The Influence of Social Security Systems on the “Demand” in Medicine

  • Noel Montgrain


We had better get used to it, medicine will never again be practised as it was in the past. Not only because it is becoming more and more scientific, nor because the doctor-patient relationship will be taught differently, but mainly because the state, the paying third, has been introduced into the medical system. All to the good, one will say straight away, since medicine has finally become accessible to all, and to this can be attributed at first thought a global improvement in health. Doubtless, all to the bad as well, since everything has a price, and what is paid, without our knowing it, joins perhaps the accounting which Ivan Illich scandalously drew up in his Nemesis Medical. Truth most often being only a more modern version of error, let us assume nothing a priori, and let us see in the contradiction the occasion for a pause for innovative thought. It is with a similar spirit that we inquire today about some unconscious psychological consequences of this revolution. To do this I myself lean on the various roles that I am called upon to hold in this system. I am first of all a citizen and a taxpayer in this country, and in this capacity I cast my vote, I pay my taxes, and I want my right of examination. I am sometimes a patient, and in this capacity, in spite of anxiety and suffering, I am pleased with the system. I am also a doctor, and in this capacity I am confronted by the system each time I accept its payments. Finally, I am an analyst, as such placed both by law and by the analytical institution on the fringe of the system--the analysand must pay for his visits--and in this capacity, I listen and I observe the jolts the unconscious structures experience in taking it in.


Centre Hospitalier Death Instinct Divine Omnipotence Moral Mandate Modern Ideology 
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Copyright information

© Plenum Press, New York 1983

Authors and Affiliations

  • Noel Montgrain
    • 1
  1. 1.Departement de PsychiatrieUniversite Laval Faculte de MedicineCite UniversitaireCanada

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