Hierarchies, bureaucracies and professions. The Medicare Review. Part two.

This paper is both a personal account and an analysis of the Medicare Review (part 2) that took place in 1985-6, to which I acted as Consultant Adviser. It analyses health policy issues associated with the recent inquiry to consider expanding the Medicare Scheme to include the services of some paramedical occupations. It considers what took place, the history of events leading up to the Review, the complexities of the review process and issues of implementation as well as the wider context. The paper moves from the descriptive to the analytical level to explain and interpret the review process from both a sociological and social policy point of view. The relevance of the Review to public health is twofold: the development and application of a new methodology to evaluate complementary health modalities on one hand, and the role of the Review in promoting both the legitimacy of these occupations, and, from a public policy analysis viewpoint, cost containment, on the other.