In this section, we present a set of analytical themes and considerations derived from our analysis of the three empirical cases in England and Canada. The intent is to elucidate the implications of our research on how we understand the medical doctor– healthcare reform nexus and to test our theoretical model's ability to explain key variations and points of convergence across the cases.

We first examine the impact on healthcare reforms of the deals and policy parameters set at the inception of PFHS. We identify foundational elements that set the scene for future debates and negotiations between the government and medical doctors in the development of reforms. Contextual factors push governments into this most significant health reform, and the creation of PFHS is a revelatory moment. It shows how the two protagonists become engaged in a common endeavour with different expectations and abilities to influence the architecture of the system. The spirit of the initial agreement and the growing interdependence between governments and the medical profession has enduring implications for their future relationship.

Second, we delineate how governments address core policy dilemmas in the context of PFHS. Manifestations of the agency of governments within the mediated space of reforms are shaped by intense political pressures to respond to dilemmas such as escalating costs and problems with access to care. They also interface with the medical profession's reactions to reformative propositions. On the one hand, governments need to secure the collaboration of a powerful insider, the medical profession, and mobilise a diversity of policy instruments that go beyond coercion. On the other hand, the medical profession's contestation of propositions, and the limited ability for protagonists to genuinely engage in large-scale joint policy-making, creates situations where governments attempt to impose – usually minor – policy changes through coercion.

Third, we characterise the institution of medical politics as a core feature of contemporary PFHS that operates as a determining influence on healthcare reforms. While governments learn through their policy work the challenges of reforming PFHS and securing the support of medical doctors, the medical profession builds its political clout on the experience of exchanges with governments. Getting involved in health reforms is a significant political experience for the medical profession.