Medical Dominance and Its Role in Australian Health Care

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Medical dominance in Australia
Within Australia, medicine has traditionally dominated every facet of health care delivery (Germov, 2002;
Willis, 1989). The professional status that medicine holds in Australia has been gained by means of its historical and political advantages (Germov, 2002;
Willis, 1989). Willis’s (1989) seminal work on medical dominance provides an extensive review of medical relationships and the power that medicine yields.
Historically, in Australia, medicine gained its position of political and economic power through its relationship
1064 A. Kenny, S. Duckett / Social Science & Medicine 58 (2004) 1059–1073 with the state (Willis, 1989). The state was dependent on medicine for
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97). The constraints being imposed by McDonaldization is not only apparent in private medical clinics but also is evident in the rise of managerialismin the public health care system( Clarke,
Gerwitz, & McLaughlin, 2000; Clarke & Newman, 1997;
Exworthy & Halford, 1999; Germov, 2002; Rhodes,
1991). Deprofessionalization refers to public skepticism to medical authority prompted by such things as medical fraud and negligence (Daniel, 1998; Gabe et al., 1994;
Rosenthal, Mulcahy, & LLoyd-Bostock, 1999). It is claimed that medicine is also being deprofessionalized by the public’s increased knowledge and demand for participatory health care (Gabe et al., 1994; Germov,
2002) and by increasing public interest in alternative and complementary therapies (Easthope, 2002; Eisenberg et al., 1998; Ernst & White, 2000; MacLennan, Wilson,
& Taylor, 1996; Zolman & Vickers, 1999). Proleterianization refers to ‘a process (rather than an end state) whereby medicine loses control over the context and content of medical care because of the bureaucratisation and corporatisation of health care’ (Coburn, Rappolt, &
Bourgeault, 1997, p. 2). Barnett et al. (1998, p. 194) claim that the professional dominance of medicine was
‘institutionalised and politically accepted given that the organization and outputs of health care
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