Professionalism and Medical Work in a Post-Soviet Society: Between Four Logics

Abstract

The relationship between the state, the market and professions has been in focus of sociological theories on professions.This study explores how Lithuanian physicians perceive these three sectors, called logics in sociological theories, to influence their work in a health care context which has experienced a rapid change.The results show that the physicians perceived the state regulated health care system as a limitation to their professional identity and practice.Market elements of care did not seem to work and instead two other mechanisms bridged the provision of services between the client and the physician: peer referrals and gift-giving.The peer referral system enabled physicians to directly refer patients to a professional colleague outside the formal referral system and thereby to improve access to health services that the state directed system could not handle efficiently.Gift-giving and gratitude payments provided some consumer influence in the delivery of health services in a failing market system.The conclusion is that in a postsocialist health care system physicians are often operating in a system guided by four logics: the state, the market, professional culture, and the informal economy of peer referrals, gift giving, and extra payments.