Policy Press

Modernising health care

Reinventing professions, the state and the public

By Ellen Kuhlmann


Sep 13, 2006

Page count

280 pages




234 x 156 mm


Policy Press
Modernising health care

Modernising health care: Reinventing professions, the state and the public is a crucial contribution to debates about the rapid modernisation of health care systems and the dynamics of changing modes of governance and citizenship.

Structured around the role of the professions as mediators between state and citizens, and set against a background of tighter resources and growing demands for citizenship rights, Ellen Kuhlmann's book offers a much-needed comparative analysis, using the German health care system as a case study. The German system, with its strongly self-regulatory medical profession, exemplifies both the capacity of professionalism to re-make itself, and the role of the state in response, highlighting the benefits and dangers of medical self-regulation, while demonstrating the potential for change beyond marketisation and managerialism.

Kuhlmann critically reviews dominant models of provider control and user participation, and empirically investigates different sets of dynamics in health care, including tensions between global reform models and nation-specific conditions; interprofessional dynamics and changing gender arrangements; the role of the service-user as a new stakeholder in health care; and the rise of a new professionalism shaped by social inclusion.

Modernising health care provides new approaches and a wealth of new empirical data for academics and students of health policy, medical sociology and sociology of professions, and for health policy makers and managers.

"This highly topical book is innovative in both conceptual and empirical terms, putting flesh to the bone of the notion of modern governance. The author has an excellent overview of the literature in the field, showing critical awareness not only of the central conceptual issues and debates, but also of a wide range of empirical studies across many countries. Most importantly, Modernising Health Care fills a gap in relation to the debate and the analysis of modern governance." Viola Burau, Department of Political Science, University of Aarhus, Denmark

Ellen Kuhlmann researches and teaches at the Centre for Social Policy Research at the University of Bremen, Germany.

Introduction; Towards 'citizen professonals': contextualising professions and the state; Part one: Mapping change in comparative perspective: Global models of restructuring health care: challenges of integration and coordination; Remodelling a corporatist health system: change and conservative forces; Drivers and enablers of change: exploring dynamics in Germany; Part two: Dynamics of new governance in the German health system: Hybrid regulation: the rise of networks and managerialsim; Transformations of professionalism: permeable boundaries in a contested terrain; New actors enter the stage: silent voices of consumers in the landscape of biomedicine; Part three: The rise of new professionalism in late modernity: Professions and trust: new technologies of building trust in medical services; The knowledge-power knot in professionalism: transforming the 'currency of competition'; Conclusion.