Beyond ubiquity: Unravelling medicalisation within the frame of health insurance and health-policy making

  • Sarah Van den Bogaert
  • Ricardo A. Ayala
  • Piet Bracke
Original Article

Abstract

Besides being extensively studied by health sociologists, medicalisation has also become a term that frequently appears in mainstream discourses on health and illness. Recently, scholars started to acknowledge a greater complexity within medicalisation. This article is situated within this research tradition and draws on three recurring critiques on the validity of medicalisation; critique on the construct validity, internal validity and external validity. By examining the interests and network of health-policy stakeholders, this article attempts to unravel different mechanisms of medicalisation and demedicalisation within a social health insurance system. The empirical data for this article derive from 30 elite interviews with key informants from 18 organisations in Belgium. Key representatives of these organisations provided us with in-depth information about their political intentions and interests. This study provides empirical evidence that both medicalisation and demedicalisation are different processes that can occur simultaneously. Furthermore, in order to facilitate studies on medicalisation in an institutional context, this article proposes some indicators for medicalisation and demedicalisation.

Keywords

medicalisation demedicalisation stakeholders health-policy making healthcare systems social welfare 

References

  1. AADM. (2015) AADM biedt een alternatief aan!. Press release, 29 June.Google Scholar
  2. Aberbach, J.D. and Rockman, B.A. (2002) Conducting and coding elite interviews. Political Science & Politics 35(4): 673–676.CrossRefGoogle Scholar
  3. Abraham, J. (2010) Pharmaceuticalization of society in context. Sociology 44(4): 603–622.CrossRefGoogle Scholar
  4. Ballard, K. and Elston, M.A. (2005) Medicalisation: A multi-dimensional concept. Social Theory & Health 3(3): 228–241.CrossRefGoogle Scholar
  5. Belgian Official Journal. (1999) Annexe au Moniteur belge du 4 novembre 1999. http://www.ejustice.just.fgov.be/cgi_vzw/vzw.pl. Accessed 30 May 2016.
  6. Belgian Official Journal. (2000) Bijlage tot het Belgische Staatsblad van 15 februari 2000. http://www.ejustice.just.fgov.be/cgi_vzw/vzw.pl. Accessed 30 May 2016.
  7. Bell, A.V. (2016) The margins of medicalization. Social Science and Medicine 156: 39–46.CrossRefGoogle Scholar
  8. Berry, J.M. (2002) Validity and reliability issues in elite interviewing. Political Science & Politics 35(4): 679–682.CrossRefGoogle Scholar
  9. Brenez, X. (2015) 6 prioritaire hervormingen voor de Onafhankelijke Ziekenfondsen. Brussel: Onafhankelijke Ziekenfondsen.Google Scholar
  10. Britten, N. (2008) Medicines and society. Basingstoke: Palgrave Macmillan.Google Scholar
  11. Bryson, J.M. (2003) What to Do When Stakeholders Matter. London: Paper presented at the London School of Economics and Political Science.Google Scholar
  12. Buffel, V., Beckfield, J. and Bracke, P. (2017) The institutional foundations of medicalization. Journal of Health and Social Behavior (in press).Google Scholar
  13. Busfield, J. (2010) A pill for every ill. Social Science and Medicine, 70(6): 934–941.CrossRefGoogle Scholar
  14. Busfield J. (2017) The concept of medicalisation reassessed. Sociology of Health and Illness. doi:10.1111/1467-9566.12538 (advance online publication 4 January).
  15. BVAS. (2015) De verplichte derdebetaler. Press release, 1 July 2015.Google Scholar
  16. Callens, S. and Peers, J. (2015) Organisatie van de gezondheidszorg. Antwerpen: Intersentia.Google Scholar
  17. Cantillon, B. (2008) De architectuur van de welvaartsstaat opnieuw bekeken. Leuven: Acco.Google Scholar
  18. Clarke, A.E., Shim, J.K. (2011) Medicalization and biomedicalization revisited: Technoscience and transformations of health, illness and american medicine. In: A.B. Pescosolido, et al (eds.) Handbook of the Sociology of Health, Illness, and Healing: A Blueprint for the 21st Century. New York, NY: Springer, pp 173–199.Google Scholar
  19. Colombo, F. and Tapay, N. (2004) Private health insurance in OECD countries. Paris: OECD.CrossRefGoogle Scholar
  20. Conrad, P. (1975) The discovery of hyperkinesis. Social Problems 23(1): 12–21.CrossRefGoogle Scholar
  21. Conrad, P. (1992) Medicalization and social control. Annual Review of Sociology 18: 209–232.CrossRefGoogle Scholar
  22. Conrad, P. (2005) The shifting engines of medicalization. Journal of Health and Social Behavior 46(1): 3–14.CrossRefGoogle Scholar
  23. Conrad, P. (2013) Medicalization: changing contours, characteristics, and contexts. In: C.W. Cockerham (ed.) Medical Sociology on the Move: New Directions in Theory. Dordrecht: Springer, pp 195–214.Google Scholar
  24. Conrad, P. and Bergey, M.R. (2014) The impending globalization of ADHD. Social Science and Medicine 122: 31–43.CrossRefGoogle Scholar
  25. Corens, D. (2007) Belgium: Health system review. In: S. Merkur et al (eds.) Health Systems in Transition. World Health Organization, pp 1–172.Google Scholar
  26. Daue, F. and Crainich, D. (2008) De toekomst van de gezondheidszorg. Brussel: Itinera Institute.Google Scholar
  27. Davis, J.E. (2006) How medicalization lost its way. Society, 43(6): 51–56.CrossRefGoogle Scholar
  28. De Block, M. (2015) Speech at the general assembly of the flemish patient platform. Leuven, 14 March.Google Scholar
  29. De Morgen. (2013) Homeopathie enkel nog door artsen met erkend diploma. 12 July. http://www.demorgen.be/wetenschap/homeopathie-enkel-nog-door-artsen-met-erkend-diploma-bbf4ad5b/. Accessed 6 June 2016.
  30. Denis, A. and Mergaert, L. (2009) De financiële situatie van patiëntenverenigingen in België. Brussel: Koning Boudewijnstichting.Google Scholar
  31. Eckert, M., Cools, S. (2016) Farmasector vertroetelt artsen en ziekenhuizen met miljoenen. De Standaard, 23 June, p 8.Google Scholar
  32. EFPIA.. (2016) The Pharmaceutical Industry in Figures. Brussels: EFPIA.Google Scholar
  33. Eikemo, T.A. and Bambra, C. (2008) The welfare state: A glossary for public health. Journal of Epidemiology and Community Health 62(1): 3–6.CrossRefGoogle Scholar
  34. Esping-Andersen, G. (1990) The three worlds of welfare capitalism. London: Polity Press.Google Scholar
  35. Farmaka. (2016) Onafhankelijke artsenbezoekers. http://www.farmaka.be/nl/artsenbezoek. Accessed 2 June 2016.
  36. Giaimo, S. and Manow, P. (1999) Adapting the welfare state. Comparative Political Studies 32(8): 967–1000.CrossRefGoogle Scholar
  37. Halfmann, D. (2012) Recognizing medicalization and demedicalisation. Health 16(2): 186–207.CrossRefGoogle Scholar
  38. Harvey, W.S. (2011) Strategies for conducting elite interviews. Qualitative Research 11(4): 431–441.CrossRefGoogle Scholar
  39. Hassenteufel, P. and Palier, B. (2007) Towards Neo-Bismarckian health care states? Social Policy & Administration 41(6): 574–596.CrossRefGoogle Scholar
  40. Illich, I. (1976) Medical Nemesis. New York: Pantheon Books.Google Scholar
  41. Lowenberg, J.S. and Davis, F. (1994) Beyond medicalisation-demedicalisation. Sociology of Health & Illness 16(5): 579–599.CrossRefGoogle Scholar
  42. Mills, J., Bonner, A. and Francis, K. (2006) The development of constructivist grounded theory. International Journal of Qualitative Methods 5(1): 25–35.Google Scholar
  43. Minister of Public Health. (2015) Toekomstpact voor de patiënt met de farmaceutische industrie. Brussels: Ministry of Health and Social Affairs.Google Scholar
  44. Moran, M. (2000) Understanding the welfare state. The British Journal of Politics & International Relations 2(2): 135–160.CrossRefGoogle Scholar
  45. Nonneman, W. and van Doorslaer, E. (1994) The role of the sickness funds in the Belgian Health Care Market. Social Science and Medicine 39(10): 1483–1495.CrossRefGoogle Scholar
  46. OECD. (2015) Health at a Glance 2015: OECD Indicators. Paris: OECD Publishing.Google Scholar
  47. Olafsdottir, S. (2010) Medicalization and mental health. In: D. Pilgrim et al. (eds.) The SAGE handbook of mental health and illness. London: Sage Publications Ltd., pp 239–260.Google Scholar
  48. Patton, M.Q. (1999) Enhancing the quality and credibility of qualitative analysis. Health Services Research 34(5 Pt 2): 1189–1208.Google Scholar
  49. Pharma.be. (2015) Pharma Figures 2015. Brussels: Pharma.be.Google Scholar
  50. Ramirez, R. (2001) Understanding the approaches for accommodating multiple stakeholders’ interests. International Journal of Agricultural Resources, Governance and Ecology 1(3): 264–285.CrossRefGoogle Scholar
  51. Saltman, R., Busse, R. and Figueras, J. (2004) Social health insurance systems in western Europe. Maidenhead: Open University Press.Google Scholar
  52. Schepers, R. (1993) The Belgian medical profession, the order of physicians and the sickness funds (1900–1940). Sociology of Health & Illness 15(3): 375–392.CrossRefGoogle Scholar
  53. Schepers, R. and Casparie, A.F. (1997) Continuity or discontinuity in the self-regulation of the Belgian and Dutch medical professions. Sociology of Health & Illness 19(5): 580–600.CrossRefGoogle Scholar
  54. Schieber, G.J. (1987) Financing and Delivering Health Care. Paris: OECD.Google Scholar
  55. Solidaris. (2016) Dès aujourd’hui, Solidaris rembourse totalement toutes les consultations chez le médecin traitant et le gynécologue. Press Release, 27 April.Google Scholar
  56. Strauss, A. and Corbin, J. (1990) Basics of Qualitative Research. Newbury Park (Calif.): Sage Publications.Google Scholar
  57. Test-Aankoop. (2016a) Genees de geneesmiddelenindustrie: teken onze petitie. http://www.test-aankoop.be/gezondheid/geneesmiddelen/nieuws/genees-de-geneesmiddelenindustrie-teken-onze-petitie#startpetition. Accessed 23 June 2016.
  58. Test-Aankoop. (2016b) Een slecht rapport voor bijna 900 geneesmiddelen! Press Release, 25 March. http://www.test-aankoop.be/gezondheid/geneesmiddelen/nieuws/geneesmiddelen-weet-wat-u-slikt. Accessed 22 June 2016.
  59. Thomson, S., Foubister, T. and Mossialos, E. (2009) Financing health care in the European Union. Copenhagen: World Health Organization.Google Scholar
  60. Tsebelis, G. (2000) Veto players and Institutional analysis. Governance 13(4): 441–474.CrossRefGoogle Scholar
  61. van der Zee, J. and Kroneman, M.W. (2007) Bismarck or Beveridge. BMC Health Services Research 7(1): 94.CrossRefGoogle Scholar
  62. Vankrunkelsven, P. (2014) Waarom artsen opgelucht ademhalen nu Maggie De Block op de stoel van Laurette Onkelinx zit, 4 November. http://www.knack.be/nieuws/gezondheid/waarom-artsen-opgelucht-ademhalen-nu-maggie-de-block-op-de-stoel-van-laurette-onkelinx-zit/article-opinion-507917.html. Accessed 6 June 2016.
  63. Wendt, C. (2014) Changing healthcare system types. Social Policy & Administration 48(7): 864–882.CrossRefGoogle Scholar
  64. Wendt, C., Frisina, L. and Rothgang, H. (2009) Healthcare system types. Social Policy & Administration 43(1): 70–90.CrossRefGoogle Scholar
  65. Williams, S. J., Martin, P. and Gabe, J. (2011) The pharmaceuticalisation of society? A framework for analysis. Sociology of Health & Illness 33(5): 710–725.CrossRefGoogle Scholar
  66. Zola, I.K. (1972) Medicine as an institution of social control. Sociological Review 20(4): 487–504.CrossRefGoogle Scholar

Copyright information

© Macmillan Publishers Ltd 2017

Authors and Affiliations

  • Sarah Van den Bogaert
    • 1
  • Ricardo A. Ayala
    • 1
  • Piet Bracke
    • 1
  1. 1.Department of SociologyGhent UniversityGhentBelgium

Personalised recommendations