[Physicians and health care: state, market or regulation? A false issue]

A cost crisis in the health care sector has focused discussion on health care services and an assessment of the results of investments in the health sector, underlining the importance of medical doctors as key actors in this area. This article reviews the main analytical approaches to professionalism in the last decade and discusses the most recent paradigmatic shifts. New approaches have emerged for correlating the medical division of labor (contained in specialized fields which are becoming more and more fragmented) with structural and historical changes in the professional market, as well as the collective action developed by these interest groups in their relationship to the state. These approaches, more closely linked to political economy, have made important contributions to this debate, because they allow for a questioning of the kind of ideological polarization contained in health care reform proposals aimed at a withdrawal of the state and the rule of the market (with no analytical justification), in addition to shifting regulation to a position outside the historically mutable dynamics between the state, health care providers, and clients of the health care sector and the public policy arena.