Gender, welfare regimes and the medical profession in France and Greece
Clientelism, étatism and the 'Mediterranean rim'
In this chapter I compare the work and organisation of hospital doctors in France and Greece in the broader context of the state and gender. First, this chapter is an exploration of two variants of the 'Beveridge' and 'Bismarckian' systems within Europe: France, because it is, perhaps paradoxically, an étatist variant of a 'Bismarckian' system; Greece, because it is an unusual variant of the Beveridge model. The examination of these two countries' health systems is carried out initially in terms of Esping-Andersen's (1990) welfare state regimes. This provides a useful framework within which to raise questions of the relationship between gender, family and health care provision, in particular the work of the medical profession. Part of the argument here is that professional jurisdiction (Abbott 1988) and autonomy - in the more loosely coupled sense of individual practitioner's discretion - is partly shaped by the officially defined role(s) of women in society (Lewis 1992; O'Connor 1993; 1996; Orloff 1993; Sainsbury 1994; Williams 1994). The chapter will discuss four sets of issues and examine their inter-relationship:
|1 the organisation and funding of the two health care systems and the public/private sector boundaries; |
|2 gender and welfare state regimes; |
|3 governmentality and state/profession relations; |
|4 the family and the issue of co-payments - official and unofficial. |
The first, concerning the organisation and funding of the two systems, is largely descriptive and it is the relationship among the remaining three that is the focus of the analysis here.
Health services organisation and funding and public/ private sector boundaries
The funding of the health services in both countries is based on social insurance (sickness funds) with the state taking an active interest.