Primary care and social control

Abstract

Role performance in primary care becomes problematic when a disproportionate emphasis is placed on the physician's legitimizing function which is geared to endorse entry into the sick role so that he is less able to devote himself to curative or preventive tasks. Israel is used as an example of a society in which the delivery system of medical care has moved far in this direction as a result of pressures both from consumers and from the wider social system. The former utilize the medical care system for its latent as well as for its manifest functions, while the latter makes use of it for legitimation of role avoidance and for allocation of scare resources on the assumption that universalistic criteria of medical need are used in these processes. Excessive utilization rates of clinical facilities and dissatisfaction among primary care physicians are apparently among the dysfunctional results of these patterns. Some questions are raised as to the implications of placing major social control mechanisms in the hands of the medical care system which in effect is not really geared to handle these tasks.