Health care is a key arena of the modernisation of welfare states. Tighter resources and a changing spectrum of diseases, coupled with new modes of citizenship and demands for public safety, challenge the health care systems throughout the Western world. This book sets out to examine new perspectives on the governance of health care and to highlight the role of the professions as mediators between the state and its citizens. It brings the interdependence and tensions between the health professions, the state and public interest into focus that release ongoing dynamics into the health system. The emerging patterns of a new professionalism in late modernity and interprofessional dynamics lie at the centre of my investigation.

I have chosen the German health care system, and in particular ambulatory care, as a case study to place this national restructuring in the context of European health systems and global reform models. I have applied a multidisciplinary approach that links the study of professions to social policy and health care research. My empirical research takes into account the provider and the user perspective, and a gendered division of the health workforce. Investigating the dynamics of new modes of governance in a non-Anglo-American context of corporatist stakeholder regulation expands the scope of health policy and makes new options apparent that move beyond marketisation and managerialism. The book highlights the context-dependency of medical power and the significance of regulatory frameworks in targeting the rise of a more inclusive professionalism. It helps to clarify whether and how new governance creates ‘citizen professionals’ that better serve 21st-century societies’ health care needs and wants of a diverse public.

Understanding the dynamics of new governance in health care

Health care is being modernised around the Western world. New models of governance have been introduced to reduce medical power and to advance an integrated health workforce and the participation of users. These developments are part of broader changes in the public sector and society at large. They can be explained in terms of modernisation processes that are related to changing modes of citizenship and new models of governance. The restructuring of health care mirrors ‘new directions in social policy’ (Clarke, 2004) and a move away from hierarchical institutional regulation towards more flexible and hybrid patterns of governing ‘peoples and the public sphere’ (Newman, 2005a).