The Changing Role of the Medical Profession, the State and the Market in Public Health: Swiss Pieces of Oral History

Like other policy fields, public health displays patterns of economization today. This tendency is not only about reducing costs. More generally, economization transforms health services into an economic good, which is valuable and measurable like other commodities. The 1982 National Cost Reduction Conference, as well as the 1994 Federal Law on Health Care Insurance with its « regulated competition » approach, were seminal steps towards economization. Very interestingly, the process was partly connected with the feminization of the medical profession, with nurses’ empowerment, and with the strengthening of patients’ rights.

Economization involves a transformation of the main actors’ roles in public health. Whereas this sector for many decades was dominated by medical expertise, by now the state and the market have become powerful forces. At the same time, the medical profession itself at least partly evolves, from the traditional liberal profession towards a more entrepreneurial stance. Hence, we can observe a tendency to move from individual medical practice to group practice, be it as employees of health firms, or as co-entrepreneurs.

This contribution rests on biographical interviews with key personalities in Swiss public health. I made these interviews, from 2014 to 2016, with fourteen persons (physicians, economists, politicians, consultants, hospital directors, state officials) who play (or played) an important role in the sector. Most interviewed persons were active already in the 1980s (some even before): They are contemporary witnesses, and often protagonists, of important events and transformations. These interviews have not yet been systematically interpreted. In this contribution, I will try to indicate, by way of some examples, their heuristic value following an oral history approach, in order to better understand the economization process.