The medical profession between new limits and values: Lessons from the Portuguese case

Abstract

The challenges of the growing exposure to the market and the neo-liberal policies generally adopted in the European countries to the governance of public services and the professions has been widely debated. One of the conclusions often referred to is the variety of outcomes across countries, particularly in the health sector, which therefore calls for comprehensive analyses focusing on such processes in different contexts. This presentation seeks to address the situation of Portugal specifically referring the healthcare system. One the one hand, the place of health professions and their relationship with the State is still poorly understood in comparison with countries sharing the Beveridge model (e.g. UK, Sweden, Norway, Finland). On the other hand, Portugal was one of the European countries subjected to the conditions imposed by financial assistance programs with the institutions also known as the Troika, which resulted in tighter mechanisms to control both clinical and managerial procedures while public investment retracted considerably. These are usually considered as factors responsible for changing professional values and autonomy in healthcare organizations. Based on a national scale survey to doctors (n=3442) collected in 2014, the aim of the analysis is to describe how doctors think their work has been affected by the policies applied during the bailout and to discuss possible implications to their autonomy. The doctors’ response is consistent regarding greater administrative controls to their practice of medicine. However, we argue that this is not enough evidence to conclude as to new limits to medical autonomy and that medical professionalism actually can be reinforced in this context. In sum, theoretical conclusions are drawn in order to help framing this evidence as indicative of the interdependence between the State and medicine rather than simply assuming new limits to medical autonomy and deep changes in professionalism.