Health system changes have resulted in regulatory changes of the medical profession. During the 1980's the profession started adapting to a new environment imposed by the health system. After decades of state regulation in training, market entry, and the labour market, the profession negotiated basic conditions for self-regulation. However, the historical gap existing among specialists and generalists did not permit generalists a self-regulated status despite representing nearly 65% of the workforce. Specialists created specialty certification councils that assured quality performance among specialties under state surveillance. In the 1990's specialists moved towards self-regulation while generalists remained subject to state regulation. Specialty councils also assumed a role in market re-entry. The Ministry of Health remained responsible for generalist certification with no apparent impact on performance nor their ability to increase market share. The state has also supported development of external regulatory agencies (National Commission of Medical Arbitration, Human Rights National Commission) which, while under state control, allow participation of others, including the public, who are concerned with the regulation process. Non-state regulatory mechanisms have also been developed through market forces, eg, private insurance companies and managed care institutions. In summary, regulatory mechanisms have been changing, particularly regarding market entry and the labour market. While the State keeps broad control of the mechanisms, new actors have increased their participation. Despite the profession's desire for self-regulation, the likely future scenario is of a profession subjected to many diverse interest groups, and of the state playing an increased role in mediating these forces.
Learning Objectives: The presentation does not have learning objectives
Keywords: Professionalism, Policy/Policy Development
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.