like to transfer some of its regulatory functions to professional associations (Moskovskaya et al, 2013). Nonetheless, it has not provided the means to do this and appears only to see self-regulation in terms of partial autonomy from the state without widespread professional control or discretion. This is likely to limit the potential impact of the National Medical Chamber, a new professionalising organisation formed in 2010 from several medical bodies, including the Russian Association of Private Medical Practitioners (Mansurov and Yurchenko, 2011). This organisation is at present endeavouring to obtain legally enshrined professional market closure, including compulsory membership of a self-regulatory register and greater medical control of qualifications. While it has had a positive relationship with the government since its foundation, the state seems to have encouraged the Doctors' Society of Russia, a less challenging body, to draw away membership from the National Medical Chamber (Moskovskaya et al, 2013). The future, therefore, hinges on the degree to which the state will cede power to medicine, alongside other developing professions, in the evolving market system (Iarskaia-Smirnova and Abramov, 2016). This currently seems improbable given the weakness of professionalising associations in medicine and the Tsarist and Soviet legacy of state centrism that is writ large under Putin (Zimmerman, 2014). Either way, though, it remains important that the new Russia puts in place regulatory mechanisms in medicine that will more effectively protect the health of the public.

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