ABSTRACT
Since the 1980s the Belgian medical profession has come under increased pressures. These are primarily related to its position within the Health Insurance System and vis-à-vis the sickness funds. Whether these developments amount to professional decline and erosion of professional autonomy is not yet clear. For several reasons caution is required. First of all, most policy changes are recent and it is hard to predict what consequences their implementation will have for the medical profession, not in the least because there is little or no systematic information available. In other instances, we are only talking of proposals. Second, the significance of these developments can only be understood if account is taken of the previous history of the medical profession, especially in its relationship with the Health Insurance System and the sickness funds. But even a longterm perspective does not provide clear answers as to the direction of change in professional status. One has to decide which points in history are the basis for comparison. As will be illustrated, certain policy changes were unthinkable a decade ago and certain proposals which seem to be considered seriously today encountered fierce opposition in the 1960s. But it is doubtful whether compared to the pre-Second World War situation the autonomy of the profession is declining. Third, even the contrast of the present and the recent past does not give enough evidence to draw any firm conclusions with respect to the nature of the changes in the social position of Belgian physicians, because it is not clear how far changes have to go before one can speak of a diminution of autonomy. Moreover, not all segments of the profession seem to be affected by the changes to the same extent. Last but not least, what we are witnessing is a process of change in the Health Insurance System as a whole, affecting the position of all participants. Since the postwar position of the medical profession is closely related to that of the Health Insurance System, its position is also changing, but not necessarily declining.
