On loyalty

One of the striking things that I've noticed in the UK, Denmark and Sweden is the emotional tie that clinicians appear to have with their health systems. Ask an Australian doctor or nurse what they think of the Australian health care system, and you're likely to be met with eye-rolling and head-shaking, and a litany of shortfalls. The 'government' and its tight-fisted short-sightedness would be named as the root cause.
In contrast, the words "We love the NHS and will fight to save it" were uttered by not one, but many speakers during a conference on clinical commissioning in Manchester, UK. A national health service that provides care to all was an important step in the UK following World War II, and it is viewed, it appears to me, by the public and clinicians as both a right and a privilege. Access to health care is a human right, but the maintenance of the system to deliver such care, is a joint effort, between government, health service workers and the community.
In Denmark, the majority of clinicians belong to one of the Danish Unions. These groups not only exist to protect workers' rights, but are involved in decision-making at hospital level, along with clinical leaders. It was clear that individuals were loyal to their union, not just for their individual needs but also because the union provided a means for their clinical voice to be heard.
A change in government in Sweden has seen a major change in the healthcare landscape. The new regime has introduced competition for the first time, allowing doctors and other health care workers to establish private clinics as an alternative to the previous state-run monopoly. When I asked a hospital cardiologist how this was working out, he said that many hospital doctors felt a sense of loss, that the previous monopoly over the continuum of care had allowed them to deliver coordinated, integrated care. The stated goal of competition was to provide choice for patients and to stimulate change and innovation. The main group to take advantage of this was GPs, with some specialists and allied health workers opening up clinics. It was too early to say whether the goals of the government or the fears of the hospital clinicians would come to fruition.