Health reforms, in theory, aim at creating some form of systemness, which includes, on the one hand, a more solid connection between healthcare providers, organisations and professionals and, on the other, the broad policy or systemic goals. The question of medical engagement, leadership and accountability in healthcare system reforms has been an enduring issue in health policy (Baker and Denis, 2011). Medical doctors have played a crucial role in determining the allocation and utilisation of resources in health systems and in shaping capacities to renew policy orientations and models of care (Denis and van Gestel, 2016). This book explores the role of the medical profession in health reforms in two mature welfare states: England and Canada. Both states have a publicly funded healthcare system (PFHS) through taxation. Comparative works on these two systems have already been undertaken by political scientists (Tuohy, 1999, 2012), but less attention has been paid to the specific role of medical doctors in health reforms. The role of the medical profession and the bilateral monopoly between states and the profession have been underlined as a major cause for blockages in health reforms in Canada (Lazar et al, 2013; Tuohy, 2018). In England, the medical profession has been supportive of universality of care, a central element of the National Health Service (NHS); however, during successive waves of reforms medical doctors have fiercely opposed governments’ efforts to rationalise the provision of healthcare services, trying to protect egalitarian values at the core of the system and their professional autonomy (Ham, 2009; Klein, 2013). The book investigates the multifaceted and paradoxical situation where a dominant profession – medicine – faces increasing pressures to become an active player and an ally in major policy efforts and system-wide reforms driven by governments.

The conceptual underpinning of this work builds on the contribution of various areas of studies, namely the sociology of professions, studies on professions and organisations and on healthcare law and policy. The analysis documents reformative processes from the inception of two Canadian and the English PFHS, and identifies the role of the medical profession in policy formulation. Our focus is predominantly the role of organised medicine (unions, professional associations and colleges) with their political struggles to promote and advance medical values and interests in a context where governments have attempted to transform healthcare systems.