RISULTATI RICERCA

A significant amount of literature has been published about the health reforms implemented during the last two decades in most post-industrialized countries, but very little analysis has been attempted about the impact on health care systems and medical profession of such reforms. The essay proposes a new model of analysis of the impact of health reforms on the medical profession at three sociological levels: micro, related to the clinical dimension; meso, about the social division of labour; and macro, concerned with the system of structural interactions among the main social actors involved. A synthetic account of the results is given to show how the model was applied in an international comparative research about the changing medical profession in USA and Europe.

Maria Malatesta tries to demonstrate, using either legislative sources than grey letterature, that italian professional associations have not omogeneous functions, but are quite different among them. The reasons of that lie on the history of professions. Medical associations have a peculiar physionomy because, since now, they have solved trade unions functions, even if these functions were not established by a State law. The reason for this anomaly, recently remarked by the Antitrust Authority, can not be found only in the Fascist period, when associations were substituted by trade unions. More complex analysis must be carried out. Specifically, the causes of such a situation are rooted in the birth of the Italian State, when doctors were subordinated to municipalities and medical associations tryed to shelter doctors from State’s control.

Costantino Cipolla and Silvia Marcadelli propose a comparison between three professional codes. The professions involved are doctors, nurses and pharmacists. Doctors’ code is very complex, if compared to the others. Even if, for many aspects, the code can be considered very up-to-date even now, the doctor code holds an authoritarian-paternalistic view on patients. Nurses’ code is very clear and open to to patient. Terms like promotion and contribution indicate the pedagogic aim upon which the code si based. Not very much is said about professional training. Pharmacists’ code is not focalised on the relationship with the patient. Yet, there are some signs that show that this dimension is more considered than in the past. A remarkable space is given to the relationships with other health professions. The authors propose to analyse the professional codes through an integrative frame.

The relationship between health professionals and citizens changes along the time, under the pressure of social modifications. Among other elements, ethics is a relevant factor of change in the relationship. The social consensus on the good practice of medicine has assumed a different outline, according to the value which has assumed a leading function: the patient’s good (ethical principle: beneficence); or the selfdetermination of the subject (ethical principle: justice). The promotion of the empowerment of the citizen is the ultimate model orienting contemporary bioethics.

In many industrialized countries there is a great attention to the reduction of health care costs. Physicians also have become aware of the problem. There are studies that consider the opinion of the physicians about the impact of financial constraints on professional autonomy, but in this article the focus is on managed care mechanisms and the their limits. Melocchi and Tousijn first deal with cost disease. Then they consider some usable tools for health care management. After a short discussion of the well known thesis on the decline of medical professionalism, the authors analyze, with favour, the hypothesis that the best defense of the profession stays in the uncertainty of the physicians’ tasks. We conclude by an appeal to professional associations that they rethink and adapt their professional logic, for some important aspects, to a changing health care system.