Health care governance and gender relations within the health services of Germany and Italy

Abstract

PurposeThe paper addresses the question of the contribution made by health service institutions towards the perpetuation of gender inequality within health occupations.Design/methodology/approachInstitutions that enable the medical profession to exercise influence over the working, training and examination practices of other health occupations will be looked at in their role as sustaining the dominance of the medical profession over all other health services. Statistically analysing the proportions of women and men in health occupations the paper examines whether this is a gender‐specific form of dominance. Using an institutionalist actor‐centred approach it will be examined whether the stability of the subordination of the allied occupations depends on whether the medical profession is also a corporate actor allotted a central steering function in the governance of the health system. A comparison is made between Germany and Italy.FindingsIn Germany and Italy physicians fulfil the criteria for professional dominance. It is shown that in both countries there exists a gender‐specific segregation across the health occupations, women being under‐represented in the profession of physician, and greatly over‐represented in the subordinate occupations. Therefore, the dominance of the medical profession is gender‐specific. The dominance of the medical profession in Germany is reinforced by several institutions with the consequence of stagnation in the traditional relationship between physicians and allied health occupations. In Italy, more self‐determination of the allied health occupations in the areas of training and examination has become a distinct possibility.Originality/valueThis is the first paper to assess the impact of health care institutions on gender inequality within the health services.