Professional Governance and Public Control: A Comparison of Healthcare in the United Kingdom and Germany

Governments across the western world face new demands to achieve greater efficiency and responsiveness in public services. The transformations are most radical and challenging in healthcare where both cost effectiveness and patient safety are major issues. Drawing on the National Health Service in the UK and the corporatist system in Germany, this article compares the dynamics of changing governance and public control in the context of different national and institutional arrangements. The analysis is based on studies carried out by each of the authors and secondary sources. The article addresses three issues: transformations in the governance of physicians who held a dominant position in healthcare; policies to promote the role of service users in defining the `public interest' and influencing the decisions of providers; and the professionalization and regulation of a broader range of health professions. The comparison between the two countries illustrates different institutional pathways to change and different conceptualizations of the `public interest' and how it is represented. This demonstrates that not only the government and service users, but also a variety of professional groups, in advancing their own professional projects, may still fundamentally shape the nature and form of public control and new governance practices.