This book set out to assess the dynamics of the modernisation processes in health care. The study highlighted the interconnectedness and tensions between the professions, the state and the public, which release ongoing dynamics and new uncertainty into the policy process and practice of health care. We cannot understand change in health care without looking at professions as mediators between the state and its citizens, and empirically studying their options and strategies to shape the reform processes under way in all health systems. At the same time, the regulatory framework of the state and the role of service users are crucial to better understanding the advancement of professionals more accountable to the public. However, welfare state categories of market, state or corporatist regulation are no longer sustainable. More hybrid modes of governing health care call for new theoretical approaches that move beyond institutional regulation, and for empirical data. The contribution of this study is to assess the global phenomena of modernisation in a new context of conservative corporatist regulation; it hereby allows for a critical review of the currently dominant reform models and turns the spotlight onto new policy options. It also brings into view a broader range of drivers and enablers of modernisation processes in health care. In summarising the findings I will focus on three issues: the rise of a new professionalism; the released tensions and dynamics in the triangle of the professions, the state and the public; and the potential of corporatism and professional self-regulation for modernisation.

Varieties of professionalism in late modernity

Developments within the medical profession and the health occupations clearly indicate that professionalism is becoming more diverse and context-dependent. New patterns of professionalism, new strategies to promote professional interest, and new patterns of professional identity are observed in the medical profession as the archetype of a profession, and also in occupational groups that strive for professionalisation, such as physiotherapists.

The emergence of managerialism and networks and more contextualised identities indicates that changes are under way in the structure, action and culture of the medical profession (Chapters Five and Six, this volume). Physicians feel a need to overcome “encrusted” patterns of SHI regulation and “stiff grandfathers” and “bureaucrats”, as some participants in my study expressed it. They are calling for the modernisation of medical self-regulation from the bottom up, but they do not aim to replace corporatist institutions.