The impact of health care reforms on the organisational behaviour of hospital doctors is a theme which is attracting considerable attention. Within many of the comparative health care analyses, the changing role of doctors tends to be discussed as an area of key importance (for example, Ham, 1997; Raffel, 1997) and research is being carried out that has as its central focus the medical profession’s adaptation to policy changes in different health care systems (van Herk, 1997). Two main influences can be discerned which shape the current debates. First, the literature on the medical profession (Freidson, 1970; 1984; Döhler, 1989; Rafferty and Light, 1995; Larkin, 1995). One of the issues highlighted concerns the form and nature of self-regulation and the importance of clinical autonomy as a mechanism to safeguard professional control. Second, the shift in many countries towards a more managerially oriented health care system has drawn attention to the question of what this signifies for the medical profession: on the one hand, the economic power of managers over doctors is being considered the overriding theme (for example, Flynn, 1992) and, on the other hand, the argument is advanced that, at the micro level, doctors are difficult to control and thus continue to determine the shape of health provisions (Hunter, 1994).
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