Le marché des soins médicaux et l'organisation de la profession médicale

L'auteur présente une analyse de la structure du marché des soins médicaux et du type d'organisation professionnelle qui paraît le mieux adapté à ce marché dans le contexte de l'évolution présente.An analysis of the role of a professional corporation such as The College of Physicians and Surgeons of the Province of Quebec requires a certain analysis of the market for medical services.THE MARKET FOR MEDICAL SERVICESCan the market for medical services be analysed through the model of perfect competition? This question is an important one because if the answer is yes, the policy of the state should then be limited to an action which would permit the mechanisms of competition to function freely. The access to the market should be left entirely free and submitted only to the choice of the consumers.It does not seem however that the perfect competition model is very well adapted to an analysis of this market even if some of the observed phenomena on this market can be analysed with such a model. This opinion is based on the following considerations :CONTROL OF MARKETThe particular structure of the market for medical care makes it necessary to have certain control established on this market e.g. compulsory vaccination, quarantine or confinement, and also quality control for the persons admitted to distribute the service.A corporation such as the College of Physicians and Surgeons of the Province of Quebec exists primarily to exercise such control on the quality of medical services; control which is necessary to maximise the social efficiency of the system. The efficient exercise of this control however is function of some very important powers which must be granted to the corporation; especially the power to control the access to the profession i.e. the licensing power.THE PHENOMENON OF SOCIALISATIONThe distribution of medical services is presently experiencing rapid changes. Medicine is now less and less an individual matter and more and more a question of collective or social organization.With the advent of insurance programs organized with or by the governments, the consumers of health services tend to be grouped in one or a few large organizations with definite monopsonistic features.The equilibrium of the market requires that the sellers of the services also get organized. The question then is: « Can the professional corporation, whose role and power we just defined, assume the responsibility of defending the doctors' interests vis-a-vis the buyer of services? »It does not seem possible to answer yes to this question without creating for the corporation a situation of conflict of interests. As a licensing body, the corporation controls to a certain extent the quantity of doctors and consequently has an indirect control over prices. On the other hand, the function of the structure responsible of defending the interests of the doctors would be to obtain the best possible working condition including remuneration