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Alford Revisited: The Professional Monopolisers, Corporate Rationalisers, Community and Markets

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Twenty years have passed since Alford's publication, The politics of health care, described the relative power of three groups, the professional monopolists, corporate rationalisers and community, in his case study of health care in New York. Alford suggested that the hegemony of the professional monopolists was the product of a correspondence between their interests and those of society. Neither the corporate challengers nor the community were able to change a system heavily influenced by the biomedical model which in turn legitimised the position of the medical profession — the supreme professional monopolists. In the two decades since, concerns about rising costs, inefficiencies in both market and planned health care systems and, in the United States, gross inequities of access, have produced changes in both UK and US health care. This article reapplies Alford's model, examining the nature of recent reforms and their effects on the professional monopolists, corporate rationalisers and community.
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Document Type: Research Article

Publication date: April 1, 1995

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