Accountable for one's sickness. Political and medical transformations of the "sick role" and its implications for European Healthcare Systems
Department of Sociology Uppsala University Uppsala, Sweden
Department for Caring Sciences and Sociology University College of Gävle Gävle, Sweden
Public health care systems in Europe are undergoing profound transformations due to advances in medical technology, demographic ageing, and neoliberal economic policies. While the bulk of sociological research on health care policies focuses on changes at the institutional level, we claim that, in order to fully comprehend current transformations, it is necessary to shed light on the interplay between medical and political conceptions of sickness and their impact on (1) the socially determined expectations toward patients, and (2) the legitimate claims to medical treatment patients can raise. The starting point for our analysis is Parsons? classic conception of the sick role. According to Parsons, sickness is linked to a social role with specific rights and duties. Implicitly, the patient in Parsons? concept appears as a victim of her disease. Recent developments in health care policy challenge this view. The current medico-political debate quite explicitly frames the sick as an active agent who by the right choices can influence her current or future health condition. Seen in this light, the specific rights and duties involved by Parsons' sick role are now about to be redefined. In order to analyze the underlying mechanisms, we introduce the distinction between "being sick" and "being counted as sick". While the former refers to physical or mental deviations observed by medical theories, the latter is the outcome of politically motivated decisions on the eligibility for being counted as sick. In medical theory and practice, a biogenetic conception of sickness has been replaced by a more extensive conception of sickness that includes psycho-social criteria for making diagnoses. This redefinition has lead to a drastic increase of claims for medical treatment, which account for many of today?s challenges public health care has to face. As a feasible response to the medical expansion, European health care policies are about to re-conceptualize the "sick role" - understood as a political observation of sickness, not as a medical one - by holding the patients accountable for their sicknesses, welfare state agencies can regulate the amount of people eligible to compensation without giving up the principles of socially just health care.