This chapter presents the conceptual framework underpinning our research. It looks at elements of the legal and political context that influence the role of medical doctors in healthcare reforms. It then analyses scholarly work on the sociology of professions and the interface between professions and organisations in order to better understand the predispositions of medical doctors in the context of reforms. The chapter closes with a presentation of the theoretical model that guides our empirical inquiry.

Agency in context: legal and political dimensions

Social scientists have long been interested in the study of change in institutions (Pettigrew et al, 2001), which requires attention to the intricacies of context (political, economic and legal), history and process that impact on change (Langley et al, 2013). Context is thus considered an environment in which agency and change co-evolve as a response to situational or conjectural opportunities and limitations (Johns, 2006). Norms and rules within a given context limit or encourage the expression of human agency. For example, national political and legal institutions (Immergut, 1990), such as courts with judicial power, provide an overarching context that shapes the negotiating space where governments and medical doctors engage in reforms.

In this first section we focus on specific components of the legal and political context that condition the space in which governments and professions interact in healthcare reforms. Legal and political elements associated with this context operate alongside secular trends such as changing demographics, economic conditions and technological and epidemiological shifts to impact the healthcare system's ability to meet population needs.

Law as a context for the expression of agency in healthcare reforms

Law is part of the distal and proximal context that influences opportunities for agency in healthcare reforms. The influence is twofold. First, law plays an overarching role in framing the agentic capacities of governments and medical doctors. While the notion of agency refers to the capacity of actors or entities to act on a situation and demonstrate free will, the agentic capacities of governments and the medical profession are conditioned by legal constraints and imperatives. As a distal consideration, law sometimes affects ex-ante options for healthcare reforms, for instance by limiting the policy options available to governments wishing to coerce medical doctors into acting a certain way or modifying rules around access to care.