ABSTRACT
The nature and meaning of "government" and "control" pertain to Foucault's concept of "governmentality". A way of conceptualizing the dilemmas faced by the state in a period of retrenchment is to sharpen and extend Michel Foucault’s suggestive concept of "governmentality". As Terrance Johnson implied in an important essay, although author commonly think of the medical profession as having used the state to establish its own autonomy and powers, the state uses professions as instruments of governmentality in a number of realms. The transformation of state control of health care costs to a competition paradigm may lead to less control and more costs. These are some of the reasons why many states, after an initial burst of enthusiasm, shrank back from changing the institutional structure of health services to a competitive one. Thus government leaders find they have adopted a notion of governmentality that threatens existing institutional domains, transgresses boundaries, and disrupts network relationships.
